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The Shift

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A Simple yet Profound Shift

Seeing people as people is an idea so simple you'll swear you've heard it a million times but so profound you'll never stop learning from it. Kimberly White discovered it in a chain of nursing homes whose leaders, nurses, and housekeepers saw their patients, not as tasks to be ticked off a to-do list, but as valuable human beings.
White helps you to this transformative shift with warm encouragement, insightful guidance, and powerfully moving, true accounts of extraordinary human goodness.

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16 Chapters

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Chapter 1: The Shift and Why It Matters

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There may be places in the world that are more obscure and isolated than Blanding, Utah, but I’ll bet it’s on the short list. It’s a very nice town—it doesn’t have that aura of hopelessness you get from small towns in decline. It’s just small and far away from almost everything. It’s located where the four least populous corners of Arizona, Colorado, New Mexico, and Utah meet. They meet there, but they haven’t done much with the place. The town does get some tourism from nearby Moab and the Navajo and Ute reservations, although in this part of the country, nearby means not too much more than an hour’s drive. I may well be the only person who ever went there just to visit its nursing home.

I was visiting the nursing home as part of a larger research project on its supporting company, a healthcare group based in California. The CEOs agreed to keep the company anonymous to avoid the odor of self-promotion and for other reasons mentioned in the preface.1 Here I will call it Healthcare Group, or HG. HG was founded on the ideas of the Arbinger Institute, a management consulting company. Arbinger promotes a unique leadership philosophy based on the singular importance of seeing people as true and valuable people in the fullest sense.

 

Chapter 2: Missing the Gorilla: Why We See People as Objects

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WHY WE SEE PEOPLE AS OBJECTS

I returned home from my third research trip with tremendous reluctance; I knew what I was going back to, and I didn’t think I could face it again. I sat in the car, looking at our tiny apartment through a dreary, unenthusiastic rain. I did not want to go in to my unappreciative, feckless husband or my quarrelsome children, who whined and complained through the homework and chores I had to make them do. I did not want to go in and pretend that I was happy to be home, when in reality I had been far happier away.

The simple truth is that I was miserable at home. Miserable and disappointed and trapped in a way that I think is familiar to many people: I felt oppressed and restricted because I was surrounded by people who, one way or another, had let me down. Acknowledging this feeling is important because it is precisely what we want to shift out of.

For me, it wasn’t that I didn’t love my family—all of them. It was just that I didn’t feel happy around them. I felt burdened and overwhelmed. And I realized, sitting there, that much of the burden came from the feeling that I was under a microscope. If I got cranky (because I saw how much laundry had piled up or my flight got in very late) and snapped at my husband, he would immediately fight back with something hurtful. If I raised my voice at my son who never put his dishes away, he would roll his eyes scornfully and say “Don’t freak out,” and no one would take my side.

 

Chapter 3: Soft Like a Brick: The Power of Seeing People as People

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THE POWER OF SEEING PEOPLE AS PEOPLE

“Welcome to Lily Ridge!” she called. I could see only her hands and her head as they poked around the corner, but they told me enough to intrigue me. Her smile was genuine and her voice a touch breathy, as though she had just run a short way, almost as if she had hurried down the hall just to poke her head around the corner and welcome me to this nursing home.

“Thanks!” I said, hurrying toward her. “What’s your name? What do you do here?” She seemed to be in business clothes rather than scrubs, so there were some fifteen nonnursing jobs she might have worked in. She told me her name, but I didn’t catch it as she explained, hurriedly, “I’m on my way to a transport, so I have to go right now, but I’m usually in reception and I saw we had a new person here and I just wanted to make sure you got welcomed!” With that and another brilliant smile, she took off at a business run back down the hall, and I was left just grinning after her.

A person who has shifted to seeing people as people is a delight to be around and has an unlimited capacity to spread positive feelings. But as you might be thinking by now, the shift is easier said than done. People do not develop a good attitude by simply being told they need one or become happy by being told to cheer up. Likewise, none of us shift to seeing others as people simply by knowing we should. And the more entrenched we are in difficult relationships, the harder it is to shift. Fortunately, just because the shift isn’t automatic doesn’t mean it isn’t possible. We can facilitate the process by turning to certain keys, and we’ll get to them later. They just turn out not to be what we expect.

 

Chapter 4: If You Can Do It Here, You Can Do It Anywhere

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“Oh, I hate nursing homes,” my friend Lynn said when I told her about the book I was writing.

Most people do. That’s why I’m bringing it up with you now. If I’m going to write a book about a nursing home company, I might as well acknowledge the elephant in the room. People hate nursing homes and certainly don’t want to read about them; to be honest, before I really engaged with nursing homes, I didn’t particularly want to write about them. But here we are, stuck in this chapter anyway. So I’ll let you in on a secret: nursing homes are an astonishingly perfect place to study what happens when we truly see people as people.

