Tag Archives: dysfunction

What My $18,289 Medical Bill Says

Warning: While this is not quite as disturbing as the poor woman with a spider in her ear on Twitter, I’m still sleeping with one eye open.

Also, TLDR: Prices play a key role in free markets, right? They help set supply and demand and indicate value. My guess is that the vast majority of healthcare and by extension health insurance in the U.S. is a badly functioning market in part because prices are nearly irrelevant.

The story, in which I bravely warn my family of danger.

Not long ago, I went to bed early and was woken up by what sounded like a very loud fly knocking against the inside of our bedroom window. I turned on the light to see a bat weaving and darting just overhead. (We have low ceilings – the bat was way closer to me than any bat should be.)

I’m happy to report that I bravely warned the rest of my family by shrieking (repetitively) at the top of my lungs; the bat got a broom-to-the-rear-end assist out the bedroom window.

Really, there was no dignity to be had for anyone that night.

But, I had a bigger problem. I had two little marks on my arm that Dr. Google suggested could be a bat bite; my primary care physician’s office told me to go to the emergency room. 

Turns out, showing up as bat woman at a suburban ER late on a Monday night makes you an absolute rock star.

I ended up getting the rabies vaccine and a shot of human rabies immunoglobulin, which was absolutely the largest shot I have ever seen in my life. Follow up was three more doses of vaccine over a three-week period.

And that’s why I received an $18,289 bill: $1,120 for the ER visit, which didn’t shock me, and $17,169 for the shots, which did.

Pic, or it didn’t happen:

No alt text provided for this image

I looked at the bill, nearly fell over and fortunately made it as far as the “You owe” box. My share, luckily, is $300; my insurance company paid $3,986.

Then I started thinking.

Why do we pay people to make up prices for healthcare, and what does it feel like to do that job?

Is $17,169 even a real price? Does anyone actually pay that?

I’m guessing no, if my health insurance company can get the hospital to knock 74% off the tab. And, given the way health insurance works in the U.S., I’d assume that every other insurance plan has negotiated some similar discount.

So, how does it feel to sit in a room with Excel open, presumably, and figure out what the rack rate is for care? What are the numbers even based on, if anything? And how does it feel to know that the only people who may get charged that are the people who are uninsured? (More on that later.)

The Centers for Disease Control and Prevention’s page on the cost of rabies prevention (published June 2019) pegs the expense for the immunoglobulin plus the four vaccine doses at $1,200 to $6,500, for the medications alone, not the hospital charge. So, how do you get to north of $17,000? And, according to First Databank, a company that monitors drug prices, the price of the drugs I received has increased 388% in the last decade, for no obvious reason, as best I can tell. Think the CDC missed that.

What is it like to be on the opposite side of this pricing, to be negotiating on behalf of the health insurer? Does someone go back to the boss to say, “Hey, I negotiated us a 74% discount!”? Doesn’t that doesn’t just strike everyone involved as laughably bizarre?

Why do we ask people to do useless work? What does that do to them, and what are we failing to grow or build or improve by asking them to focus on this nonsense?

Was it cost-effective to treat me?

This bill got me metaphorically scribbling on the back of an envelope.

Is $17,169 a fair price? Well, maybe that’s a silly question, because that’s not what my insurer and I paid together.

Let’s just assume that the fair price is about $4,000, which is roughly what we paid for the shots.

Rabies is a nearly completely fatal disease, and the onset of symptoms to death is about seven days. Let’s say the resulting hospitalization and treatment costs $100,000 (source: wild guess). Soullessly assigning no economic value whatsoever to my life (which I, by the way, value greatly), we should be willing to pay for 25 courses of rabies shots to prevent one case, or whenever the risk of catching rabies is 4% or higher.

What was my risk of catching rabies? The estimates I saw suggested that anywhere from .1% to 10% of bats are infected with rabies, depending heavily on local conditions. It is easily transmissible, apparently, especially with a confirmed bite, so let’s assume that, if my bat friend had rabies, I would get it.

