On November 13, 2023, after years of advocating for it, due to excruciating menstrual conditions and scary cysts, I was finally granted my FULL hysterectomy!
I was so excited at the prospect of NO more painful, profuse, and unpredictable periods or worrying over my stubborn ovarian cysts. The procedure was fairly simple on my end and less painful than expected – definitely promised great reward for the surgical risk.
The scariest and most difficult part?
Waking up from the anesthesia, a process that could have been a TON smoother with just a little training on how to set expectations effectively.
Failure to Set Expectations Effectively
I see it all the time as an executive coach. My clients will express their frustration with a certain employee because they “just don’t get it – just won’t meet the expectation – no matter how many times I repeat myself!” I quickly default to the question:
“How exactly did you explain the expectation and check for understanding?”
That last point is the most missed and most important. Asking for the same thing over and over again when getting the same results is ineffective and will only lead to frustration on both sides.
A Very Personal Medical Example
I. Failure to Acknowledge
As I woke from my induced sleep, I found myself in a freezing, sterile room sectioned off by curtains beyond which I could hear other voices, some whimpering and others moaning in pain. Above my head, I heard a stoic female voice ask, “Can you tell me your name?”
Tell you my name? Are you kidding me? I can’t even breathe right now!
“Do you know where you are?”
Too many questions. I managed to force out a faint “I can’t breathe.”
“Your oxygen levels are fine.” (Gee thanks! Not an acknowledgement at all.) A solid acknowledgement lets the person know they have been seen/heard. It can be as simple as: “I totally understand.” That would have been enough. She could have then followed it up with, “The good news is your oxygen levels are fine.” Instead, her response seemed to dismiss what I was experiencing, which felt very real to me.
I was exasperated, confused and breathless. I started to panic. I could feel my body trembling and my chest tighten. The nurse was NO help. She just wanted answers, but I wasn’t feeling acknowledged or heard.
I managed to produce two words in supplication: “My husband!” (He knows what to do to calm me down. Get him in here!)
“You can see your husband once you are out of this section and in your own room. Can you tell me what procedure you just had?”
“(Gasp) Having trouble breathing (Gasp) Full hysterectomy.”
“Ok. Take deep breaths. Your oxygen level is good. (Again, not helping.) On a scale from 1-10, 1-4 being tolerable, how would you rate your pain?”
More Questions?! Dammit! Let me catch my breath. I am underwater here!
“I don’t know – 6?”
She administered pain medication into my IV and continued to prove useless in calming me down. I continued to gasp for smooth airflow.
II. The Value of Training and Technique
When you master a technique, it becomes second nature and instinctively kicks in when the pressure is on. The pressure was ON!
My inner coach stepped in:
“Mitch, you need to slow your breathing. C’mon, you know what to do – Box Breathing (Inhale for 4 counts, hold for 4, exhale for 4, hold for 4…)”
I started to comply with the voice inside – choppy at first, struggling…then eventually… smooth, steady, consistent breaths, interrupted only to answer more repetitive questions about my name, what procedure I had done, and my pain level. I thought, “Just let me breathe. Let me calm myself.”
In time, I started to feel more awake and in control - not drowning anymore - the inner coach coaxing me along to keep counting breaths and relax my body. I asked the nurse,
“What do I need to do to get out of here?”
I would do whatever she asked of me. I yearned to see my husband and be away from this frozen purgatory.
“Breathe, Mitch – BREATHE!” My inner coach kept working hard, “1-2-3-4…” It was working. I was feeling increasingly in control.
III. When Failure to Get Compliance Turns to Force
They wheeled in a woman next to me. I heard her tiny gasps for air and the nurse,
“Can you tell me your name?”
The woman was having trouble responding. It took a few repetitions of that question before a muffled and labored voice replied, “Katie.”
“Katie, do you know what procedure you just had? (I guess they ask everyone that question to ensure they are lucid enough.) The answer made me feel sad for her and fortunate for myself – I was there by choice, preventative.
“Double mastectomy.”
“Katie, your double mastectomy and reconstructive surgery was successful. However, your oxygen levels are low. I need you to stabilize your breathing before we can get you moved to your room. Just take deep breaths.”