How does any ordinary person shift from seeing people as objects—as problems, puppets, or irrelevancies—to really seeing and feeling and being awed by the complicated, infinite, precious greatness of others? If the shift were easy and obvious, we would all see people as people all the time; we would never waste time crippling and blinding ourselves and restraining our potential happiness by seeing others as less than they are. And yet we do it all the time. (At least I do it all the time.) We’ll soon learn exactly how we make that shift, but for now the issue is whether it really is possible to see anyone, let alone everyone, in this way.

 

Chapter 5: The Paradise Delusion: What the Shift Isn’t

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WHAT THE SHIFT ISN’T

It should be clear by this point that the shift is well worth it; it is a change from blind self-focus to a clear-sighted appreciation of profound humanity that leads to teamwork and contentment and dedicated effort. What is not clear yet is how to actually make the shift. I am getting to that—we’re only one chapter away. But the shift itself is so easy to misunderstand that we have to clarify one thing before we can get there and that is what the shift isn’t.

Once upon a time, there was a SNF resident named Howie. It is not uncommon for patients with psychiatric issues, dementia, or cognitive deficits to express their frustrations or disappointments with distracting, difficult, or even destructive actions, which are known in the industry as “behaviors.” Well, Howie took behaviors to another level. He was only in his forties but was very physically impaired and had communication and psychiatric issues. He used to repeatedly ram his wheelchair into walls until he put holes in the drywall. Or he would put himself on the floor, and when staff members came running over to help him, he would kick them in the face. Howie’s behaviors were a drain on the staff, but since skilled nursing facilities are penalized for using antipsychotic medications, there was no easy answer. The administrator trained the nurses to keep their distance so they wouldn’t get hit and developed specific protocols for when Howie was on the floor to keep both him and the staff safe. It seemed that the best they would be able to do would be to cope with him and try not to get hurt.

 

Chapter 6: The First Key: Pay Attention

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PAY ATTENTION

In this book, we have been talking about the shift, the tremendous change in perception and relationships that occurs when we stop seeing people as objects and start seeing them as people. We finally have enough background to talk more about how the shift happens.

The bad news is, the shift isn’t something we can do automatically. It’s not like flipping a switch; we can’t do it just by wanting to or recognizing that we should. And often we find ourselves highly resistant to switching (I sure was) when our troubled relationships are complicated or strongly entrenched. The good news is, that doesn’t mean we can’t make it more likely.

If we see people as objects when we are self-absorbed, then the key to seeing them as people is to stop being self-absorbed. To some extent this is easier said than done (there’s a self-perpetuating enjoyment to focusing on myself) but we can take steps to facilitate the shift, and the next six chapters will explore them. The simplest is just this: be around people and pay attention to them.

 

Chapter 7: How to Use the First Key: Toil with Them

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TOIL WITH THEM

When Phil was in one of his first facilities as a nursing home administrator, before he ever dreamed of starting HG, he knew exactly how he wanted to change it; he saw so clearly how to make things right. The facility was a mess; the previous administrator and director of nursing had literally been escorted out by law enforcement, and Phil had been dropped in to save the day. As a former management consultant and practiced speaker, he knew how to solve problems and speak insightfully, so the first step he took was to pull his team together so he could give them his vision speech. He has the rumbling voice of a morning DJ and the compelling presence of a high-powered businessman, and it was a great speech, full of memorable and insightful phrases. Because he knew Arbinger’s ideas, it probably included a heartfelt determination for all the staff to see one another as people.

But in spite of all these impressive personal qualities, about seven minutes into Phil’s genius vision speech, he had a sort of out-of-body experience where he could suddenly see himself the way others were seeing him. His staff members were bored; they were waiting for the minutes to pass. They weren’t moved by his consulting background or his stage presence or his turns of phrase or the Arbinger insights about seeing people as people. They were there only because the new boss said they had to be, but they weren’t listening. They had real work to do. It didn’t matter that Phil had been to London and hobnobbed with rich businessmen—how could it matter? They had patients they loved who needed their water pitchers filled, their hair brushed, their briefs changed, their laundry done, and their hands held. Nothing Phil could say from his ivory tower could matter to them.

 

Chapter 8: The Second Key: Look through Their Eyes

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LOOK THROUGH THEIR EYES

There once was a skilled nursing facility night shift. The members of this night shift expressed a lot of complaints to Sheldon, a top executive from HG, when he visited them. We will look at only two of them. First, they had supply issues, particularly with gloves. Second, the facility supposedly had a storage shed, but it was essentially useless to them because it was way out back, without any lighting. They said they never used it because of the long, time-consuming walk, and anyway, it seemed dangerous to go out there in the dark in the middle of the night, especially for the women. One person added, “I heard the storage shed doesn’t even have the inventory that we need, so why go out there anyway?” So they had supply issues they couldn’t solve because of the shed, which, though all well and good for the day staff, was no good to them.