So we’re within a wide margin of error based on avoiding costs. What if we ghoulishly try to value a life? There are lots of papers on this topic. I’m no expert, but I’m going to pick $100,000 per remaining high-quality year of life left, which seems roughly reasonable based on the literature. Let’s assume I have 40 high-quality years left, or $4 million of value.

Treating a known bat bite definitely makes sense.

Maybe the cost makes sense from that perspective? But would you need to consider it as part of all of the healthcare I will receive from this point on in my lifetime? Or just at this moment, with this choice?

I don’t know, but I’m pleased that I was able to make a rational economic decision on the fly.


See also: Mental Health Even More Critical Now

How did we end up in a place where life-saving, cost-effective treatment is most ruinously expensive for the people least able to afford it?

If I had been uninsured and gone to the hospital, I’m going to assume I would have been treated, at least with the first set of shots, though I don’t know for sure. If I had gotten the full series of shots, how much would I have been billed? The full rack rate? The worst negotiated rate with an insurance company? Something different?

(My $300 ER copay alone represents a significant burden for many families, including those affected by joblessness or reduced working hours because of COVID.)

I did some research – it turns out the major manufacturers of rabies treatments have programs to pick up the cost for those who can’t afford it. I’m sure this is an enormous relief for those who qualify, which I desperately hope is everyone who can’t pay the price. I also hope it’s easy to apply.

But, systemically, how does this make sense?

We set fake prices that are beyond crushing for most families. Then we don’t charge them to people who are insured. We save the worst prices for people who don’t have health insurance, who are even likely less able to pay ruinous prices than those who do have insurance. So then the manufacturers have programs (complete with separate paperwork!) to waive or minimize the cost for the uninsured, at least those who apply.

And since the manufacturers still need to make a profit, those waived costs actually get funneled back into the pricing the insurance companies negotiate with the healthcare systems.

Again, what information is in the pricing for these drugs? And in what ways are the healthcare and health insurance markets dysregulated as a result of the lack of clear pricing information?

As both the consumer of our healthcare insurance and the employer paying for it, how am I supposed to assess this situation?

My co-founder and I picked out our health insurance plan. While there seemed to be a whole lot of choice for a business of our size, the plans were really all the same… $2,000 deductible with $50 copays? $2,005 deductible with $49.75 copays? And so on.

I’m exaggerating, but not by much.

The service our healthcare plan provides is fine, and the cost seems reasonable, but how do I assess whether the plan is as efficient as it could be? The costs paid to healthcare providers get passed back to us (all of us insureds) through pricing. If the plan pays too little, it isn’t fairly compensating the medical providers, which will eventually refuse to work with our health insurance or go out of business, meaning we have an availability problem. If the plan pays too much, we pay for it.

Am I supposed to be really pleased that our health insurer negotiated a $14,000 discount? Or should I be mad it didn’t negotiate a $15,000 discount? How would I know? How could I make a more rational decision?

The answer is…I can’t. There’s so little information in the pricing, and so much opaqueness, that we’ll have to make another decision next year based on price and service when we renew our health insurance. 

Why do we tolerate the healthcare and health insurance mess we have in the U.S.?

I’m willing to believe that all of these ridiculous pricing mechanics exist for a reason, but do the reasons still make sense?

There are so many distortions here…

  • Even when I am both the buyer and user of employer-sponsored health insurance, I don’t have the information I need to make any kind of a rational decision except what makes the most sense for us for the next year.
  • There’s no easy way to understand how much healthcare will cost before treatment, especially in emergency situations.
  • The list prices are no more than sky high caps on medical procedure prices.

I’m no expert in health insurance, but I see that same underlying issue here that I do in my own familiar property and casualty space – massive systemic complexity.

