Working with People Who Aren’t Self-Aware

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Even though self-awareness — knowing who we are and how we’re seen — is important for job performance, career success, and leadership effectiveness, it’s in remarkably short supply in today’s workplace. In our nearly five-year research program on the subject, we’ve discovered that although 95% of people think they’re self-aware, only 10 to 15% actually are.

At the office, we don’t have to look far to find unaware colleagues — people who, despite past successes, solid qualifications, or irrefutable intelligence, display a complete lack of insight into how they are coming across. In a survey we conducted with 467 working adults in the U.S. across several industries, 99% reported working with at least one such person, and nearly half worked with at least four. Peers were the most frequent offenders (with 73% of respondents reporting at least one unaware peer), followed by direct reports (33%), bosses (32%), and clients (16%).

Un-self-aware colleagues aren’t just frustrating; they can cut a team’s chances of success in half. According to our research, other consequences of working with unaware colleagues include increased stress, decreased motivation, and a greater likelihood of leaving one’s job.

So how do we deal with these situations? Is it possible to help the unaware see themselves more clearly? And if we can’t, what can we do to minimize their damage on our success and happiness?

Understanding the problem

Not all badly-behaving colleagues suffer from a lack of self-awareness, and not all who do can be helped. Therefore, you must first determine whether the source of the problem is truly someone’s lack of self-awareness. Ask yourself:

What’s behind the tension?

When we’re having trouble working with someone, the problem isn’t always a lack of self-awareness on their part. Interpersonal conflict can arise from different priorities, incompatible communication styles, or a lack of trust.

To determine whether you’re truly dealing with an un-self-aware person, consider how others around them feel. Typically, if someone is unaware, there’s a consensus about their behavior (i.e., it won’t just be you). More specifically, we’ve found several consistent behaviors of un-self-aware individuals:

They won’t listen to, or accept, critical feedback. They cannot empathize with, or take the perspective of, others. They have difficulty “reading a room” and tailoring their message to their audience. They possess an inflated opinion of their contributions and performance. They are hurtful to others without realizing it. They take credit for successes and blame others for failures.

Where is this person coming from?

In contrast to the unaware, certain difficult colleagues—like office jerks—know exactly what they’re doing, but aren’t willing to change.

I once knew a chief operating officer with a reputation for humiliating his team whenever they disappointed him. When finally confronted about his behavior, his response was, “The best management tool is fear. If they fear you, they will get the work done.” (Unsurprisingly, his superiors did not share his views and fired him several months later).

The biggest difference between the unaware and the Aware-Don’t-Care are their intentions: the unaware genuinely want to be collaborative and effective, but don’t know they’re falling short. Whereas the “aware don’t care” unapologetically acknowledge their behavior (“Of course I’m pushy with clients. It’s the only way to make the sale!”), the unaware can’t see how they’re showing up (“That client meeting went well!”).

Helping the unaware

Once you’ve determined someone suffers from a lack of self-awareness, it’s time to honestly assess whether they can be helped. Think about their intentions and whether they’d want to change. Have you seen them ask for a different perspective or welcome critical feedback? This suggests that it’s possible to help them become more self-aware.

But the odds can be steep. Our survey found that although 70% of people with unaware colleagues have tried to help them improve, only 31% were successful or very successful. And among those who decided not to help, only 21% said they regretted their decision. So before you step in, ask yourself:

Am I the right messenger?

The number one reason our survey respondents gave for not helping an unaware person was that they didn’t think they were the right messenger. It’s true that when helping the unaware, providing good, constructive feedback only gets us part of the way. For someone to truly be open to critical feedback, they must trust us — they must fundamentally believe that we have their best interests at heart. When trust is present, the other person will feel more comfortable being vulnerable, a prerequisite to accept one’s unaware behavior.

So think about the relationship you have with your unaware colleague: have you gone out of your way to help or support them in the past? And are you confident they will see your feedback for what it is—a show of support to help them get better—rather than inferring a more nefarious motive? Or, are there others who might be better suited to deliver the feedback than you?

Am I willing to accept the worst-case scenario?

The second most common reason people decide not to help the unaware is that the risk is simply too high. As one of our study participants noted, “I may not be able to help and trying [might] just make them angry.” The consequences of help-gone-awry can range from uncomfortable (tears, the silent treatment, yelling) to career limiting (an employee might quit; a colleague may try to sabotage us; a boss could fire us).

Here, power differentials are a factor. For example, though unaware bosses have an especially detrimental impact on their employees’ job satisfaction, performance, and well-being, confronting one’s boss is inherently riskier because of the positional power she holds. Conversely, the risk is usually lower with peers, and lower still with direct reports (in fact, if you have an unaware employee, it is literally your job to help them). But regardless of their place on the organizational chart, we must be ready to accept the worst-case scenario should it occur.

If you believe you can help, then what’s the best way to do so? There are certainly many helpful resources on providing high-quality feedback, and most apply with the unaware. There are, however, three practices worth underscoring for these individuals.

First, talk to them in person (our research suggests those who provide feedback via email are 33% less successful). Second, instead of bringing up their behavior out of the blue, practice strategic patience. If possible, wait until your colleague expresses feelings of frustration or dissatisfaction that (unbeknownst to them) are being caused by their unawareness. Ask if you can offer an observation in the spirit of their success and wellbeing (using the word “feedback” risks defensiveness). Third, if they agree, focus on their specific, observable behavior and how it’s limiting their success. End the conversation by reaffirming your support and asking how you can help.

