Blog 7A.  Mergers and Split-Ups




A “belief” is something you’re comfortable with. Mergers make beliefs change. The company’s culture changes because there are new people.

In a merger, the new beliefs give everyone a conflict within themselves: everyone from the top to the bottom of the new company. Often people in the new company also have conflicts with each other.

People must discuss both conflicts, the internal and those with others. The listener may be a colleague, a mentor, an adviser, or a psychologist. Most companies pay for people at the top to do this. Everyone needs to do it, but there isn’t money for everyone.

An open meeting can help the staff for whom there aren’t funds, as Patrick Lencioni described in Silos, Politics, and Turf Wars.

A facilitator chairs the meeting. All staff attend. Executives and managers attend and listen but don’t speak.

The staff vents fears, frustrations, and suggestions until all have vented and are satisfied they were heard. The facilitator declares breaks. During breaks the facilitator discusses privately, with the executives and senior managers, the major points that were just aired.

After each break, the facilitator tells everyone that the executive team will handle the concerns just raised; by when, and, as much as possible, what each outcome is likely to be.

[The discussion will be continued in Blog 7B.]

Illustrations in my blogs are either my own drawings or courtesy of

Contact me at 650-762-6755 or for more information or to start a conversation.

Pieter Kark, MD, San Mateo, CA 94401-2238


Illustrations in my blogs are either my own drawings or courtesy of


Contact me at 650-762-6755 or for more information or to start a conversation.


Pieter Kark, MD, San Mateo, CA 94401-2238


Blog 6. Unproductive Teams


A new team often wonders how it should proceed. Longstanding teams can lose focus or sense of purpose.

A simple technique gets the team to inspire itself to high performance. Once a facilitator from outside the team gains the team’s respect and trust, the facilitator asks about the team about the importance of what they are doing. The facilitator lists answers so everyone can see.

When the team feels complete, the facilitator makes a fresh list and goes through the first list item by item, asking its importance. At the end, the team will state their purpose or the facilitator will express a sense that they are saying/meaning/suggesting X.

The team feels revitalized, wanting to give high performance. Because they feel they inspired themselves the facilitator doesn’t need to return.

For example, the government cut back re-imbursement to a nonprofit, Abilities United in Palo Alto, CA. The managers of its service departments and programs, largely trained in social work and education, needed to explore new approaches.

We used the iterative questions as above. By the end of an hour, the managers inspired themselves to make plans for fee-for-service activities for each program. Abilities United soon improved its financial stability.

I was twice assigned to help failing Toastmasters clubs. Once we had mutual rapport and trust, each club spent an hour working with the iterative technique. Each club inspired itself. They succeeded. I never had to come back. To this day each club continues to flourish.

On the other hand, my wife and I mentored a new club. What we did worked, but we had not yet learned the importance of motivating–to-inspire and didn’t suggest it. The club faded away a year later.

Illustrations in my blogs are either my own drawings or courtesy of 

Contact me at 650-762-6755 or for more information or to start a conversation.

Pieter Kark, MD, San Mateo, CA 94401-2238


Blog 5C. Emotional Situations



This continues the examples presented in Blogs 5A and 5B.

A hospital where I practiced needed careful, rapid decisions about caring for dying patients. Families didn’t know what to do and were scared. Most doctors didn’t know how to handle care when a patient was certain to die.

The hospital started an ethics committee. Three doctors rotated month by month to chair its consultation team. A senior nurse, a therapist, and a dietician rotated on the team as did three business men, from outside the hospital, interested in ethics.

A family agreed it was best to let mother die peacefully. A son arrived late at night from the other coast. Because he’d not seen mother for decades, he felt painfully guilty.

“Do everything you can to keep mother alive!” he insisted.

A senior nurse and a business man joined me on the ward with the son and the local family, and two senior nurses from the ward.

Our team’s nurse and its business man acknowledged the son’s wish to talk to mother, his guilt about not having seen her for decades, and praised his coming so far.