In the P&C space, I’d argue that most of the complexity derives from old court cases that created boundaries between lines of insurance. This led to technology solutions for each line and specialized staff and culture to handle input into, maintenance of and output from these ossified systems. The market need for those silos has blurred or disappeared, but thus far they’ve been indelible marks in the insurance landscape.

The same is probably true of health insurance. I’ll add the root of employer-sponsored health insurance (which usually separates the buyer from the end user), which stemmed from wage controls during World War II.

There’s an interesting historical summary in National Bureau of Economic Research Working Paper 14839. In short, fringe benefits were excluded

The issue is that systemic problems require systemic solutions. Systemic solutions are so much less attractive than quick fixes – they don’t sound catchy, they don’t boil down to one sentence, they take time to implement.

Yet, as a people, our failure to fight for systemic solutions is surely catching up with us.

from WWII wage controls, which caused employers to add more benefits to attract and retain workers. Health insurance existed in a fragmented way before this, but really came into its own and was firmly established as an employer benefit in the period. And now, 55% of Americans get their health insurance through their jobs, according to the Census Bureau. This has to be a piece of the complexity.

See also: 6 Life, Health Trends in the Pandemic

Public Service Announcement: Rabies is really nasty. Nearly always fatal, and really, really nasty – it kills tens of thousands of people worldwide each year, mostly in places where rabid dogs are common. It’s also not specifically spread by animal bites; it’s spread in the saliva of ill animals, so a scratch or a lick to a mucus membrane can also spread it. If you may have been exposed (including if you wake up in a room with a bat — bat bites don’t necessarily hurt and can be nearly invisible), you really need to talk to a medical professional.

Postscript: I had a long conversation about CEO pay at pharmaceutical companies with someone regarding this whole situation. CEO pay can be grotesque, especially at companies that do not pay their workers living wages and don’t provide decent benefits. However, cutting CEO pay is largely an issue of equity, not much of a solution to this cost issue. I looked up the 2019 salary of the immediate past CEO of Sanofi Pasteur, which manufactured the shots I was given. If he had worked totally for free, applying the savings evenly over their revenue, my bill would have been $4 lower.

Breaking Through The Barrier Of Hardnosed Workers, Part 4

Winning Them Over
In Part 3 of this series, safety officer Ken Malcolm talked about the importance of building trust between hardnosers and those who try to change them. To this, Malcolm adds respect.

“Give them [hardnosers] respect,” he says, “and problems go away. They might not like you, but when you handle people accordingly, someone is always watching, and that tough but fair method gets you respect.”

Trust and respect form the pivot point that directs difficult employees away from dysfunction, toward responsibility. Hardnosed workers will never trust or respect you more than when you demonstrate to them that you have their best interest at heart.

You do this when you create intentionally interpersonal safety training to meet the intensely interpersonal weaknesses of workers.

Intentionally Interpersonal Safety Training
Not all worker resistance is of the severe magnitude experienced by the desperate general manager described in Part 1. But to any manager who suddenly realizes that “good employees” in his organization are on the verge of spinning into the Cycle of Rejection (see Part 2), the situation can seem as serious.

Such was the panicky attitude of a global manufacturing company's operations excellence director when he realized that his plants' safety representatives, were, for no apparent reason, beginning to resist his carefully crafted 5-year safety excellence plan. Midway through the plan, he found that the ability of his safety representatives to engage employees — younger employees in particular — was less than he initially believed.

The harder he pushed them to engage employees, the more they resisted. Sound familiar? The interpersonal skills of his representatives required improving in a manner that did not risk further alienating them, so he called the author for help.

Since hazard recognition was the next focus of the 5-year plan, it was decided to integrate relational skill development into the safety representative's hazard recognition training program. An emphasis on reaching younger workers was included. One of the company's values, integrity, served as the drumbeat.

The human development goal was to help the representatives understand the difference between the preferred behavioral tendencies of older workers, such as themselves, and the preference of the plants' predominately younger workers. An easy four-part behavior profile was incorporated to help the participants understand the difference. From earlier articles in this series, you may recognize this goal as helping the hardnoser understand why people do what they do.