What to do if they don’t change

It’s easy to feel hopeless when you can’t help someone who is unaware. The good news is that although we can’t force insight on them, we can minimize their impact on us.

Mindfully reframe their behavior: The popular workplace practice of mindfulness can be an effective tool for dealing with the unaware. Specifically, noticing what we’re feeling in a given moment allows us to reframe the situation and be more resilient.

Here is one tool to notice but not get drawn in to our negative reactions to the unaware. I first came up with the “laugh track” when I had the misfortune of work­ing for an Aware-Don’t-Care boss. One day, after a particularly unpleas­ant encounter, I recalled my favorite TV show growing up, The Mary Tyler Moore Show. Mary’s boss was a surly man named Lou Grant. On a good day, Lou was grumpy; on a bad day, he was downright abusive. But because his comments were followed by a canned laugh track, they became surprisingly endearing. I de­cided that the next time my boss said something horrible, I’d imagine a laugh track behind it instead. I was frequently surprised at how much less hurtful (and occasionally hilarious) this tool rendered him.

Find their humanity: As easy as it can be to forget, even the most unaware among us are still human. If we remember this, instead of flying off the handle when they’re behaving badly, we can recognize that, at the core, their unaware behavior is a sign that they are struggling. We can adopt the mindset of compassion without judgment.

Researchers have found that honing our compassion skills helps us remain calm in the face of difficult people and situations. As management professor Hooria Jazaieri points out, “there are [negative] consequences…when we are…thinking bad thoughts about someone” — compassion “allows us to let them go.”

Play the long game: When it comes to dealing with the unaware, one of the most important things to remember is that just because they’re that way now doesn’t mean they won’t change in the future. Unaware behaviors sometimes have to be pointed out multiple times before the feedback begins to stick — or, as one of our research participants noted, “Sometimes they have to bump their head enough times to finally see the light.”

In our research, we’ve studied people who made dramatic, transformational improvements in their self-awareness. Though it takes courage, commitment, and humility, it is indeed possible—and whether or not the people around us choose to improve their self-awareness, we have complete control over the choice to improve ours (find a quick, high-level assessment of your self-awareness here). At the end of the day, perhaps that’s where our energy is best spent.

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More and more big businesses are providing workplace protections for LGBTIQ+ (lesbian, gay, bisexual, transgender, intersex and queer) people. It’s becoming clear that when workers can bring their authentic selves to work, they are more productive and engaged. Research shows that coming out increases job satisfaction, intention to stay, and emotional support from co-workers, whereas staying “in the closet” has costs — both for the individual and the company.

And yet, many people are still reluctant to come out at work. In our study, we surveyed 1614 LGBTIQ+ Australian workers and held focus groups with 60 participants across various industries. We found that 68% of respondents are not out to everyone at work. Other studies show that this number decreases to 46% in the US, and 35% in the UK.

We know that when LGBTIQ+ people work in a safe environment, they are more willing to come out. But while workplace policies and practices are critical, the decision to come out at work is a complex and personal one. It involves other factors, like when, how and whom to come out to.

Our research considers this, and digs below the surface to examine the experience of LGBTIQ+ people at work. We challenge myths that are drawn from common assumptions about coming out and offer suggestions to organizations that want to help their workers feel safe being themselves.

Myth #1: Coming out at work is not a big deal — after all, it’s the 21st century!
Though the LGBTIQ+ community has seen big wins in the past few years — same-sex marriage is now legal in 26 countries, and around 20 have passed some kind of legislation recognizing transgender rights — coming out is still dangerous in many areas of the world and can be deadly for trans and gender diverse people. Even in countries that are economically-developed and progressive, like Australia, homosexuality has only been decriminalized since 1997, and marriage equality was just legalized in December of last year. The LGBTIQ+ rights movement is still very much in progress, and this factors into some workplace cultures and how comfortable people may feel coming out.

Myth #2: Coming out is similar for all LGBTIQ+ people. The LGBTIQ+ community and their workplace experiences are diverse. In Australia, there has been a gradual transformation in gay and lesbian rights over the past 40 years, which has also seen support for and protections of gay and lesbian people at work. However, trans/gender diverse workers have been historically overlooked. They are often less willing to come out at work due to fears of discrimination and social exclusion. Our research finds that 32% of trans/gender diverse people fear they would lose their job if they came out at work versus just 6% of LGB (lesbian, gay and bisexual) people. Not surprisingly then, 49% of trans and gender diverse workers try hard to conceal their identity from colleagues, compared to only 13% of LGB workers.

Myth #3: LGBTIQ+ workers have complete control over whether they do or don’t come out at work. For some LGBTIQ+ workers, living authentically at work remains an aspiration. While almost three-quarters of our respondents indicated coming out is important to them, only one-third are out to everyone at work, suggesting that not everyone who wants to be out feels comfortable being out. For others, decisions about when and how to come out are often out of their control. Some individuals are outed against their will, while others are forced to come out because of workplace policies. One transgender respondent wrote, “Give me a choice to NOT disclose – the reason HR knows I am a trans man is because it was policy for HR to process police checks when I started at my current workplace.”

In fact, research shows that transgender people going through the transition process often have to come out to co-workers, causing great anxiety and distress. For some transgender people, living authentically means keeping their gender history private, particularly if they affirmed their gender identity when they were very young. For others, who transition later in life, as one participant told us, “we are out merely by existing.”

Myth #4: Coming out has nothing to do with work. Our research reveals that people who are able to come out at work are happier. Compared to workers who are out to some people or no one at all, those who are completely out at work are significantly more satisfied with their job (29% versus 16%), enthusiastic about their job (40% versus 26%), and proud of their work (51% versus 38%). Other research finds that having a double life — being out in private life but not at work — increases social stress and depression.