Sheldon thought about this problem and came back the next night, saying, “Well, let’s just dive into this. Let’s solve this for these guys.” He was prepared to figure out what went wrong with the lighting, find ways to make the walk safe, and then fill the shed with gloves. He said to the group, “Well, take me out to the shed!” and it turned out that none of them—not one person on the night shift—had ever been out to the shed before. They’d all heard about it, but none of them had ever tried to find it.

 

Chapter 9: How to Use the Second Key: The Thirty-Day Rule

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THE THIRTY-DAY RULE

The most unpleasant, least friendly nursing home I ever visited was Cedar Villa; it had just been acquired by HG a few weeks earlier. Under previous ownership, its administrator had been essentially absent, and the remaining staff had been doing his work and covering supply shortfalls with their own money. They had badly failed their most recent state health survey. It was in a tiny, run-down building tucked away confusingly at the rear of a larger medical complex, its bland façade made blander by the odd presence of an elevated trailer structure that squatted oppressively on the lawn. Through the unmarked front doors—distinguishable as the entrance only because there were no other doors—brooded a tiny gray square of space, completely empty, shut off by another door from the rest of the building. I stood in that gray space for long minutes, waiting for someone to whom I could introduce myself. A couple of people darted in and out without a word or a glance as though I were invisible. When I finally got one woman’s attention, she asked irritably, “Do you need something?” When I explained that I was meeting the administrator to attend the stand-up meeting, she rolled her eyes; I was half an hour early. When I asked if I could pass the time looking around the facility, she flatly said no and told me to go wait out in the squatting trailer, where the meeting would be held.

 

Chapter 10: The Third Key: Realize I’m the Problem

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REALIZE I’M THE PROBLEM

Sometimes, especially in longer and more fraught relationships, thinking about the other person isn’t enlightening so much as it is infuriating. Many times I tried to see my husband as a person, tried to see his point of view, but thinking about him would leave me so frustrated and angry that I would abandon all my noble ambitions. “Yes, I can see that he is frustrated and disappointed, but that doesn’t mean he should say that!” I would say to myself.

I didn’t shift at all by thinking that way—if anything, it entrenched my bitterness. I needed a different approach; I needed the third key.

Social psychology includes a phenomenon called the correspondence bias or the fundamental attribution error.1 Quite simply, it means that we have a tendency to assume that when others are behaving badly, they are doing so because of their permanent personality characteristics. (If someone cuts me off in traffic, I assume the person is a jerk.) But when we behave badly ourselves, we recognize it’s because of our circumstances. (If I cut you off in traffic, it’s not because I’m a jerk; it’s because I’m in such a desperate hurry.) I take very seriously all the factors in my life that influence me to behave how I do—the stresses, the conflict at work, the long history of my husband making me late, and so on—and I know they’re the reason I, for example, raised my voice. “I’m not a yeller, it’s just that all these things were piling up.” But when someone else yells, I tend to conclude “She just has no consideration for other people.”

 

Chapter 11: How to Use the Third Key: When You’re Still a Jerk

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WHEN YOU’RE STILL A JERK

Here’s the problem with starting to see people as people: it turns out you’re still you.

So much about my life changed when I began to see my husband as a person; our relationship was transformed, no question, unbelievably for the better. In those first couple of weeks I thought we might never argue again because I was so completely changed.

It’s okay, you can laugh.

What I hadn’t counted on was that even with a new perspective on my life and my relationship, I was still the same person I was before, with the same faults, failings, and limitations. Only a month or so later, I came home from a trip to the usual disarray and became as angry and critical and judgmental as I ever had been before. I stormed around, shouting at the children to put things away, slamming a door in anger about all the burdens that fell to me, and in every possible way behaving with humiliating boorishness.

Of all the confessions I make in this book, this one pains me the most: I turned out, even having seen my husband as a person and having that perspective to draw on, to still be capable of being a big jerk. I did it much less frequently and pulled out of it more quickly, not being as convinced by my own self-absorbed perspective these days, but I was horrified to discover I was still capable of that kind of selfish, heedless, object-seeing frustration, even in the short term. My perspective had shifted, but my personality was the same.