The safety management goal was to teach the representatives a simple 1-2-3 hazard recognition process that could be persuasively communicated to employees.

The resulting outline for the 8-hour training course delivered by this author is as follows.

Course Achieving Safety Integrity through Hazard Recognition
Length 8 hours
Format Live presentation; interactive workshop
Section 1 Hazard Recognition: A Matter Of Integrity
Participants are asked to think of hazard recognition as a matter of integrity, as a way of “doing the right thing.”
Section 2 Clearing the Value Path to Hazard Recognition
Participants learn about a “perfect storm” of negative social influences that hinder employee “buy-in” to hazard recognition. How to turn these negatives into positives is taught.
Section 3 Capitalizing On Communication Desires to Jump-Start Haz Rec
Participants learn a behavioral approach to hazard communication — capitalizing on the communication craving of Generations X and Y — in order to achieve employee engagement in hazard recognition.
Section 4 Making Haz Rec Work Simply
Participants learn a simple 3-step process for Haz Rec — observe, interpret, apply — that engages everyone in the routine practice of hazard recognition. A 3-question mechanism for gaining accountability is taught.
Section 5 Using Behavior Recognition Skills to Build Haz Rec Effectiveness
Participants learn the strengths and weaknesses of each behavior type so that they may better recognize how employees allow hazards development and loss to occur. Correcting unacceptable behaviors before an incident happens is taught.

Learning Objectives

  1. A review of the company value of integrity in relation to hazard recognition
  2. A simple effective 3-step method of hazard recognition
  3. A knowledge of the participant's own core behavior tendencies
  4. A method to accurately recognize (read) the behavior tendencies of others
  5. An understanding of how to 'sell' hazard recognition to others via persuasive communication skills targeted to the behavior tendencies of others
  6. A strategy for maximizing hazard recognition through the networking behavior of Gen X and Y

The effectiveness of the intentionally interpersonal approach to safety training was immediately evident in the participants' feedback. Hardnosed safety representatives are not easily fooled. Most have seen a dozen lackluster varieties of the “safety flavor” of the month.

“He left no stone unturned,” said one. Grasping the dual nature of the training, another said, “Not only did I learn about safety recognition but I also learned more about my own personality and the personality of coworkers.” [The course emphasized behavior, but the common use of “personality” is close enough.]

Still another of the 75 participants said, “It wasn't what I expected.” No, it isn't, which is the point. It met felt needs, unlike other safety training. Added the participant, “I liked the straight talk.”

Most telling is the participant who stated that she will “use these ideas at work and at home.” It is a reminder that the greatest needs are life skills. Another participant said that he would use the course material to “make personal changes.”

Intentional Results
Success is never guaranteed. But the intentionally interpersonal safety training advocated in this article has proved successful in every work environment from which the T-JTA data that defines a hardnosed worker was extracted.

In addition to improving the measures of traditional safety management — recordables, lost times, observations — several measures of human resource management effectiveness were improved, including personnel turnover rate, workers' compensation claim rate and various measures of employee engagement or attachment.

One large maritime company saved over $20 million during a 2-year period as the author and his colleagues worked with them to conduct a company-wide interpersonal safety training program.

An organization committed to breaking down the barrier presented by hardnosers may reap the unimaginable “better results” spoken about by John Bennett in Part 3. But to do so requires a shift in management perspective — from a reactive posture in which the hardnoser is viewed as an object to be conquered to a proactive policy of ministering to the hardnoser's needs.

Below is the story of one company that made this commitment. It's the company whose desperate general manager initially called the author in Part 1. Remember him? He is the one who thought that his supervisors were acting like troubled kids. And he was right. So was his inclination to react in the right way.

Enabling A Safe And Profitable Transition
One beneficiary of the blended safety training approach was Chotin Carriers, Inc., now a part of the Kirby Corporation. Kirby's impending buy-out of Chotin, a small company of 120 employees, only added to the human resource and safety management challenges faced by Chotin's general operations manager, Arnie Rothstein.