Because workplaces are where people share their personal experiences, coming out — and feeling safe enough to do so — is about something as simple as participating in conversations without having a guard up or editing. For an LGBTIQ+ person, telling a story about their weekend could be an indirect way of signaling their identity.

Heterosexual and cisgender workers typically don’t face the same dilemma because they are part of a majority group when it comes to sexual orientation and gender identity. They have the privilege of being visible just by being. LGBTIQ+ people often must choose to come out if they want to be visible at work. If an LGBTIQ+ person feels that they can’t come out or chooses not to, others might assume that they are also a member of the majority group. One gay male respondent reported, “I am more masculine and fit a certain (jock/rugby) stereotype and so people assume that I am straight and I often don’t correct them.”

Myth #5: Coming out at work happens just once. Coming out is actually a repetitive process. It occurs not just once, but on multiple occasions. For instance, a bisexual woman may come out to her immediate manager when she is first starting a job, but also later, when she meets new co-workers, other managers, or clients.

Among our respondents who indicated that they openly talk about their LGBTIQ+ identity at work, only 17% of them openly talk about their identity to clients. Some are concerned that being out may jeopardize client relationships and negatively impact the company as a whole. One respondent reported, “During the marriage equality vote, my organization had a big client – we are talking about a multi-million-dollar client — who said ‘if you publicly support marriage equality, you will lose our business.’” Other respondents indicated that being out at work meant risking their lives: “[With] every new client, I’m scared that it might be my last time walking the earth as I enter their house.”

Myth #6: There is only one way to come out or not come out. There is a range of ways LGBTIQ+ people can signal their identities, or hide them. For instance, 47% of our respondents display objects like photographs, magazines, or symbols to reveal their identity at work. In contrast, 21% of our respondents avoid revealing their identity by keeping quiet when co-workers talk about their romantic lives, and 23% said they avoid behaving in ways that may conform to stereotypes associated with their identity group. Others who conform to heterosexual or cisgender stereotypes say they can ‘fly under the radar’ altogether.

Myth #7: People are scared to come out just because of career risks. Coming out is a constant cost-benefit analysis and requires weighing different risks. A lack of support from co-workers and supervisors, and past experiences of discrimination, often prevent LGB workers from coming out. But our research also shows that respondents are more concerned about social exclusion than career penalty. While about 19% of respondents who are not out at work worry their careers would be ruined if they were, 70% are concerned coming out would make their colleagues uncomfortable around them.

The importance of a supportive social environment plays a huge role in a person’s coming out decision. So what can organizations do to develop a work space in which living authentically is an everyday reality for LGBTIQ+ workers? Leadership makes all the difference. Our research reveals that respondents whose leaders publicly support LGBTIQ+ issues are 50% more likely to be out to everyone at work. We recommend leaders who want to create an LGBTIQ+ inclusive culture:

Develop a working partnership with leaders who have a different sexual orientation or gender identity than your own. This will help you learn, champion change, and challenge your assumptions. Make LGBTIQ+ inclusion visible in your organization. You can show support by displaying rainbow flags or other inclusive symbols, asking HR to create a diversity group for LGBTIQ+ people to connect and share their experiences, or developing a network of staff allies. Learn about all members of the LGBTIQ+ community. This means not just LGB people, but also people who are trans or gender diverse, who have an intersex variation, or who are pansexual. Check your assumptions to see if they hinder LGBTIQ+ inclusion. For instance, assumptions like: everyone is straight; everyone prefers binary pronouns; coming out is a purely personal issue, and not a workplace issue; this person must be LGBTIQ+ because of how they look, sound, dress, or behave; it’s ok to ‘out’ someone. Avoid non-inclusive or presumptuous language, like “that’s so gay,” asking women about their “husbands” and men about their “wives,” or assigning someone a gender pronoun. If you see someone participating in these behaviors, confront them. When you do so, that person will be less likely to do it again and they will also be more likely to change their views on what is appropriate behavior — as will any bystanders.

Finally, we should point out that it’s not just about leadership. Organizational policies and strategies that recognize the specific needs of, and sometimes just the existence of LGBTIQ+ people, are also key to establishing an inclusive environment.

We recommend organizations:

Include sexual orientation, gender identity, and intersex status in diversity and inclusion policies; have transition policies and supports in place for staff who are trans or gender diverse; make sure parental leave policies recognize LGBTIQ+ people. Review workplace forms to ensure that they are inclusive, and have an option for people who don’t identify as male or female. Make some bathrooms gender-neutral, and introduce gender-neutral dress codes if your company has dress codes.

LGBTIQ+ people can be themselves and have a real choice about coming out at work when their employer and people at work are supportive. Being aware of the common assumptions and the challenges people face is the first step toward building a work environment that is inclusive and safe for LGBTIQ+ people.

* “LGBTIQ+’ refers to lesbian, gay, bisexual, transgender/gender diverse, intersex, and queer. The “+” recognizes that LGBTIQ doesn’t include a range of other terms that people identify with, or use to describe themselves.

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“I would not be caught dead in a pink suit now,” says Susan Perry, the founder of SpeechMED, a startup that translates complex medical information into language patients can understand.

