Tips on Public Speaking: Putting People First

Whether you are constructing a PowerPoint or having a critical conversation with someone, inverting your traditional approach to communication can lead to better comprehension.  This means that instead of focusing on what you want to say, you start with focusing on what your audience wants to hear.  While it may seem like a good idea in a broad sense, putting your audience first in any communication can be difficult in practice. 

This is a concept that I get the most pushback from.  It is perceived as giving your audience control over the presentation or reinforcing their thoughts or perspectives.  But this is not what it means.  It means starting from a perspective that your audience does not care about what you are talking about as much as you care about talking about it.  You may take a position of demanding that they care because of how important the subject is, but this is a poor way to motivate people.  Imagine a conversation where someone says, “But I don’t care about eating right/recycling/the corporate policy regarding personal cell phone use” and the other person says, “Well you SHOULD care!”  We know that conversation is not going anywhere.  Telling me that I better care about something does not inspire in me a desire to care.  If you tell me that my job depends on it, I might pretend to care, but that is the extent of it. 

Many conversations we have with coworkers, patients, or students are data-dumps.  Whether it is a bedside shift report, a discharge information review, or a lecture on electoral politics, it is all about communicating some bit of information.  We might add a little bit of social norming, with a “how are you doing?” or “how’s your day going?” but let us be frank: we don’t really care about the answers to these questions.  We treat these as the social theatre that they are.  We need the other person to listen and accept this information with as little stress as possible. 

The problem is that we often¹ approach these glorified data-dump conversations as very transactional.  I will give you this packet of information.  You will ask any questions that come up immediately and I will answer them.  If you are lucky, I might give you an avenue for additional questions that you come up with eventually.  We are finished and part company.  As a result, our approach to these conversations contains the following steps.

1. What do I need them to know?

And that is it.  I deliver on that as efficiently as possible and then we are done.  Their opinion on the material is, well, immaterial.  They need to accept the information on the new corporate compliance policy; they don’t need to agree with it.  To inspire attention, they need to know all the ways that failing to honor the policy will rain down a torrent of pain and suffering upon them and the organization.  It doesn’t matter what they think of the policy.  It is not for them to ask why, but for them to simply do or die. 

But let us turn this around.  Everyone reading this has been forced to attend a mandatory training on the Stark Law² or sexual harassment.  How much of that presentation do you remember?  Heck, when was the last time you were trained on these topics, even if you cannot remember the actual content?  One of the organizations I worked at had reviewing PowerPoints on these subjects as part of the yearly conditions of employment.  I, like a lot of people, got really good at taking as little time as humanly possible to scan the document, take the short quiz, and move on with my day.  The organization checked a box, and I got to work another year.  But I would fail a test of my understanding of the minute detail of these policies, and I don’t think I would be alone.³

Frankly, if you remember anything about the training session, it is likely the part that applies to your life.  Why?  Because most of what they needed to you to know was not something you felt that you needed to know.  Think about the communication about discharge instructions.  The nurse has a stack of papers that they need to go through with a patient who already has their shoes and coat on.  Neither party wants to make time for this, so nothing gets explained well or retained at all.  It is performative and not valuable.  But it is done and the box has been checked.

So how do we provide information in a way that makes the experience valuable?  The real order for information should be:

1. What does the audience want to know?
2. What does the audience need to know?
3. What do I need them to know?

It means putting the audience first.  If you want to successfully train someone, you need to put their wants and needs first and tailor your message to that rather than putting your information out and hoping that they pay attention.

Audience Wants

Any presentation should start by identifying and delivering on what an audience wants to know.  Sometimes you know what that is.  You can put yourself in their shoes and imagine where they are coming from.  Sometimes you need to ask. 

For example, a Chicago hospital I worked with got great value in flipping the script when it came to discharge instructions.  Usually discharge instructions are presented as a long litany of do’s-and-don’t’s delivered with all the pacing and subtlety of a flash flood.  At the end, the nurse will say, “Do you have any questions?” to which the patient will almost always say, “Um, no.”  Just because you may have answered their questions in your recitation, does not mean that they captured everything that you said.  Often, they were waiting for a specific bit information, and in waiting for that, they did not process any of the other information you were providing.

For example, imagine that a patient is primarily focused on whether a follow-up appointment with their primary care provider was scheduled, or if they have to schedule it.  The nurse goes over post-discharge care, the new prescriptions they have been assigned, and warning signs to be aware of.  Then on page 4, they mention follow-up care.  The nurse finally answered the question the patient had, but in the process, the patient missed every other thing that was said. 