Chotin's overall personnel turnover rates for the years previous to the buy-out were respectively 47%, 40%, 44%, 35% and 41%. Rothstein conservatively estimated that each employee turnover cost Chotin a minimum of $4,300, or an average annual turnover cost of $349,760.

Starting in Chotin's buy-out year, the author administered a series of training programs that addressed both the safety need of Chotin and its human resource development challenges. The result was that Chotin's turnover rates dropped to 20.3% and 2% respectively over a two-year period, saving Chotin thousands of dollars in personnel turnover costs.

During the same period of time, Chotin's safety performance was also improved. The company's total injury index rate (per 200,000 man-hours) dropped from 8.0 to 4.32, a 46% reduction. With an estimated cost of over $30,000 per lost time back injury, special emphasis was placed on reducing lost time injuries. The result was a 64% reduction in Chotin's lost time injury frequency rate.

Better than these results to Rothstein was the sweet aroma of employee cooperation, evidenced by one of the company's reformed hardnosers, who said, “I've learned more from this training than I've learned in all the other training put together.”

Why Bother?
It is convenient to be like the skeptical Cleveland-area businessman in Part 3 who views everything in this presentation as silly “social work.” But the evidence presented here suggests that you can not pretend that a sub-culture of hardnosed workers does not exist.

Take it from an expert in destructive behaviors. If there is one thing that delights a hardnoser — that encourages his resistance — it is knowing that management will ignore him, allowing him to run amok. Such tolerance provides him with a complete sense of control. It justifies his retreat into emotional isolationism, disengagement, and dysfunction.

Ignorance by management is not bliss. There is a price to pay for such folly.

Massive amounts of money are spent on strategies that, at best, merely limit the ongoing damage done by change-resistant employees.

No amount of pre-employment screening can solve the problem. No human resource policy, employee management strategy, or performance evaluation criteria can deter it.

Nothing short of a purposeful, committed effort to provide hardnosers a path to healthy personal development will decrease their resistant nature. Safety is the open door to that end.


“Focus On Teamwork, Attitude Improves Quality And Safety.” The Waterways Journal. April 25, 1994: 41-44

Newton, Ron. No Jerks On The Job. Irving, TX. PenlandScott Publishers, 2010.

Riddle, Glenden P. An Evaluation Of The Effectiveness Of Stress Camping Through The Use Of The Taylor-Johnson Temperament Analysis Exam. Research Project. Dallas Theological Seminary, December 1978.

Taylor, Robert. Taylor-Johnson Temperament Analysis Manual. Thousand Oaks: Psychological Publications, Inc., 1992.

Breaking Through The Barrier Of Hardnosed Workers, Part 3

Turning The Corner
Admittedly, Part 1 and Part 2 of this series may be a bit discouraging to the solution-seeking reader. But as a wise professor states, “There is no implementation without, first, evaluation.”

So what has our evaluation revealed?

First, the dysfunctional nature of the average hardnosed worker employed in traditionally change-resistant work sectors is representative of his greater employment family, both labor and management. It is not the portrait of an isolated employee or two. The nature is systemic, as are its crippling effects.

Second, the extent of potential behavioral dysfunction in hardnosers is staggering. The research data points past the occasional whimsical, inane antics of the passive-aggressive worker who simply annoys others. It directs us to the darkly devious behavior of someone, or a bevy of someones, who is self-destructive, emotionally unengaged, and constantly looking to jump off the ship after lighting the fuse that may blow it up.

Third, management has largely failed in its attempts to wrestle control of the workforce away from hardnosers. Traditional quick-action employee management strategies lack the foundational understanding of both the cause of defiant behavior and the dysfunctional team dynamics that it creates.