Clothing is just one of the issues Perry has reconsidered when it comes to how she pitches her business. As a middle-aged woman, she has faced bias because she doesn’t fit the stereotype of what an entrepreneur looks like. Raised to be soft-spoken, Perry now makes a conscious effort to lower her voice, plant her feet firmly, and speak directly. When she gets one of the tough, defensive, “prevention-oriented” questions that women entrepreneurs tend to receive from investors, she redirects and instead offers a bold and expansive vision for her company, more in the style of how a man might answer.

Perry’s transition to a more gender-neutral, or even masculine, pitching style seems to be working. Her company completed the Women Innovating Now (WIN) Lab at Babson’s Center for Women’s Entrepreneurial Leadership, was accepted into the gener8tor accelerator program, and is currently gearing up to pitch dozens of investors. Most importantly, she now feels confident about her pitch and her ability to raise money.

We know that women entrepreneurs face significant challenges securing funding from investors. Our research found that only 15% of companies receiving venture capital investment have a woman on their executive team and less than 3% have a woman CEO. Perry’s experiences — and my own years of research on gender and funding — help explain why.

While we often assume women entrepreneurs are discriminated against simply for being women, my research shows that they’re actually penalized for exhibiting stereotypically feminine traits. In fact, men are also at a disadvantage when they display “feminine” behaviors in the pitch room, while women are not penalized if they project more “masculine” behaviors.

A study my colleagues and I recently published found that masculinity and femininity, rather than gender identification (whether someone is a man or a woman), affect how entrepreneurs are perceived by potential investors. In an elevator pitch competition, investors were less likely to select as finalists entrepreneurs who demonstrated stereotypically feminine behaviors like warmth and expressiveness, regardless of their gender.

What’s unique about our study is that it looks at how gender roles and gender stereotypes, as distinct from sex, impact the pitching process. Our findings suggest that it’s not women who have a harder time raising money from investors, it’s anyone who fits certain feminine stereotypes. This is supported by the fact that, as a group, the women in our study were no less likely to receive investor interest than the men. It was behaviors, not gender, that mattered.

While this bias against feminine traits is certainly problematic, being clear on what plays well to investors is something women can use to their advantage. You can’t change your gender, but you can control how you present yourself.

Pitching a business is like any kind of performance — you need to know your audience. The pitch room is a unique environment with its own cultural norms and expectations about what kinds of behaviors are hallmarks of a successful entrepreneur. Just as someone wouldn’t show up to a pitch without a slide deck or proper business attire, it’s critical to take these behavioral norms and expectations into account as well.

That doesn’t mean remaking your personality or the way you express your gender. It simply entails thinking carefully about what sides of yourself you want to emphasize when you pitch. We’re all more or less aggressive, nurturing, assertive, or sensitive in various areas of our life, depending on the role we play in a given situation. Women should consider what might happen if they brought forward certain parts of their persona in the pitch room and left others outside.

Perry doesn’t view adopting a more masculine pitch style as trying to be something she’s not, but instead as uncovering a part of her “natural self.” She’s felt empowered to drop some of the ways society trains women to hold themselves back. “Women are risk takers,” she says, but “we’re sometimes taught that it’s not nice to be seen that way.”

Indeed, research shows that women in many fields face a catch-22 when navigating gender: They are discriminated against for being feminine (which conflicts with the norms of jobs and industries perceived as masculine) but also penalized if they try to act masculine (which contravenes the norms of their gender). Perhaps the most famous example of this phenomenon, known as gender role congruity theory, is when Hillary Clinton was criticized for being too ambitious, aggressive, and cold (all masculine traits) during her presidential runs. Though she was also critiqued as “weak” for exhibiting stereotypically feminine behaviors, people liked her more when she behaved in a manner consistent with her gender.

A number of studies have found that women face this particular bind in areas including politics, management, and corporate leadership. However, our research shows that this dynamic does not apply to entrepreneurs seeking funding. Women in our study were not punished for behaving in more masculine ways; instead, they benefitted by avoiding the penalty that comes with acting feminine. This finding suggests that women don’t need to fear backlash when shifting toward a more bold, assertive approach in their pitch.

This shift should encompass both style and content, for example, having aggressive revenue projections as well as presenting them in a confident way. Perry says, “As women, we want to collaborate and calm people’s fears, but we are not rewarded for that when we’re pitching. We’re rewarded for thinking boldly and being comfortable about risk.”

Access to early-stage capital has been shown to be important, often critical, to startup success, which is why the funding gap between men and women entrepreneurs is so concerning. Yet the strategy of simply having more women investors won’t work if feminine traits are penalized in the pitching context by investors of all genders. In the long run, investors need to broaden their view of what makes a successful business leader and create room for both masculine and feminine entrepreneurs (and those in the middle).

For now, women founders can benefit from having a clearer understanding of what the expectations are when they step into the pitch room and how they can present themselves most effectively.

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Facing escalating costs of medications and technology, health care patients and providers in the United States continue to search for opportunities to reduce overall costs while maintaining and improving health care outcomes. At the Mayo Clinic Comprehensive Stroke Center Practice, we conducted a project to design and deliver care more customized to the needs of individual patients while reducing cost and resource constraints. It is a risk-stratified approach that could be applied to treating many medical conditions.

The Mayo Stroke Practice used time-driven activity-based costing (TDABC) to study costs associated with alternative protocols for stroke care (see the graphic below). TDABC uses a bottoms-up approach to identify the actual clinical processes and resources used to care for a patient over a period of time. TDABC works from a process map of a patient’s care pathway, attributing costs to the time of each resource used at each step of the pathway. With this information, clinicians learn how to make more efficient use of high-cost resources, leading to lower total costs while achieving the same or better patient outcomes.