 

Chapter 12: Staying Shifted: Why Behavioral Rules Won’t Help Us

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WHY BEHAVIORAL RULES WON’T HELP US

The shift to seeing people as people does a lot of the work for us, in terms of erasing resentments and dissolving blame. But we are still “meaty, sweaty humans”1 with personalities and brains that aren’t necessarily the way we want them to be. We fail, we fall into old habits, we return to our self-absorption, where we get to feel more important than others and gloriously blameless. But that’s okay; that’s reality. When I see others truly as people, I see both that they are gorgeously rich in unexpected greatnesses and that they are riddled with weaknesses and failings and hobbled by fears and disappointments. I am the same; we all are. We are towering with greatness and sunken with flaws at the same time. None of us will shift perfectly and completely; not even Doug Coulson sees people as people all the time.

One of our tendencies as meaty humans, when confronted with a powerful idea like the shift, is to come up with rules and lists to follow. Instead of having to think about others’ perspectives and consider their pains, sorrows, and heroism, why not just come up with a list of actions that we should or should not take to see others as people? I mean, if not yelling is an effect of seeing people as people, then why not, for example, ban yelling or gossiping or saying “I hate you”? That seems simpler and far less prone to backsliding.

 

Chapter 13: What’s the Right Thing to Do? Using the Shift When Things Are Tough

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USING THE SHIFT WHEN THINGS ARE TOUGH

Nursing homes are the most highly regulated industry in the United States.1

I mention this because I heard you thinking about how difficult your particular circumstances are and wondering whether seeing people as people could ever work for you. And I don’t know; your challenges are tough, that’s for sure. But if you’re thinking that HG can do all this seeing-people-as-people stuff only because its industry is easier than yours, you’re way off base.

To put this in perspective, nuclear power plants have fewer regulations than nursing homes. Yes, you read that right: nuclear power is less regulated than skilled nursing—not by much, but still less. Even hospitals—which can cut open your body and put things inside it—are significantly less regulated than the skilled nursing facility where Pop Pop plays bingo. At the state level things can get even more complicated: in California, no fewer than seventeen government agencies oversee skilled nursing facilities in one way or another.

 

Chapter 14: The Poop Chapter: Astonishing Things Transformed by the Shift

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ASTONISHING THINGS TRANSFORMED BY THE SHIFT

The first CNA I ever met was a young woman named Elena, who had two children and worked part-time in another facility in addition to working full-time at the facility I was visiting. She wore burgundy scrubs and had her gorgeously coiffed long black hair styled back just enough to be out of her way for work. Her English was understandable but heavily accented; she was quiet but friendly and professional. I asked her about the best part of her job, and of course she said the residents. Then I asked her, “What is the worst part?”

Now of course I know what the answer is, don’t you? The worst part has to be feces. I mean, part of a CNA’s job is to change the diapers of old people with their grown-up sized poop. That is absolutely the worst thing I can imagine doing, wiping saggy bums and cleaning up adult stools and even adult diarrhea. I can think of very few things I would hate doing more than changing stinky adult diapers, and those things all pretty much involve larger amounts of feces.

 

Chapter 15: Part of the Solution: How the Shift Solves Disagreements

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HOW THE SHIFT SOLVES DISAGREEMENTS

The CEO, two regional presidents, and a guy from finance walked into a bar. Well, actually, they were sitting in an office talking about numbers related to a new federal payment scheme and all the implications it would have for the industry; the bar thing was to get you to continue reading this story, even though it starts out kind of boring.

The CEO said, “I don’t think that number’s right.”

One of the presidents, Cole, disagreed. “Yes it is,” he said, “I’m sure of it,” and gave his reasons for thinking that number was accurate. The finance guy also sided with Cole; the number was right—his team had double-checked it.

The CEO, however, was unconvinced; he was sure the number was significantly off and that the calculations were in error. The group went back and forth for a few minutes about the accuracy of this number. The discussion grew not heated, because there was a distinct lack of animosity, but serious, because the approach to an important issue would depend on the accuracy of that number. After a while, the CEO sent the finance guy to “check it again, and see if you can find an error,” and the rest of them started talking about something else.

 

Chapter 16: Welcome to the New World

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Rachel was the type of elfin old lady whose delicate frame seemed like it might fracture at a touch. Her skin was creased with dry, papery wrinkles—nothing on her had sagged with age, only contracted. She was clear-minded and carefully dressed in crisp slacks and a pristine yellow cardigan, recovering from surgery in the nursing home but due to return to her daughter’s home later that week. The staffer with me asked Rachel if she would mind talking to me about her life, and she replied, “Oh, sure,” in a voice that was steady but very quiet, so quiet that I had to kneel next to her bed and lean close to hear her.

She began talking of her life and her beloved parents and the tragedy it was that she had no pictures of them. That seemed terribly sad to me, and when I said so, she gently took my hand. She held it while she continued. She told me she came from a large family and she was the only one left—the only one who “made it out,” as she put it. She spoke about her older sister’s long, beautiful golden hair, which she wore in braids. I could hear in her voice the artless adoration of a younger sister for an older one; she gloried in that hair as though it had been her own.

 

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