The medical evidence showed mother would never wake up or speak. We all told the son mother could probably feel him hold her hand and feel the emotion in his voice. He should tell her he loved her. Now he agreed with the rest of the family: keep mother comfortable, let her die peacefully, no more tests, no breathing machine.

I called mother’s doctor. He was never trained to deal with dying patients. He listened, asked me good questions, and followed our recommendations.

Illustrations in my blogs are either my own drawings or courtesy of

Contact me at 650-762-6755 or for more information or to start a conversation.

Pieter Kark, MD, San Mateo, CA 94401

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Blog 5B. Emotional Situations


This continues the examples presented in Blog 5A.

In the late 1990s senior staff of the New York State’s Department of Motor Vehicles (DMV) started a Medical Advisory Board for the Department’s Commissioner. The Board’s biggest job was to help with media over-reaction to medical issues about driving that worried the state legislature.

An eye doctor chaired the Board. He started with issues about eye-sight. He asked me to chair a committee about black outs and seizures.

The Chair passed scientific medical studies to his committee about new ways to test vision for driving. The new ways were better than those New York State was using. Three members of the vision committee didn’t think the studies proved their point.

I offered help. None of the three had ever done scientific research. They were on the Board because they had other knowledge, and skills the Board needed.

The three thought the authors of the scientific studies weren’t sure of the conclusions. Why not? In each study, the discussion section pointed out weaknesses in methods and interpretation.

The three needed coaching about scientific writing but without making them wrong. It’s assumed no scientific paper is complete and no single project can look at all possibilities. A paper has to point out these limitations and suggest other interpretations or it won’t get published.

Once the three understood this, they read the cautious sentences in the papers’ discussion as mere cautions. The eye doctor presented a unanimous recommendation to the DMV’s Commissioner. Within six months, the new vision tests in all New York DMV offices. I believe they are still used today.

Further examples will come in Blog 5C.


Illustrations in my blogs are either my own drawings or courtesy of


Contact me at 650-762-6755 or for more information or to start a conversation. 

Pieter Kark, MD, San Mateo, CA 94401-2238


 Blog 5A. Emotional Situations


teacher-1276272_1920Companies often promote people technical experts to manage their team. The new subordinates ask the new manager how to handle emotional problems at home or at work. Often the new manager barely recognizes emotions. How can s/he cope?

Some new managers take courses at a college, workshops given by consulting groups, or learn by making mistakes and correcting them.

I suggest coaching. It doesn’t matter whether the coach is from inside the company or outside. The new manager’s chemistry has to work with the coach’s. The mistakes the coach made are good examples for new manager.

The two probably should meet two or three times a week. The manager has to learn to be honest both with her/his self and with the coach about failures. Once the manager can speak frankly in detail, the coach can make good suggestions. The coach needs gentle care and compassion.


In my career, medical colleagues needed to deal with emotional situations that frightened them: brain disease. My practice included diseases of the brain. Most doctors heal or keep healthy the organ system they specialize in so that organ will support the brain. We needed to collaborate on patients with a brain disease on top of the illness my colleague treated.

We’d together sit in the cafeteria or go to a conference room. I took responsibility for the brain’s problems, explain how the part of the brain that was damaged should work, and how the disease caused difficulty. I’d tell how I would treat the disease, and how long it might take.

We’d discuss the problems that might come up. I was responsible for talking with the patient and the patient’s family about these.

It worked when I felt how my colleague responded. I failed when I was abrupt or dogmatic.

(More information will appear in my next blog, 5B.)


Illustrations in my blogs are either my own drawings or courtesy of


Contact me at 650-762-6755 or for more information or to start a conversation.


Pieter Kark, MD, San Mateo, CA 94401-2238


New Blog 4. Meetings of Boards, Major Committees, and Councils







Meetings of boards, major committees, and councils bog down when there are arguments, personality clashes, or fixed viewpoints.  Any of these blocks productivity of the meeting. Dissent and argument are valuable, so lubrication is the way to proceed.