 

However if one could predict a patient does not need such care, this could save the system, as well as payers, a lot of money. The daily cost of an NSPCU bed — both to the payer (insurers and patients) and the hospital — averages $500 a day less than an ICU-level care bed, which is multiplied by length of stay (LOS). There are also measurable costs “turning over” a hospital bed in terms of both time delays such as patient’s waiting in the emergency department as well as financial expenses in cleaning and sanitizing a room to be ready for the next patient. Similar to the opening moves in a game of chess, which can determine the rest of the game, similar bed logistics can make or break hospital bed flow. So how can one improve both hospital bed flow and improve value-based care in stroke patients?

Using existing stroke data and TDABC mapping, one can stratify a stroke patient’s true risk for needing or not needing ICU-level care using the National Institutes of Health stroke scale (NIHSS). Historically, a “step-down” unit or progressive care unit (PCU) was typically used on the back end after ICU-level care for patients too sick and unsafe to send to a regular hospital bed because they might decompensate and end up back in the ICU. Using a NPCU strategy on the front end for some stroke patients is revolutionary in the sense patients are admitted directly from the emergency department after receiving TPA. This reengineering of hospital bed flow allows a relative cost savings without compromising quality and improves the value.

Since 1995, when TPA was FDA-approved to treat stroke patients, the common practice was to monitor these patients in the ICU environment due to concerns for decompensation from intracranial bleeding and complex interventions. Under fee-for-service reimbursement, however, stays in the ICU can incur daily charges up to $2,500, nearly 25% of Medicare’s total reimbursement ($11,000) for TPA treatment.

The Mayo stroke team used the NIH Stroke Scale (NIHSS), which ranges from 0 (normal) to 42 (severe), to stratify patients into different risk categories and identify those who truly needed ICU-level care. In a trial for intravenous TPA for acute stroke care, reported in 1995 in the New England Journal of Medicine, the average NIHSS score was about 14.

The most severely affected stroke patients had a NIHSS greater than 24 were most likely to need ICU-level care for monitoring. Therefore, Mayo Clinic’s stroke center data showed similar findings and proposed that stroke patients with an NIHSS score of 18 or higher should be monitored in the ICU for the first 24 hours after receiving TPA. Such patients often suffered medical complications that required advanced interventions such as intubation and mechanical ventilation. However, patients with few comorbidities and NIHSS scores of 14 or less had a reduced probability of severe complications that required critical interventions. Care for these patients could potentially be managed and monitored in the lower-cost NSPCU environment.

The team saw an opportunity to reduce costs based upon how and where patients received care, while still meeting Joint Commission requirements for post-TPA care, by treating low-risk patients in a NSPCU-level bed with a specialized hybrid level of nursing care (see the table below) for the first 12 hours. This risk-stratified care model improved value by delivering equivalent care quality with a lower-cost mix of resources. In addition, the stratification process allowed for better “demand elasticity” of ICU bed utilization.

Comparing NeuroICU and NSPCU Nurse Monitoring for Stroke Patients

Optimizing NSPCU and ICU bed utilization therefore is analogous to the game of Tetris in which players fit blocks of various sizes inside an available structure. All hospitals play a similar game to optimize space utilization by getting the “right patient to the right bed” with the fewest moves possible. ICU-level care beds are the most expensive in the hospital and are reimbursed at the highest rate. Ideally, they should be used only for the most complex medical/surgical cases or for transfers from emergency department (ED) and other hospitals. By freeing up ICU beds, previously used for lower-risk stroke patients, hospitals have more capacity, or elasticity, to admit postoperative ICU patients and ICU admissions from the ED and allow those care teams to focus on those patients.

Getting the right patient to the right bed also reduces the number of transitions of care (TOCs). Historically, some patients underwent four separate handoffs as they made transitions initially from ED or an operating room to the neuroscience ICU, then to the NSPCU, and finally, to a regular floor bed. This represents at least four moves (A →B→C→D) for the patient and adds risks: Details about medication allergies and other Important information about the patient can be lost, communicated incorrectly, or misconstrued during the handoff from one care team to the next. Handoffs are similar to those in football. The number of handoffs increases the complexity of the play and is associated with a higher likelihood of “fumbles,” or medical errors. When stroke patients are admitted from the ED directly to the NSPCU, a regular floor bed the next day, then discharged home, there is at least one less TOC, or handoff. In addition to reducing the total number of TOCs, a standardized, or structured, communication tool — a checklist — for exchanging important patient information during handoffs can reduce the number of medical errors as well.

As illustrated in the above examples, the ability to stratify and predict patient needs up-front opened the door for actions that enhanced process efficiencies, reduced operational costs, and improved patient outcomes. Patients that received TPA and were subsequently monitored in the NSPCU had an average reduced cost of 25%. Of 448 stroke patients seen in the past three years, all of whom would previously been sent to the ICU, 166 (37%) were monitored in the NSPCU, leading to a net cost reduction of nearly 10%, with no adverse impact on patient outcomes.

While the role for a progressive care, or step-down, unit is not new in health care, it is one we believe may be underutilized for elderly and more complex patients, especially when its cost advantage over the highly-resourced ICU has not been quantified. An NSPCU increases the effective capacity of existing ICU-level beds and provides better utilization of regular-ward-floor beds for medically-stable patients. Importantly, the risk-stratified approach does not replace or supersede physician judgment about factors not accounted for in the NIHSS-weighted model when deciding the best overall course and bed status for the patient.