Last, management has often chosen the wrong method to seize control of hardnosers. The preferred tactic has been to tighten control through the repeated issuance of compliance standards. Such “what to do” and “how to do it” standards stiffen the hardnosed worker’s resolve to reject management’s ploys.

Engineering consultant Kevin Sorbello fittingly compares the change-resistant workforce to a dysfunctional family in which “those making the rules unconsciously see themselves as adults in charge of children.” Conversely, he notes that workers of lower rank see themselves as being “treated like children by unfit elitists. The fact that this scenario is so ubiquitous,” he says, “is disheartening.”

In light of this stark portrayal, what can be done to heal a defiant and dysfunctional employment family?

Capitalize On Dysfunction
One word points us down the right path. It keeps cropping up [five times above]. The word is dysfunctional. There’s a reason it is our key word.

Dysfunction brings with it opportunity. The same weaknesses that define dysfunctional workers are the ones that open the door for us to help them personally and to improve the cooperative nature of the entire workforce.

But this can’t happen until we acknowledge several hard-to-believe truths about the nature of hardnosed workers. These are beliefs gleaned by the author after four decades of listening to, observing, profiling, and helping dysfunctional people.

1. Hardnosers really want to improve.
They are really not into self-flagellation, though they expect it to happen (defeatism) — they’d rather have the opposite: success.

2. Hardnosers are stuck and need a push.
They really don’t know how to solve their own problems, nor why they are stuck in a defeatist rut.

3. Hardnosers want simple honesty.
They will not trust you until you first demonstrate to them your complete honesty.

4. Hardnosers desire compassion, not charity.
They innately sense the difference — one is considered condescending and offensive to them; the other is acceptable.

5. Hardnosers respond best to old-fashioned “tough love.”
They desire hard boundaries, particularly those that help them achieve hard-to-reach goals.

6. Hardnosers want you to earnestly listen to them.
They want to tell you vital information about themselves — their real and felt needs — that enables you to help them mature.

It is difficult for some skeptics to embrace these beliefs. It is easier to adopt the attitude of one Cleveland-area business owner who believes that “most employees with bad attitudes come that way and it is not up to you to be a social worker.” To him, any alternative to improving the quality of workers other than perfecting the hiring and firing process is “silly,” even if personnel turnover costs are astronomical.

Safety officer Ken Malcolm at Safety & More P/L begs to differ. He says, “Hardnosed negatives can become hardnosed positives.” The key, he says, is trust.

Malcolm states that trust does not exist because “the past experiences [of workers] have not been good.” He suggests that workers have rarely been exposed to managers “who put value on worker input.” Perhaps they once worked for a grumpy guy in Cleveland. More likely, they’ve been jaded by repeated exposure to the Cycle of Rejection described in Part 2 of this series.

Agree with it or not, the path to profitability involves helping hardnosers cure their dysfunctional behavior, a task that starts with listening to what they say about themselves and about control-minded authorities.

Listening For Needs
Within the well-worn contentious discourse proffered by hardnosers is an easily recognizable admission of their foibles.

  • I have trouble accepting authority of any kind.
  • I am emotionally cold and uncaring.
  • I often say the wrong thing in the wrong way.
  • I don’t trust anyone enough to give them my loyalty (everyone is out to get me).
  • I am not a good team player.

You can also hear their pleas for help.

  • Help us accept authority, not persistently fight back.
  • Help us live emotionally healthy lives, not crawl into an emotional shell.
  • Help us develop better interpersonal skills, not alienate others.
  • Help us bond with each other and the company, not be disloyal.
  • Help us be better team players, not self-interested individuals.

These needs should sound familiar — they directly correspond to the “snapshot” of a hardnosed worker described in Part 1 of this series.

A hardnosed worker is a self-destructive, emotionally self-centered, uncontrollable person who would rather cut-and-run than commit.

From this snapshot, the human needs that it reveals, and the failure of traditional means to change hardnosed behavior, you know that there is only one action plan — one line of attack — that will result in positively changing a resistant workforce into a cooperative one. But, like the hardnosed Cleveland businessman, you might have trouble admitting it.