So, the Chicago hospital would start discharge instructions with “I am going to go through the discharge instructions, but before I do, what questions do you have for me?”  The patient would ask about follow-up appointments, and the nurse could flip to page 4, and highlight the answer.  By giving the patient what they wanted to know first, you have cleared the deck and can now give the patient all of the other information that they need.  The hospital found that their HCAHPS score on the discharge instructions questions went up.  They also noticed fewer follow-up phone calls from patients. 

Sometimes what the patient wants is to get done with this as quickly as possible and they will say this.  The nurse can acknowledge this desire, highlight the phone number to call if the patient has questions, and then do a lightening round delivery of the information. 

This applies to all training.  People can have fears or misconceptions about getting kickbacks or what behavior constitutes harassment.  Letting an audience voice their questions or concerns upfront allows you to address them so that they can then focus on what you have to say.

This doesn’t mean you have to change your presentation.  If the audience size supports it, I will ask an audience what questions they have.  If the question is not on-topic, I will say that I won’t be talking about that but would be happy to discuss it with them in another forum.  If I will be addressing that question, I will let them know and then when I cover that material, I will pause and ask them if they have any further questions on that topic.  All of this is designed to keep the audience with me as I talk and not squirrelling on some point or concern. 

Audience Needs

As a non-clinician, I am not going to run afoul of Stark Law violations over getting kickbacks by requesting patients seek care at facilities that benefit me.  So why do I have to sit through a presentation on it?  The presenter can acknowledge that this does not directly apply to my behavior, but also stress:

• The law and legal counsel demand that everyone be briefed on this illegal activity.
• Briefing me on this makes it possible to identify concerns if I see others performing in a sketchy way.
• While I may not be a clinician, there may be things I do that I don’t know is illegal.  For example, I might be responsible for leasing out surgery bays and not aware that giving some physicians a better rate than others is a violation of the law. 
• I might want to know if a pharmaceutical rep bringing bagels to a clinic, or if the landscaping crew that is contracted to keep up the hospital grounds giving me a discount on my personal landscaping is problematic.

Letting an audience know that some of their behaviors could be construed as problematic is important but tailoring them to your audience is how you build memorability. 

Speaker’s Needs

Once you have addressed your audience’s wants and needs, you finally have them where you need them.  You can now share what you need them to understand.  This is not to say your needs are unimportant, but only by answering their first-level questions and addressing their misconceptions about the topic, can you bring them to a place where they can actually listen and process what you are saying. 

You can try to start with your needs and build back to the audience’s needs and wants, but this is rarely successful.  Your presentation will generally crash upon two sets of rocks. 

• First, your audience is apt to run out of patience.  How many times have you been in a training session, thought, “This doesn’t apply to me!  Why am I here?” and then mentally checked out on the rest of the presentation.  The truth is that if you see no value in what you are being told, you are likely to start reading emails, playing a game, texting snarky comments to friends who are in the room, or just daydreaming about absolutely anything else.  By the time the speaker tries to connect the concept back to the audience’s lives and experiences, the audience has stopped listening.
• Second, you run out of time.  I have lost count of the times I have been in a meeting where a department will report on work.  They are so focused on trying to say everything that they need to say that they run over on time.  So, even if the audience was ready for this work to be connected back to them, or the opportunity to ask questions, there is no time for those things.⁴ 

Some of you are reading this thinking, “But I have to tell them this stuff!”  I understand that some information is non-negotiable.  Just remember that HOW you tell them, though, is up to you.  After all, the reason you must tell them information is so that they act accordingly.  But if you do it in a way that they are not processing, then how confident can you be that they will act accordingly?  I am reminded of the old adage, “people don’t care what you know until they know that you care.”  By structuring your presentation and your approach to teaching in the way I suggest, you will certainly be demonstrating this principle.

¹I say often when I really mean mostly or even always.  I just don’t want to alienate you too quickly in the essay.  If it helps the medicine go down, you can think about how this really describes other people more than yourself.

²The Stark Law is a statute that prevents a healthcare provider from sending patients for services at businesses where the provider gets some sort of benefit.   Along with the federal Anti-Kickback Statute, it prevents providers from things of value that skew care plan decisions.

³Please do not mistake this for a lack of caring.  I absolutely think kickbacks are a problem and harassment is horrible and wrong.  But most of my knowledge on these things and my effort to behave appropriately comes from being a reasonable person who wants to treat people with respect and someone who wants to avoid prison. 

⁴The great twist is that when I lead with what an audience wants and needs to know in a meeting, that audience is generally willing to give me another five or ten minutes if I threaten to run over because the presentation is bringing value to them.