As this case illustrates, process mapping of care pathways and accurate costing makes it possible to design and deliver care that is more customized to the needs of individual patients. The customization produces equivalent or better quality and outcomes at reduced costs because of more efficient resource utilization and diminished risk from medical errors. None of the gains discussed in this article are unique to stroke treatment, and the NSPCU model can be extended to many medicine and surgery areas to improve the value delivered at hospital, national, and international levels.

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Global carbon emissions need to be reduced to net zero by 2050 to have a good chance of holding global average temperature rises to no more than 1.5oC, a level that would be disastrous, but not catastrophic for human civilization.

So states a new report from the Intergovernmental Panel on Climate Change (IPCC), which sets out the policy choices governments around the world need to make over the next 12 years to 2030 if they want to limit global temperature rises to 1.5oC rather than 2oC.

If global temperatures rise more than 1.5oC, the risks of draught, floods, forest fires, heat-related deaths and loss of agricultural productivity all worsen significantly.

The response from political leaders so far has been mixed. Some governments may be poised to revise their climate change targets in line with the call for net zero emissions by 2050.

Others have been less enthusiastic. The Australian government has rejected the report’s call to phase out coal power by 2050. In the U.S., President Trump’s response to the IPCC report so far has been to cast doubt on it. This follows his summer 2017 announcement that he was withdrawing the U.S. from the Paris Climate Agreement. Since then the Trump Administration has been busy unravelling a series of public policy initiatives and regulations that underpinned the Paris commitments the U.S. had made, like the Clean Power Plan and vehicle emissions standards, citing them as an impediment to business.

Predictably, environmentalists, pro-environment politicians, and countries especially vulnerable to climate change have reacted to all of this with distress.

But perhaps a little less predictably, so have many business leaders.

For example, many American CEOs spent considerable energy in the weeks building up to Trump’s Paris announcement lobbying the President not to withdraw. Over 1,700 companies and investors have subsequently signed the We Are Still In statement, making public their commitment to uphold the agreement.

While it’s become more normal in recent years to see some businesses taking proactive measures to drive innovation to tackle some of the world’s most pressing social and environmental challenges, it generally remains a widespread assumption that business leaders see government intervention in the economy and increased regulation as something to be avoided.

But there is now a growing trend of some CEOs actively lobbying for more ambitious government action and regulation on a whole range of social and environmental issues.

Many businesses were actively involved in lobbying governments to make an ambitious agreement on climate in Paris in the first place. Unilever CEO Paul Polman was one of many who worked tirelessly to push governments to higher ambition. More than 365 companies and investors voiced their support for the US Clean Power Plan in 2015. More than 200 companies have publicly called for the introduction of carbon pricing. Business leaders are now calling on governments to create the policy frameworks to achieve net zero emissions by 2050.

And it’s not just on climate. Companies invested significant resources in pushing for high public policy ambition in agreeing the UN Sustainable Development Goals in 2015. On human rights issues, companies have lobbied the UK government for stronger regulation tackling Modern Slavery in corporate supply chains, and the Cambodian government for stronger protection for worker’s rights.

What’s going on? Businesses aren’t supposed to want more regulation of their activities. This growing trend is the subject of a research program at Hult International Business School, where we have followed a number of CEOs and companies involved in such advocacy activities over the past few years.

Part of what’s been driving more ambitious corporate action on innovation to address social and environment challenges is increased pressure and higher expectations from the rest of society that business should play a role in helping sort out contemporary global challenges. Ultimately, long-term legitimacy, reputation, and license to operate are at stake.

A number of CEOs are realizing that such expectations cannot be met by innovation and voluntary actions alone. The scale of today’s social and environmental challenges requires government action, too — there are some ways in which public policy can drive change that cannot be achieved otherwise.

In some cases, regulatory change can lead to direct commercial benefit, creating markets that didn’t exist before, or handing competitive advantage to those better able to capitalize on the regulatory change. For many companies, the right solutions are available for tackling social and environmental challenges, but they don’t become commercially viable unless regulatory change aligns commercial incentives with the right thing to do.

As a result, some CEOs have started overcoming their aversion to government intervention and fears that incompetent government meddling will get in the way of prosperity. There’s a growing recognition that ambitious government intervention has a crucial role to play in both addressing global challenges and helping business succeed.

So what are these companies learning about how to do this kind of advocacy well? Our research, as well as recent studies by others such as Business Fights Poverty and Harvard, and scholars at the University of Lugano in Switzerland, point to a number of key issues to get right.

Respect the leadership role of government, but be prepared to use your voice and influence. Your activities should be aimed at informing and supporting—but not replacing—the responsibility of governments to decide public policy. But that doesn’t mean business should be silent if government is not acting in the public interest. Aim for public policy outcomes that seek to effectively address societal challenges. The aim should be to reach solutions that address the problem and have consensus backing, rather than making sure your own interests prevail regardless of the impact on others. This may sometimes involve accepting public policy initiatives that could result in a short-term hit to profits, because in the long run they are going to help solve the problem, and help maintain your longer-term legitimacy. The outcomes you are aiming at need to be consistent with key universal standards, such as UN Global Compact and UN Guiding Principles on Business and Human Rights. Be inclusive. Traditional lobbying is done between government and individual companies or trade associations. But advocacy for more ambitious public policy is more effective if it is done on a multi-stakeholder basis. Public policy outcomes are going to be more effective if all groups affected have had a say in shaping them. Ensure the voices of the marginalized have a say in the process. Consider active joint advocacy with NGOs. Unlikely partnerships between companies and NGOs can have more impact on influencing policymakers, as each can compensate for the weaknesses of the other. Governments can distrust NGOs as being purely ideologically motivated, and can distrust business for being purely profit-motivated. Joint advocacy can deal with these legitimacy questions of both sides. Be transparent and truthful. Lobbying often happens behind closed doors, and the worst kind of lobbying in the past has been characterized by misinformation and misdirection. Public policy outcomes are going to be more effective if people have confidence that they know what different groups were calling for and they can trust the basis on which these positions were put forward. Be transparent about third party lobbying organizations that you offer financial support to. Invest to be able to advocate from a robust evidence base, for example on climate or health and nutrition. Make sure you have coherence and consistency between your external advocacy positions and internal policies and practices. You should also ensure the advocacy positions of trade bodies you are a member of are consistent too. Make sure you have the right skills and capabilities. It turns out that lobbying to persuade governments to introduce new regulatory measures often requires a different kind of skill set to the traditional government affairs function. Many companies have found themselves hiring in campaigners from NGOs to join their advocacy teams.

