Nonviolent communication in a waiting room

‘Employees in the Netherlands report bullying, violence and intimidation at work more often than the European average. Two thirds of Dutch doctors and nurses, for example, regularly have to deal with it’, according to the 2006 Working Conditions Balance that minister Piet Hein Donner of Social Affairs sent to the House of Representatives on Monday. Dutch people more often suffer from undesirable behaviour such as bullying and intimidation. Especially in healthcare, education and services, employees report this unwanted behaviour, according to the TNO study carried out at the request of the Ministry of Social Affairs.

Communication in the waiting room: a dialogue or verbal intimidation?
Recently I was at an outpatient clinic in a hospital. Unable to let go of my background as a (communication) coach, I find the communication processes in the waiting room fascinating.
There are people who complain and who talk mainly about what is going wrong, people who mostly mind their own business with their nose buried in a magazine, and people who watch, sometimes take part in an unexpected conversation with the person next to them and then watch others again.

It was the start of consulting hours, which made me catch myself expecting to be helped on time. But the clock ticked past the limit of the appointment. Meanwhile others grew restless because of the longer waiting times.

A young woman was angry because she was not helped straight away, even though she did not have an appointment. The assistant explained that a number of people ‘with an appointment’ already had to wait because things were running late, and that she could not simply place her ahead of all the appointments; she would have to discuss this with the doctor. She could fit her in, but then she would have to wait a while. This explanation was not enough. Fuming, she left the waiting room, with all kinds of remarks about the poor quality of the hospital. A little later, when I myself had finished my appointment, I saw her come out of the doctor's consulting room after all.

A man from the island of Sint Maarten complained that he had to wait a long time. In English he discussed his complaint: a sore knee. He had already been waiting so long in the waiting room, whereas if he were on his island, he said, he would be rid of all complaints thanks to the warmth of the climate.
A woman did not have a sticker with personal details on her card. When the assistant handed back her blank appointment card with the request to go and fetch the sticker in the corridor, the woman answered: ‘But it is your fault’. Snorting, she left the clinic to make her 30 metre walk to the appointments desk.

These are a few incidents, of which two probably represent the mildest forms of ‘violent communication’. Why is it that staff in hospitals and in education in particular are regularly confronted with violence and intimidation? What other emotion might lie beneath the anger?

‘Out beyond ideas of right and wrong there is a field. I will meet you there’ Sufi poet Rumi
The psychologist Marshall B. Rosenberg studied all kinds of forms of violence from his youth onwards. During his studies and doctoral research in clinical psychology, he discovered the influence of language and the violence in our way of communicating. He developed a form of ‘nonviolent communication’: an application of communication skills that allows us to distinguish the circumstances that affect us from the feelings these evoke in us. We learn to recognise our emotions and needs and then to clearly put into words what exactly we want in a given situation. And: we let go of the need to be proved right. It is a different way of thinking. Often difficult, because in a situation or confrontation a lightning fast trigger takes place: people react largely automatically. This is a way of acting on the basis of a stimulus without our being aware of why we choose that action.

An example: A colleague walks past you without greeting you. You become angry, because you think he does not want to see you. Last week the two of you had an argument, so that will be the reason he is not greeting you. Heavily irritated, you ask him the next time why he said nothing. Surprised, he answers that he was so lost in thought because there was a problem on the department that he had to solve immediately. He had not seen you at all. You put into words your fear that the exchange of words might have made a difference to your collaboration.

In short, the model of ‘nonviolent communication’:

1. Observe without judgement
2. Feelings: recognise, acknowledge and express them
3. Needs: take responsibility for our feelings
4. Requests: a request for an action to fulfil the need without it becoming a demand. The other person is not obliged to carry out a requested action. Phrase the request in positive language. With a negative formulation people often become confused and slip into resistance.

(Source: M.B. Rosenberg: ‘Nonviolent Communication’; for more information: www.geweldlozecommunicatie.nl)

This way of communicating requires a lot of practice but above all a different way of thinking. It is not about no longer being allowed to feel emotions, or always staying calm in a dialogue, but about acknowledging your own emotions and the needs that lie behind them. Once you are aware of these, conversations go differently.

How communication based on this model could have gone differently in the waiting room:
The young woman is afraid. Some symptoms of a serious illness she has had are back. She would like to speak to her internist, but she has no appointment. At the desk she asks whether she can have an appointment because she is worried. The assistant indicates that this is possible, that she will be fitted in, but that she will have to wait a while until a number of patients have been helped.

That this model is applicable not only in a hospital or in education should be clear.

Valérie Docters van Leeuwen