What Leaders Can Learn from a Doctor About How to Deliver Bad News

Posted 08.21.2009

One of my favorite sayings about leadership is that it’s a two part job. The first is to define reality. The second is to offer hope. The challenge is to strike the right balance between the two in a given situation.  It’s hard to get it right. Some leaders go long on reality and short on hope. Others, perhaps because it’s more fun and energizing to focus on the future, don’t spend enough time and attention on defining reality.  

Of course, another factor in avoiding the discussion of reality is because it often involves delivering bad news. Unless they have some sort of pathology, delivering bad news is not something that most leaders enjoy or look forward to. As a result, a lot of leaders aren’t particularly good or effective at delivering it.  In a time of great change and upheaval, as this one is, leaders will frequently find themselves in a situation in which defining the new reality requires delivering some bad news. It’s important to develop some skills in this domain and that’s the point of this post.

What got me thinking about this topic was an article in Thursday’s New York Times by Anemona Hartocollis called, “At the End, Offering Not a Cure but Comfort.”  Her reporting focuses on Dr. Sean O’Mahony who, as a palliative care specialist, informs and counsels patients facing the end of their lives.  The article is informative, instructive and beautifully written.  I highly recommend it to you.

Dr. O’Mahony spends his days delivering bad news and, as the article makes clear, he is highly skilled at that. He strikes a fine balance between establishing connection with the patient while maintaining a level of detachment that he needs to protect himself so he has the emotional reserves to serve the next patient. While many leaders do not have to deal with literal issues of life and death, if you lead long enough at a certain level or above, you’re almost guaranteed to have to deliver bad news. It could be firing someone, closing down a division, disappointing someone who was expecting something they’re not going to get or any number of other situations. How well you handle these situations will determine how well things go for you and the organization after you deliver the bad news. As a former executive myself and now as a coach, I’ve had a lot of direct and indirect experience with delivering bad news. I know how hard it is. There’s a lot that leaders can learn about how to deliver bad news from how Dr. O’Mahony does his work. Here’s a list of the lessons I noticed in the Times article:

Be Informed:  The doctor is well informed about the particulars of a patient’s case before he begins a conversation with them. He doesn’t freelance or wing his way through it. When you communicate with people about something that is deeply important to them, they expect that you will have had enough respect for them to do your homework beforehand.

Be  Honest:  If a patient has cancer, Dr. O’Mahony tells them they have cancer. If there is no cure, he says, “there are no established cures.”  He respects his patients enough to tell them the truth in simple, direct language. If he was a corporate executive, my guess is he would call a layoff a layoff instead of a made up word like rightsizing. He understands that people need to hear the truth in language that acknowledges their intelligence and their value as a human being.

Listen with Questions:  After he delivers the news, the doctor stays with the patient and listens for clues about where the patient is in the process and what the best next steps would be. In a case highlighted in the Times article, he asked his patient questions like, “What are your biggest concerns?,” “What’s your understanding of the status of the tumor?” and “What gives you strength?”  Asking open ended questions like this gives his patients space to process their thinking and identify what’s most important. In an organizational leadership setting, just about any bad news conversation should at least include the question, “What questions do you have?”

Acknowledge What You Don’t Know:  Dr. O’Mahony has learned that it’s a risky game to predict the future and believes that offering “very concrete estimates of survival can cause as much harm as good.”  He resists the desire that patients often have for specific answers for things that he can’t control and instead focuses on what he can do to help the patient in the situation they’re in. That strikes me as a good rule of thumb for leaders delivering bad news.

Take Care of Yourself:  Early in the Times article, the doctor states, “I do not feel obligated to be sort of eternally involved with the experience of death. It’s not healthy to be there all the time.”  That might sound cold on first reading. I’d suggest, though, that Dr. O’Mahony understands that he needs to maintain a certain level of emotional detachment with each patient so he can be fully present and engaged with all the patients to come. He is doing difficult work and needs to manage his emotional reserves to do it.  The same is true for organizational leaders in challenging times. To effectively deliver bad news, you have to believe that you’ve done what you can to help the people affected while leaving yourself with the reserves needed to lead the rest of the organization.