If I’m a member, I sit where I can feel everyone, only contribute when needed, and then from intuition. Often someone who readily dissents will become a contributor to a consensus or even suggest a consensus that allows the group to accomplish its tasks.

When I forget to suspend judgment my efforts don’t work. If I don’t feel everyone in the room, my efforts don’t work.

Even more effective is to scribe for the meeting. Write key phrases and summations of discussion on paper on an easel all can see. That evening,  turn these into draft minutes, ask the chair to edit, and send the final version to everyone who attended.

I did this for the committee that set direction, values, and policies when two Red Cross Chapters merged. The best practices from each chapter were to be incorporated into the new one. Scribing was am effective contribution. The tools of consciousness lubricated  discussion. The new chapter was very effective. Two other key committees of the new chapter asked me to scribe to keep them effective.


Illustrations in my blogs are either my own drawings or courtesy of


Contact me at 650-762-6755 or for more information or to start a conversation.

 Pieter Kark, MD, San Mateo, CA 94401-2238

Blog 1A. Recognizing a Conflict

Frustrated ManThe CEO called an emergency meeting of the executive team. “The CFO just showed me our new data. We’re still increasing productivity and profits, but the curve has slowed down a bit.”

“Why don’t we wait a while longer and see?” said someone. “Maybe in a few more days or a week things will be back on track.”

“I don’t know”, said someone else. “If it gets worse instead of better, we could get in real trouble.”

“Yeh”, said a third. “On LinkedIn, I saw this profile of a guy who’s been a psychiatrist. He says pain like we’re having is likely from an internal conflict. He can come and explore it, get back to us at the end of a day, and give us a plan.”

“I’ve seen it too”, said another. “He’s also been doing this for 40 years and has a long track record. He’ll stay for as long as we need him, but then he’ll leave so he’s not a permanent item on our budget.”

“You’re right”, said the third. “And there’s another thing. If he finds something he’s not comfortable handling, he’ll recommend someone else he trusts, and he won’t charge us for his day’s work.”

“There’s more”, said the other. “If we like what he’s done, and we decide we’d like to handle internal conflicts ourselves in the future, he’ll train us to do it.”

“OK”, said the CEO. “I’ll see if he can come in later today or tomorrow to talk.”


Illustrations in my blogs are either my own drawings or courtesy of 

Contact me at 650-762-6755 or for more information or to start a conversation.

Pieter Kark, MD, San Mateo, CA 94401-2238


Blog 3B. You Can Resolve Conflicts in Your Company



This portion of the blog continues where the last portion, Blog 3A, left off.

Note that the pictures in this and other blog posts, where not drawn by me, are from

  1. Conflicts from a split-up.

Split-ups cause conflict the instant the CEO announces one. Everyone in the company worries. What will the new companies be? Who will lead each? Who will stay? Who will be fired? The worries block creativity and productivity. Fear makes our brain go into “fight or flight” responses instead.

It helps to have a series of meetings like those for mergers.

  1. People who no longer contribute to the company.

Some have burned out. They may need to rest; a change of task or need help dealing with burnout.

Some are upset by believing their advice is not valued or someone else stopped respecting them.

Some miss a colleague who has left.

Some have a problem at home that takes all their attention.

To handle these problems, explore the root causes with the person.

The most serious is a person who resents the company’s goals and now has a hidden agenda. Many companies fail because one person has a hidden agenda.

I’ve used compassion and empathy to examine such a person’s agenda and feel their fear. There is something they believe they can’t deal with.

Then, I’ve facilitated open discussion between the executive team, the person with the agenda, and anyone else who was directly involved on either side. Now the agenda isn’t hidden. Open discussion will strengthen the company.

Sometimes the person will realign with the company’s goals. People with criminal tendencies, with a basic disruptive attitude, or whose fear comes from an illness usually need to retire or be fired.