You have to help them develop the relational skills that they lack.

But don’t let this series tell you the obvious, though it bears repeating. Let the desperate general manager from Part 1 of this series say it. He’s the one who in 1992 initially linked the characteristics of a juvenile delinquent to the antics of his hardnosed employees. The assistance he sought from a troubled youth expert is as difficult as it is simple.

“I simply want you to help my people treat each other as people,” he asked.

He knew the problem pointed to a lack of interpersonal skills. So do you. And so do the perpetrators, who secretly want your help.

But how do you provide assistance without risking further rejection?

Using Safety To Change People
Job safety is the only joint partnership with management to which the hardnoser has ceded a modicum of control and cooperation. It is the only “face saving” venue in which he consents to [non-craft skill] personal development. To him, change for safety’s sake is grudgingly agreeable.

With safety training comes the opportunity to change the hardnoser, if the correct approach is utilized. Felt needs should be front-and-center — the odor of command, control, and compliance should be reduced.

John Bennett, VP of M.C. Dean, urges us to remember that “it is not about the system, regulations, nor policy or procedure. It is all about the people.”

Ill-conceived training strategies in which personal development is added-on to standard compliance training rarely work. Hardnosers are stubborn, not stupid. They can sense a convenient manipulative end run by management. Ever hear them call leadership training “charm school?”

To achieve human change requires a more carefully crafted safety training strategy than most organizations currently employ. Such a strategy demands a more need-sensitive safety management system.

What is recommended here extends beyond simple supplements to standardized compliance training programs. What is needed is a radical redesign of safety thinking in dealing with a sub-culture of resistance.

Above all, one hard-learned lesson about securing cooperation from defiant people must be remembered. You must meet their felt needs before they will fully give you what you want — compliance and control. If safety doesn’t do this, you remain stuck in the sink hole of opposition, forever containing resistance rather than correcting it.

Life Skills Are Felt Needs
A felt need is simply anything people consciously lack and desire. As noted, the hardnoser consciously but quietly desires self-improvement, particularly in life skills.

One example is the need of supervisors to learn practical leadership skills. As new supervisors quickly rise from the lower ranks of organizations, many supervisors suffer from the lack of leadership development inherent in on-the-job training.

Joe Johnson says that new supervisors are likely to be “given a ‘white hat,’ put in charge, and sent out in the organization with instructions to make things happen safely.” But of the leadership creation process, Johnson asks, “What ‘tools’ have these individuals been provided to insure he or she will be a good safety manager?”

In addition to leadership skills, other life skill needs that are likely felt by hardnosers of all ranks include:

  • Interpersonal communication skills (all aspects)
    • Accurate listening skills
    • Accurate shaping of the message to the listener
    • Accurate delivery of the message for acceptance
    • Accurate use of reflective listening, clarification
  • Relationship building
  • Behavioral awareness and pattern recognition
  • Anger management/tolerance/empathy
  • Team building
  • Critical thinking and decision-making
  • Coaching and mentoring

Under the confines of employee development and safety training, we have regrettably postponed meeting these needs until it is too late, after the worker feels under-appreciated. Properly, these are the needs you should start meeting at the beginning of new hire orientation.

What Do I Do?
The practical answer to the initial question — What should I do to change hardnosed workers? — is as basic as it sounds complex.

To change a hardnosed work force, you should implement a hybrid training program that simultaneously combines traditional safety-related training subjects with topics that develop the character of the hardnoser in their expressed area of needs.

The key is seamless simultaneous integration. Safety and human development should be taught at the same time, not as separate courses.

To avoid the Cycle of Rejection discussed in Part 2, the hardnoser must not feel that personal manipulation is the purpose of the training, nor should it be. Yet he should also walk away with a sense of obligation to practice (note: different than “comply with”) what is taught.

To make a life-changing combination of safety and personal development training workable requires two organizational commitments.