This would continue to be the nurse’s “setting of expectation” over and over with no result. She would pop in and out, check poor Katie’s vitals on the computer that stood between us, and repeat the same command to no avail – “You need to take deep breaths.” Each time I sensed the nurse’s voice more laden with frustration until she slipped down into force/threat:
“If you don’t get your breathing under control, we can’t get you moved to your room.”
Often, when a leader is struggling to get compliance with an order or expectation, they will turn to force or threats. This is a method that can be effective in some cases, but not all. It is not sustainable leadership. The more productive approach is to find out where they have a gap in understanding, perhaps walk them through the process, allowing them to work it out; not on their own completely, but with guidance. Too much force or threat can plunge someone into apathy – seeing no hope, they just stop trying altogether.
I was afraid that was where Katie was finding herself. She may have been hearing the nurse’s words, but she was not making the cognitive connection from direction to action. This frustrated everyone, including the patient in the next bed – me! I could sense how badly Katie wanted exactly what I did – to be in her own room with her husband loving and comforting her. If only the nurse would give her a little guidance. The inner coach jumped out of my skull, deeply concerned for poor Katie (plus, it’s always therapeutic for me to shift focus away from my own ailments to help another).
I waited for the nurse to walk out. Feebly, I turned my head towards my cellmate, intent on getting us BOTH out of there! I struggled to put sentences together and get them out of my mouth, with a reassuring smile:
“Katie…breathe with me. In for 4, hold for 4, out for 4, hold for 4, etc.”
She rolled her eyes over toward me and then back up to the ceiling. I persisted. She began to breathe – 1-2-3-4, out for 1-2-3-4, slowly, painfully, she was doing it. I could sense her starting to calm down. She was letting me help and that made me feel energized because I was being useful – a testament to the role of purpose and utility in our own survival and vitality.
“It’s called Box Breathing,” I managed to articulate, “They teach it to the Marines.”
I heard Katie’s soft voice as she turned to me and asked:
“Are you a Marine?”
“No.” I found the question surprising and comical. “I teach people how to relax. (Yeah, that’s the best I could come up with in the moment.)”
“Well,” Katie said, finding more strength and her humor, “I need to take your class – (gasp for air) – I suck at that!”
We both enjoyed a tiny chuckle.
“You’re doing great, Katie!” I continued to reassure, managing to forget about my own pain and discomfort while doing so.
Eventually the nurse came back in and reported Katie’s oxygen levels were finally normalizing. Imagine that!
If she only knew. If she only had been trained to take those few seconds to direct her patients, guide them through her expectations, instead of futilely repeating the same command over and over! She could completely change the waking and recovery process in that post-anesthesia phase. She could save her patients so much panic and labor with just a few slow and focused directions – “Breathe in – 1-2-3-4.”
How many times do we think we are setting clear expectations when in reality we are just droning on, repeating words that do not translate into understanding or action for the person receiving the commands? You walk away expectingly, without checking for understanding or asking the person to walk you through their process so you can detect any gaps in their understanding.
How many jobs and lives could be improved, even saved, by just following a few simple steps? As a corporate trainer and executive coach, I have devised a full set of tools and exercises around this ONE point. It is that key. Mastering this is vital to salespeople, customer service representatives, managers, medical professionals and even parents!
How To Set Expectations Effectively – Coaching & Training
There are exact steps to effectively setting and getting expectations met. These steps include, among other things, ensuring the person is actually present, being detailed and clear about your expectations, and checking that the person has truly understood not just the expectation itself, but how to go about achieving it. The steps take practice as they do not always come easily or innately, but they can be mastered.
Additionally, it helps to learn how to apply skills like active listening, increasing EQ (Emotional Intelligence), and adapting to different behavioral styles (DISC). Training and coaching play a vital role in helping a person or team improve these skills, thereby increasing productivity and success. Furthermore, as in the personal example I shared, when you truly master a skill, technique will rise to even the most stressful of occasions.
I help leaders and teams develop these skills and apply these techniques, which fills me with immense joy and satisfaction. When you master these skills, your life and the lives of those around you will be drastically improved. Win-Win!
