Reclaiming Conversation (34 page)

In focus groups with HeartTech employees, I hear variations of the same story. Managers mean well. They don't want employees to be stressed. But everyone at this company is trying to prove that they are worthy of being there. Being always available, online, is the simplest way to show this. And since the company code of showing devotion through presence runs up the chain of command, your boss, too, is also likely to be always “on,” a glowing green heart.

So employees complain that their managers will send emails at ten at night and give no sign if they expect that email to be answered that evening or if ten o'clock is simply when they got to their email because they have young children and are busy until their kids are down at nine. With no clear signal, those who report to these managers are afraid to assume that a late email doesn't call for an instant reply. One programmer says, “My manager talks the right talk, all about ‘centering' and ‘pausing' and ‘taking time for you.' But she is like Twitter: reactive, always on—her mind responds like a feed. It's hard to know whether to follow what she says or what she does.” This kind of confusion keeps people on a treadmill. It cuts down on face-to-face conversations because people are either
in scheduled meetings or on their computers trying to keep up. And making sure to “show up” on the messaging system.

One programmer says she treasures her time in the office after six in the evening. During the day, she is in back-to-back meetings, so at night she feels more relaxed. She gets some food, she finds an unscheduled conference room, and she works quietly and sometimes talks with colleagues. She says, “People have real conversations after six.” But even her after-hours schedule comes with the conflict she feels all day. Even at night she thinks it would be a mistake to appear on the messaging system as “away.” And once she is on the system, she says, “There are always messages.”

At HeartTech, there is conflict between what you are told and what you believe. I sit down at a cafeteria lunch table and a young engineer strikes up a conversation. Then he apologizes for bothering me and explains that he is new. His supervisor wants him to talk to strangers at lunch. But despite the kitchens, the food, and the explicit instructions to chat, he knows that what HeartTech most wants from him is to be available online: “My manager wants to see that green heart.” Of course, once you are on the network, you can't easily get away for face-to-face talk. And solitude is interrupted by incoming messages.

The tensions in the HeartTech culture teach a lesson. If you think conversation is important for your organization, you can't just say so or design beautiful kitchens and cafeterias to facilitate it. You have to leave time and space. Most of all, senior management has to model it, leading by daily example. If not, the beautiful spaces simply become amenities. And new employees who start conversations will wonder if they should apologize.

Here is how Kristina Roberts, in her mid-thirties, looks back at what it has been like to “grow up” in the HeartTech culture, where she reads the key values to be responsibility, being the best, and devotion. She came to HeartTech determined to make a success of it:

From the beginning, I did not want to be seen as irresponsible. So being available on email was a great way to be shown as responsible.

I focused on having my little heart on the messaging system always being green. Engineers would focus on their little heart being green even when they are on the ski lift. And in that environment, my stress level and level of depression went higher and higher. The mountain just got taller. There was this desire and urge to keep climbing that mountain and I'm sitting with you at dinner and you can go to the bathroom and I can check my mail. So, I began to stay on the messaging system all the time.

As Roberts sees it, the company identified “strong performers” as those who were always online. But she couldn't think if she was responding to email every few minutes. Over time, her sense of what made her valuable as an employee (devotion as shown by availability) came to be at odds with what she personally needed to do her best work. It took a long time, many years, to get that clarity. For all those years, staying on the system was her highest priority. She was rewarded for it in the company. And personally, it became a requirement. She came to see her phone and the HeartTech messaging system as a kind of drug.

As Roberts sees it, the HeartTech culture undermined infrastructure that had been explicitly designed for conversation (the cafeterias, the micro-kitchens). The level of stress, particularly from the unstated demand to be always on the system, got in the way of collaboration. And spilled over to the rest of life.

Being “always on” for HeartTech meant that Roberts was always on for everything else as well. Her phone began to be everything to her—the way she connected to the rest of her life: her friends, her family, her romances. Roberts's efforts to show devotion at HeartTech put her in the machine zone: Communication came in a relentless stream; she felt reactive and scattered and
dependent
. Speaking of herself, she says, “You need to have your phone with you always. . . . Because if you imagine what happens if you drop below your baseline of stimulation, part of you is saying, ‘I need to go back to the phone.'”

HeartTech is a large, diverse company, and I found best practices within it—places, for example, where managers make specific efforts to
get people out of the expectation that one should always be online. I hear about one manager who sends out emails through the night but is explicit that she does this because she has young children and late at night is her best time to work. So, the emails she sends out at one in the morning are not emails to which she expects an immediate response. Everyone on her team is grateful for her clarity. Another HeartTech manager says she finds it even better to take the next step. She drafts her late-night emails but then she doesn't send them. She says, “Write it, get your work done in the hours that are convenient for you, but keep it in your draft folder. At 7:00 a.m., when you think that people may be up and starting to do early-morning emails, then hit send.”

And indeed, some of the most admired managers at HeartTech are the ones who send emails out in bursts, not throughout the day, but at times that will be convenient for their employees. They model a relationship with the network that leaves time and space.

HeartTech knows its employees are stressed. To help them, the company has put in place mindfulness and meditation programs, designed to encourage a state of calm awareness. There is a regular company-wide “pause” during which employees are asked to relax and breathe during the workday. HeartTech employees see value in these programs; many see great value. But they harbor no illusions. To many, the message of the mindfulness programs seems at odds with the feel of their job. In focus groups of HeartTech employees, I hear that they are, after all, not being paid to be calm. And as one puts it, “We are not being paid to have conversations.”