  1. Executives and managers who follow the adage, “the beatings will continue until morale improves.”

This problem is due to the function and organization of our brains. A manager may respond to a minor issue in a way that “shuts down” subordinates’ brains. It’s how the subordinate’s feel the manager’s response, not how the manager views it. The subordinates go into fight-or-flight mode. This can be handled but it takes a long time and a lot of work. There are short-cuts and there are ways to prevent the problem.

  1. A cultural gap in your corporation.

Cultural gaps are expensive to fix. It takes a year or two. Done well, a poorly performing company becomes highly effective and productive.

I’m attached to They analyze the cultural gap with three tools, one for the whole corporation, another for silos, and a third for workgroups. After that, experts from AchieveCorp collaborate with the the company giving expertise about changing culture while company provides expertise about its work, clients, and vendors.

Contact me at 650-762-6755 or for more information or to start a conversation.

Pieter Kark, MD, San Mateo, CA 94401-2238

Blog 3A. You Can Resolve Conflicts in Your Company 


How do you cope with a conflict in your company?

What ‘s needed? Explore details. Keep an open mind.

The pattern of the conflict suggests the approach that is likely to succeed.

Common patterns

  • Clashes and fixed viewpoints in board meetings
  • A technical expert promoted to management but clueless about the emotional problems of their new subordinates.
  • Polarized arguments in executive committees.
  • Teams that can’t move forward.
  • Mergers and split-ups.
  • People who stop contributing.
  • Managers blocking creativity.
  • Cultural gaps.

Do you staff feel autonomous or under a manager’s thumb? What kinds of personalities contribute to the conflict? Will they change? Can you inspire them to work together?

  1. Problems in board block productivity. You need to lubricate, to boost everyone’s creative abilities.

You can sit quietly using tools of consciousness. You can scribe for the meeting so people see the discussion on large paper. That evening, the notes need to become minutes the Chair approves and everyone receives.

  1. Executive committees often get into a conflict that gets worse the more the committee debates. Each side’s position gets fixed until the committee is polarized and no one wants to give in.

Because everyone is in the same company, you can find the valuable but forgotten key they agree on.

Explore the views of each side during a meeting.

Would one side ever do what the other side does? After you feel the underlying key, bring it out. Then suggest a solution. When each side understands the other side, everyone will move forward for the good of the company.

  1. Teams that are stuck.

It may be a new team. It may be a team that has lost focus. A facilitator from outside should explore. With everyone’s trust, the facilitator asks, “What’s important about all this?”

The facilitator lists answers as given so everyone sees them.

The facilitator posts the list so it’s visible and makes a new list. “What is important about item one on the first list?”

This process continues until “What is important?” has been asked for every item on the first list.

The team feels eager to give high-performance. They feel they’ve inspired themselves.

  1. Learning to deal with emotions

A new manager, promoted because technical expertise, suddenly must help subordinates come with emotional issues at work or at home.

There are college courses, workshops, or learning by doing. I recommend direct coaching by a coach whose chemistry fits with the manager (or executive). It helps if the coaches can use the mistakes they made in dealing with emotions as examples. The two probably need to meet at least twice a week. The new executive or manager will need to learn to be frank and detailed with the coach, especially about difficulties and failures.

  1. Conflicts after a merger.

We are comfortable with the beliefs we know. A merger means we need new beliefs. A culture is a set of beliefs and the new company has a different culture because there are new people.

There are conflicts from the top to the bottom of the new company. Many conflicts are within people themselves from stretching into new beliefs. They need to be talked through.

Companies can pay for top people to talk with a counsellor or mentor. Since everyone must do it, use open meetings for the rest of the staff.

A facilitator chairs a meeting and lets everyone vent fears, frustrations, and suggestions. It’s wise for senior managers and executives to be be there but silent. (See Patrick Lencioni’s Silos, Politics, and Turf Wars).

Resolve conflicts between people in the merger quickly! What are the details: the cultural differences, the old beliefs, the new culture and structure, the personalities in conflict? Coach or inspired them to change. Experiment. Use an approach from a detached expert for three to six months. Then let everyone decide.


The second installment of this blog will give additional examples.