Finally, this is a question of personal leadership. Our research showed high levels of peer networks in CEO advocacy for more ambitious government action – each CEO reaching out to others to make the case for them to get involved in advocacy coalitions. An effective approach needs a personal commitment from the top.

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Understanding Customer Emotions and Addressing Them in Your Sales Strategy

Emotion is the driving force in today's buying process. Customers seek objective analysis as a counterbalance to their emotions. This characteristic of buying is most prevalent in high-stakes, complex sales. Sales professionals must tune in to these feelings because the customer's emotions change throughout the process.

Emotions are unique to each stakeholder. Emotions may run steady or peak at different stages of the buyer's journey for different individuals. In fact, emotions unrelated to the "buy/don't buy" decision can enter the picture. Research from Harvard and The University of California has found that emotions carry over from one situation to the next. Researchers call these "incidental" emotions.

A common example is a person taking their frustrations out on an uninvolved party. This problem is even further complicated by the fact that the carryover of incidental emotions typically occurs without awareness. Sales professionals must always remember that emotions influence business decisions. Generally, these emotions fall into two categories:

Fear of loss: A poor decision has serious implications for the individuals, the team and the business. People fear they will lose credibility and possibly their job if the solution fails. Relationships and money are at stake. These factors create a burden for the decision-makers. In many cases, these emotions are strong enough to overpower the most compelling evidence for a buy decision. Motivation for gain: A successful solution offers recognition and financial gain. The buyer advances on their competition and gains the freedom to pursue other business goals. Just as a fear of loss can deter momentum, the motivation for gain pulls a customer through the buying process. This motivation is what encourages the buyer to explore solutions.

To identify which of these two drivers are in play, sales professionals must identify the buying factors. Buying factors are the set of facts, influences and circumstances that all contribute to the decision to buy or not buy. These factors are dynamic and interrelated. Facts and circumstances continue to evolve and change as the customer progresses through the buying journey. Sales professionals must understand the key factors. The three most important buying factors are:

The case for change: Before a customer can confidently buy, they need to ensure that they have a strong business case to support that decision. The customer's case for change is not complete until they have evaluated all of their options and assessed value versus risk. Any big investment must help the customer achieve their strategic goals and objectives. The case for change revolves around a targeted issue – a problem or opportunity that is severe enough to warrant a change. The sales professional must help the customer compare their options, identify the best solution and evaluate value vs. risk. A common trap is to assume that the customer has already sold themselves internally on the case for change. Fear of change is ever-present. In fact, the closer the customer gets to the purchase, the more their fear rises. Stakeholder dynamics: Buyers must get their own stakeholders on board. Questions the customer considers include: "Who on my team can help me take this forward?"  "Who do I need to align on my team?" Who might be against this?" Sales professionals need to identify those who will champion change and the power structure in which they operate. They must understand the differing needs among stakeholders and how to align each person. The decision process: Timelines and competing priorities pull stakeholders into different directions. Projects stall because new stakeholders emerge, requirements change, and projects get reprioritized. Effective sales professionals manage this process. At the same time, a CFO and a procurement specialist will have a strong influence on the decision makers.

The case for change, stakeholder dynamics and the decision process are all external. They can be seen by watching how a group of buyers interact with each other and with the sales professional. However, these factors are often governed by unseen biases. Some common examples are:

Regret aversion: Regret aversion is the expectation of regret. That is, the customer is anticipating regret, not actually experiencing regret. This anticipation becomes another piece of information used to make the decision. In this respect, regret aversion might have equal weight to other information like ROI or price. A study in Psychological Science found that people's choices are driven by a fear of regret, even though they are less susceptible to regret than they imagine. Sunk cost fallacy: The customer is seeking a solution because something in their business needs to change. However, the old way of doing things represents costs already incurred, or sunk costs. The sunk cost fallacy is the urge to stay the course simply because the money has been spent, and changing plans leaves the results of those investments unrealized. Sales professionals must be prepared to help customers overcome this powerful bias. Choice overload: Simplicity sells. The customer's attention is divided. The buying process is only one of their responsibilities. Sales professionals should limit the number of choices they ask the customer to make. The sales professional's language, written communication and visuals should be simplified for the same reason. Status quo bias: After enough time, everyone becomes comfortable with current conditions. Upending the status quo is uncomfortable and incites anxiety. The status quo is one of the most immovable forces working against sales professionals. When sales professionals understand the power of the status quo, they can prepare to leverage every asset and capability they must in order to move the customer forward. They need to leverage the buying factors. The takeaway

In business, we're reluctant to acknowledge the role emotions play in our decisions. We prefer to see ourselves as entirely rational beings. We want our choices to be the result of analysis unencumbered by our leanings. Rather than ignore the emotional factors, sales professionals can empower themselves by exploring the emotions in play on the customer's side of the table.