1. The organization must improve its quality of training.
A higher level of training is required, as is a better quality instructor skilled in safety, communications and human development. Revised curricula must be employed. Cattle-call training must be replaced with a caring personal attitude.

2. The organization must meld its safety and operation cultures.
A unified work culture is required, one which leaves hardnosers no wiggle room for discarding their training lessons under the excuse of “safety behavior” versus “operational behavior.” Operations cannot be allowed to deprive the hardnoser of training’s human development gains.

John Bennett underscores the mistake of trying to create a safety culture within an existing company culture in order to change people. He states that the tactic “is incongruent with the overall mission of the company.” Bennett suggests that “building upon the existing culture and simply inserting the safety aspect” is a more sensible way to build a unified work force. “Involving people in a sincere way,” he says, “will produce better results than were heretofore imaginable.” The hardnoser agrees wholeheartedly.

The Essentials
For the best results, a hybrid safety training program should immediately focus on the greatest needs of the hardnoser: interpersonal communication skills, emotional openness and honesty, and relational teamwork. All these needs share a common denominator. They point to the hardnoser’s fundamental lack of behavioral understanding.

Rarely are hardnosers properly educated about behavior — they do not bring such knowledge with them to the job. Most struggle with discerning why people do what they do — many ascribe the wrong motive to other’s behavior. It’s easy for hardnosers to fall into the Cycle of Rejection.

As explained in Part 2, answering the why question is vital to securing the hardnoser’s cooperation. If you desire to tear down the walls of resistance in your work force, here’s what you need to know.

  • If you help the hardnoser understand his unique behavior temperament and its affects on him — why he is prone to repeat certain behavior patterns — he will call you a friend.
  • If you show him why others act as they do because of their unique behavior temperaments, he will call you a good friend.
  • If you teach him how to build productive relationships with others despite their differences in temperament, he will call you his best buddy.
  • If you do none of the above yet try to change him, he will think you are simply attempting to control him. We’ve seen where that leads.

It is essential to integrate a simple behavior paradigm into every aspect of safety training. Uncomplicated behavior assessment profiles like the DISC or the Myers-Briggs Type Indicator® can serve this purpose. These are accurate, easily integrated “tools” that produce the type of behavioral understanding needed by hardnosers and non-hardnosers alike.

But this is no shill for the traditional haphazard use of behavior profile tools to soothe the ruffles of an agitated work force or as a guest speaker’s play toy. This is a call to deeply interweave two narratives — safety management and human development — on a consistent basis to meet the targeted needs of employees.

This author will attest to the instant magic brought by behavioral self-discovery through platforms like the DISC or MBTI. One unforgettable incident occurred when the cigar-chomping director of one company’s division first saw the results of his DISC self-analysis. The director’s cigar dropped from his mouth as he stood up, staggered about the training room with his analysis, and shouted, “This is me! This is me! This is freakin’ me.” Presto.

But that momentary magic is useless unless it is converted into tangible results while sustained within a framework of a safety training program that is designed to simultaneously control and change lives.

To do this requires a bold commitment from executive managers that are tired of butting their heads against behavioral barriers. Let the general manager mentioned in Part 1 remind us again that the alternative, letting hardnosers drag the company down, is “not an option.”

What this commitment looks like in practicality, and the results that it can accomplish, will be the subject of Part 4 of this series.


“Focus On Teamwork, Attitude Improves Quality And Safety.” The Waterways Journal. April 25, 1994: 41-44

Newton, Ron. No Jerks On The Job. Irving, TX. PenlandScott Publishers, 2010.

Riddle, Glenden P. An Evaluation Of The Effectiveness Of Stress Camping Through The Use Of The Taylor-Johnson Temperament Analysis Exam. Research Project. Dallas Theological Seminary, December 1978.

Taylor, Robert. Taylor-Johnson Temperament Analysis Manual. Thousand Oaks: Psychological Publications, Inc., 1992.