Yet, at HeartTech, the respect for mindfulness, like the many efforts to build spaces that are conversation-friendly, are significant. The more the business world appreciates the importance of composure, attention, and face-to-face communication to its own financial interests, the more distance it will take from technologies that disrupt them. Over time (but in this industry, time moves swiftly) this will give business common cause with consumers who are trying to reclaim all these things for themselves. One software developer has suggested that his industry
redefine what it means for an app to be successful. It shouldn't be how much time a consumer has spent with it but
whether it was time well spent
. In the long run, consumers and industry together could reframe the design principles for our world of devices and apps.

H
ere I have concentrated on the conversations that take place in offices because so many of us work in them. But other kinds of workplaces have equally vexed relationships with conversation. Perhaps medicine is the most dramatic case.

The medical exam is one of the most highly charged contexts for communication. There, it would seem, almost by definition, that the patient has the physician's full attention. Yet senior physicians are concerned that young doctors come into medicine expecting that the answers to problems will be found not so much in the examining room but “elsewhere”—in diagnostic tests the physician will see later. Because they believe in the scientific data they will get about the patient, they don't focus on the patient. The belief in data that will come in later becomes a way to justify an only cursory conversation with the patient now. A sixty-year-old faculty member at a major teaching hospital says of the residents he currently trains: “They want to use tests to rationalize not talking to patients because talking to patients is difficult and usually takes skills young doctors don't have.”

In his view, in the new “rely on the test” culture, the standard physical exam seems strangely intimate to young doctors. You touch the body; you investigate the past; you ask odd questions. Some of this touching and talking starts to seem unnecessary if you believe the tests are going to tell you everything you need to know. You become comfortable with being a doctor who touches and talks less. Your skills for doing a physical exam degrade and you need the tests even more. This senior physician is sad as he considers his students' discomfort:

They don't want to take responsibility for the things that might come up in a conversation, things that would come out during a full patient history. They don't want to hear that their patients are anxious, depressed, or frightened. Doctors used to want to hear these things. They knew that the whole person got sick. The whole person needed to be treated. Today, young physicians don't want to have that conversation. My students welcome the fact that the new medical records system almost forces them to turn away from the patient and keep the interchange about relevant details. They don't want to step into a more complicated role.

The physician and author Abraham Verghese writes about how medicine has moved away from treating the patient to
treating the “iPatient
,” the sum of the data we have collected about a person. In the process, Verghese argues, physicians lose more than an empathic connection with the human being in their care. They lose the ability to cure.

Yet medicine is also a place of hope in the story of how a professional culture can reclaim conversation. For one thing, it is a field that is talking about its flight from conversation. The dangers of physicians looking at screens rather than patients, the over-reliance on tests, the need to return to the extended conversations of the traditional medical history—
all of these are being discussed
. And acted upon. I meet a senior physician who is struggling with the intrusions of a new electronic record-keeping system in her hospital. She explains that if she uses the system as intended, she will not be able to make eye contact during patient visits. She will be too busy entering data into the program. Her accommodation to the system has been to take notes during patient meetings and enter the records into the system at night, after her children are asleep. Her system strains her, but she is trying to organize the other doctors on her service to change hospital rules to make room for conversation.

She belongs to a generation of senior physicians committed to teaching medical students how to have rich conversations with patients. An oncologist in his late fifties regularly participates in courses for first- and second-year medical students that focus on the physical examination and
patient interview. He talks to me about all the pressures in the medical system that work to silence doctors—the expectations that they see so many patients during a day, the allure of running a high-tech diagnostic exam, the pressures of paperwork and forms—but he is proud that at least in his medical school, so much stress is placed on conversation. His students are learning how to form a trusting relationship, how to deliver bad news, and how to use good news to build a stronger bond. He worries how much his students will be able to “hold on to ten years out.” But while they are in medical school, they are encouraged to see communication as central to practice.

And medicine has responded to the pressures that cut off conversation with a spirit of invention. A new profession—of medical scribes—has grown up, designed to separate the doctor from the many screens that demand his attention. The scribes are trained assistants who follow physicians around, filling in the reports required by insurance companies and computer record-keeping systems. With those responsibilities lifted from their shoulders,
doctors can more easily engage with patients
. The introduction of the scribes into medical practice illustrates how a profession can invent its way into necessary conversations.

We saw that spirit of invention in Alice Rattan's introduction of a “parking lot” for phones during meetings, in Stan Hammond's elevator to the fifteenth floor, and in the breakfasts without agenda at Stoddard. Like the scribes, all of these are inventions and interventions to reclaim conversation. We can invent more. They inspire next steps for the workplace that have resonance for what we can accomplish in education and in our families as well.

T
he next steps explore the special role of business leaders in reclaiming conversation. A business culture reaches far beyond the life of a firm. It can determine whether we feel we can put down our phones at family dinner or need to be on call all night. In a world where everyone
“knows” that multitasking is bad for you but doesn't do anything about it, things change if your employer tells you that you are going to be given the time, space, and privacy to begin and
complete important tasks one by one
.