Contact me at 650-762-6755 or for more information or to start a discussion.

                             Pieter Kark, MD, San Mateo, CA 94401-2238

Changing a State Law about Death and Dying

Until 2000, New York State’s laws about dying dated from the 1950s. The old laws reflected medicine and dying in the era before intensive care units. People died in a few days from an acute illness or the acute phase of a chronic one. Ethics and the law required that dying people be given hydration and nutrition. If dying people couldn’t take it by mouth, they needed to get it “artificially” by tube or vein.

But by the mid-1990s, this approach increased suffering of patients, of their families, and of their caregivers. Now patients frequently died slowly on a hospital ward or in an ICU. Artificial hydration and nutrition caused horrendous problems. ICU nurses and staff suffered and rebelled. If the patient could communicate what care s/he wanted and didn’t want, doctors would comply. If the patient could not communicate, there was a dilemma.

The Bioethics Committee of the New York State Medical Society debated the outdated laws in 1999. The 20 to 30 of us on the Committee met for six to eight hours a day in a large second floor conference room of the Society’s headquarters. The debate took several full-day meetings. The more it went on, the more acrimonious it became.  The more it went on, the more fixed each side’s position became.

The next year, 2000, the NY state government wanted the medical society’s guidance: should they update the law?  The Medical Society charged our committee to decide. A colleague of mine and I remembered the debate the year before. My colleague is a compassionate, humane physician, retired from academics but active in palliative care, end-of-life care and practical applications of medical ethics.

We double-checked. Yes, two-thirds of the committee, largely physicians and surgeons in academics, legal medicine, or institutes for studies of medical ethics, still did what they and the patient’s surrogate thought best, despite the existing law.

The other third of the committee were were conservative. Their leader in the arguments was the respected orthodox Jew who founded the Bioethics Committee decades before and continued to chair it. He practiced in an academic hospital, applying his orthodox Jewish ethics to medical situations. He was by nature a flexible debater. However, in 2000, illness turned him authoritarian, dogmatic, and rigid.

Other orthodox physicians on the committee sided with him. So did doctors and medical ethicists appointed to the committee by the Roman Catholic Archbishop of New York City.

The conservative group said they followed the law strictly. They believed the approach of  the other two-thirds was wrong, and could not possibly be enshrined in law.

My colleague and I asked the conservative group,

“OK, was there ever a time when a patient suffered so much you did what the others do?”

The leader pondered, hesitated, and finally answered, “Yes.”

“Could you give us examples?” we asked.

On one occasion, he cared for a dying man who could no longer speak or write, who had no surrogate, and who was being given food and hydration through a nasogastric tube. The man kept pulling the tube out and fiercely fought every attempt to put it back.

On another occasion, a dying woman was given liquid and dissolved food in a baby bottle. She repeatedly pulled the bottle from her mouth, threw it across the room and pinched her mouth closed to fight every attempt put the bottle back.

These fights lasted a few days with each patient. In each case, the orthodox physician decided that the patient didn’t want the “support.” He ordered the artificial hydration and nutrition stopped and allowed each patient to die peacefully.

“But there’s no way to turn a specific case into law. There’s no way to have the law sanction a change,” he declared.

My colleague and I could feel an underlying alignment in the Committee. I used tools of consciousness: neutral attention, empathy without being drawn into another’s emotions, supporting everyone’s creativity.

“So would everyone like to find a way out of this impasse? Would you all like to help the State government one way or the other?” I asked.

“Yes, if there’s a way to do it,” both sides said; “It’s our duty to respond to the state’s request.”

“What if we compromise?” I asked. “I’ll tell the state that most of the committee withholds artificial feeding and nutrition despite the current law. The minority only does so in specific cases, but the minority doesn’t believe this can ever be enshrined in law.”

Within an hour, everyone agreed. I testified to the state assembly and to the Governor’s office. The law was changed. Doctors whose dying patients cannot communicate can now base decisions on discussions with a surrogate and on the patient’s clear comfort and needs.