To do so, they must first understand if a fear of loss or a motivation for gain is driving the business decision. Second, they need to uncover how the three primary buying factors influence the buyer's journey. Finally, sales professionals need to explore the cognitive biases at work. As Benjamin Franklin famously wrote, "If you would persuade, appeal to interest and not to reason."

To learn more about the importance of a customer-centric buying process that helps address your customer's emotions, download Richardson,s white paper, "Pursuing Opportunities with an Intentional Strategy."

8 Strategies for Fewer Abandoned Shopping Carts

Virtually all businesses that sell anything are developing or already using e-commerce websites or landing pages to sell their products online. Though the convenience of placing orders without leaving the comfort of your bedroom is remarkable, one practice of it has given many enterprises feet of clay.

The downside of e-commerce for merchants is shopping cart abandonment – when prospects drop out of the checkout process before making their purchase. The scenario is like when a customer walks into a department store, is about to make a purchase, and then gets a call to return to the office immediately. E-commerce business owners are constantly looking for solutions to shopping cart abandonment. The trend implies that shoppers are not pleased with some features of the online or mobile shopping experience. If you're looking for ways to reduce shopping cart abandonment in your e-commerce store, these eight strategies will help you out.

1. Develop a mobile app.

Reports have it that users interact with about 10 apps on their mobile devices on a daily basis. With the rise of e-commerce, users prefer shopping conveniently on mobile apps to the rigorous process of websites. To this end, your e-commerce mobile app should be user-friendly and easy to navigate. The app should be speedy, contents separated into their various categories and the general interface designed in a way that speaks to the user. This blog post will help you understand how to create an app for your e-commerce store.

 

Editor's note: Looking for help developing a mobile app for your business? Fill out the below questionnaire to have our vendor partners contact you with free information.

 

 

2. Keep carts visible.

Shopping carts should not be far from the user, whether they're shopping on a mobile app or the e-commerce website. Shoppers need to stay in the know of the items they have added to their list and the cost. E-commerce sites such as Amazon do a great job of this: The cart icon is positioned at the top with the number of items in it.

Visible carts and order costs keeps shoppers on track till orders are completed and helps them decide when they've added enough items (or cost) and should check out. This strategy reduces shopping cart abandonment because shoppers won't have to go back to check their cart, keeping the checkout in their sights.

3. Indicate shopping progress.

A first-timer to online shopping may be at a loss, especially when orders are to be validated. To this end, you should integrate a progress indicator to guide shoppers till the end of their checkout. A shopper can easily see how close they are to checkout so they don't give up.

The checkout process can be simplified by breaking it down into steps. For instance, shipping options and the shopper's details can be categorized into Shipping/Billing Method. The idea behind the progress report is to give shoppers a good view of their completed steps and last-mile actions to complete their purchase.

4. Allow guest checkout.

E-commerce stores often run digital campaigns to increase sales. Most data is extracted from user behaviors, so registration is often mandatory before checkouts can be made. This has been one of the problems that lead to shopping cart abandonment.

To solve this, registration should not be mandatory. Guest checkout should be enabled, allowing a shopper to go about their business without stopping to make an account. If you must require it, do so after checkout. The idea here is that shoppers should be allowed to shop and complete their orders without having an account on the site, or else they might just give up when you ask them to fill out a form and create a password before they can buy anything.

5. Offer a money-back guarantee.

Most shoppers are afraid of getting products different from what they ordered. There's also the concern that items might be defective or of low quality. The best method to retain trust is offering a money-back guarantee within a certain timeframe. Shoppers are always pleased with openings to return items they're not happy with and getting their funds back or using store credit to place another order. Thus, the money-back guarantee is a great strategy to prod users to complete their purchase.

6. Use a secure payment gateway.

Many users are reluctant to offer their personal details when filling out forms, not to mention their credit card numbers. This last-mile challenge had made many users back off from completing their orders.

The solution is using trusted payment channels that do not have access to users' details. Strive to partner with reputable payment gateways that can process cross-border transactions, because online retail should not be restricted to one region. Also integrate verification icons such as Verisign. Payment gateways should vary by user preference and include payment options that appeal to your target audience.

7. Enable cart saving.

Shoppers may not want to spend much time surfing e-commerce sites. Distractions are imminent, and a shopper will abandon their cart to watch the latest movie trailer. When they return to the site, the frustration of starting over again often keeps users from making the purchase.

You can solve this problem by allowing them to save their cart. Some shoppers are out for the best deals and flipping between multiple sites to find the lowest prices. Saving their carts and searches in their history allows them to come back and complete their orders after making comparisons.

Cart saving is mostly limited to registered users, but it should be extended to guests. Since guests don't have accounts, you can use cookies to give them access to their browsing history at their fingertips.

8. Create fear of missing out.

Shoppers often abandon their orders indefinitely without worry because there is no competition for the items. You can create scarcity to reduce shopping cart abandonment. Placing the remaining quantity of an item beside it increases chances of a sale, because a shopper might be scared that the item will be gone if they don't buy it now.

Users drop off their purchases for an avalanche of reasons. Improving the user experience by implementing these features is vital to boost sales. The checkout process is the soul of every e-commerce business, so yours needs to provide the great user experience that will prod them to click the order button.

MIT Sloan Management Review

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