DIFFICULT CONVERSATIONS STUDY GUIDE


Conflict is an inescapable feature of health care delivery in the USA. Why?

   1. H...
Conflict Dynamics Profiles Insights

   1. Conflict = Any situation in which people have incompatible goals,
        inter...
1. Difficult Conversations Defined
      a. Anytime we feel vulnerable, or when our self esteem is
         threatened
   ...
7. Three biggest mistakes made in difficult conversations
      a. Getting the facts right (Conflicting perceptions, feeli...
ii. Anticipate, but do not attempt to control another’s
                  feelings
             iii. Feelings withheld ten...
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Difficult Conversations Outline

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Difficult Conversations Outline

  1. 1. DIFFICULT CONVERSATIONS STUDY GUIDE Conflict is an inescapable feature of health care delivery in the USA. Why? 1. Hospitals are complex organizational structures, with many layers of management. Top down and bottom up communication is inherently difficult. 2. A dynamic external environment ensures constant organizational adaptation. 3. Patient care processes call for many healthcare professionals, in different disciplines, and working in different shifts, to function together effectively 4. Health providers tend to focus on technology and medicines, whereas patients are concerned with service and information. 5. The work force is predominantly female, and the power structure is predominantly male. 6. The workforce is increasingly diverse, reflecting demographic changes in the broader society. 7. Admitting physicians, for the most part, are independent practitioners, and not employees of the hospital. 8. Disagreement, among physicians and care givers, as to what constitutes quality of care and best practices. 1
  2. 2. Conflict Dynamics Profiles Insights 1. Conflict = Any situation in which people have incompatible goals, interests, principles or feelings 2. Workplace conflict statistics a. Conflict management is #1 developmental need of managers in the Center for Creative Leadership’s® Foundations of Leadership program b. Unmanaged employee conflict responsible for 65 % percent of work performance problems (Dana, Conflict Resolution: Mediation Tools for Everyday Worklife) (2001) c. 30-42% of typical manager’s time spent in dealing with conflict and its consequences (Thomas & Schmidt, “A survey of managerial interests with respect to conflict” Academy of Management Journal (1976) and Watson and Hoffman, “Managers as Negotiators” Leadership Quarterly (1996) ) 3. Query: How much time do you spend in managing conflict? Prefer to spend less time? Use existing time more productively? 4. The goal of successful conflict management is not its elimination, but to reduce its harmful effects and maximize its useful ones 5. Harmful? a. Pain and suffering b. Time diverted away from more important tasks c. Diminishes teamwork, shared initiatives, etc d. Forces people to choose sides e. Barrier to culture change f. Reduce productivity 6. Useful aspects of conflict? a. Surface alternatives and options for action b. Improve decision-making (Drucker : The first rule of decision making is that one does make a decision unless there is disagreement.) c. Deepen relationships d. Discover problems sooner e. Avoid group-think 2
  3. 3. 1. Difficult Conversations Defined a. Anytime we feel vulnerable, or when our self esteem is threatened b. The issues at stake are important, and the outcome uncertain c. When we care deeply about what is being discussed, or about the people with whom we are discussing it d. Conversations that we dread and find unpleasant, or that we avoid or face up to like bad medicine e. “ A difficult conversation is anything you find it hard to talk about” 2. Difficult conversations from your personal life? a. Money b. Placing loved one in Nursing home c. Raising children d. Loss e. Different values f. Retirement g. Politics and religion 3. Difficult conversations from your professional life? a. Employee discipline b. Employee termination c. Asset divestiture d. Top management infighting e. Budget spats f. Cost cutting g. Space wars 4. Rate your skill at difficult conversations on a scale from 1-10 a. Historical class mean = 3 5. Your options, simply stated a. Deliver a message b. Have a learning conversation 6. Why have learning conversations? a. To learn—there is information in opposition b. To enhance a working relationship c. To get your message delivered and understood d. To move toward joint problem solving e. To model this technique for others to emulate f. Transforming cultures requires that you tap into people’s feelings and emotions g. To increase the options for managing or resolving the conflict 3
  4. 4. 7. Three biggest mistakes made in difficult conversations a. Getting the facts right (Conflicting perceptions, feelings, and values cause the rift) b. Not asking enough questions (Measure % time spent in advocacy and % time spent in inquiry) c. We need to stay rational and avoid feelings (Which are central to the discussion) 8. Pattern: Every difficult conversation operates simultaneously at three levels. The authors refer to these levels as “three conversations” 9. Level One-The “What Happened” Conversation-the substance, and the most evident level. Who said what, who did what? Who intended what? What did each party contribute to the problem? a. Perceptions and values rule, not facts b. Seek understanding, not agreement. Generally, people do not change their attitude about something important, unless they first feel accepted and understood as they are. c. Identify the contribution of either party to the dispute d. Be careful with assigning intentions i. Can’t know another’s intentions; can only guess ii. Tendency to demonize others, while sanitizing your own iii. Tendency to portray other as one-dimensional, when most of us are multidimensional iv. “If you spot it, you got it” (LDP Executive coaching Observation) e. Be persistent about listening-mirror their words, paraphrase, ask for more information (Help me to understand). Reframe their statements to distill the substance and emotion you hear. 10. Level Two- The Feelings Conversation-the feeling each party is grappling with. Some feelings are easy to express or hear, others are not as easy to express or hear. a. Positive feelings: joy, pride, love, ownership, satisfaction, affirmation, vindication b. Negative feelings: Anger, pain, frustration, humiliation, fear, anxiety, shame, confusion c. Which feelings are hardest for you to express and why? Which feelings are the hardest for you to hear and why? d. Process issues: i. Be sure to express feelings (Inviting conversation), not judgments (Inviting confrontation). 4
  5. 5. ii. Anticipate, but do not attempt to control another’s feelings iii. Feelings withheld tend to leak out, in the form of body language, tone of voice, complexion, and in the worst case, an explosion! e. Level Three-The Identity Conversation-These conversations are inherently difficult because they threaten our perceived identity. For example, we may see ourselves as competent, generous or fair. Anything that challenges the notion we have about ourselves “knocks us off balance” or causes an “identity quake.” f. Process issues: i. Frontal attacks on Identity are met with fierce opposition! ii. “Complexify” your self image. Your identity is not one- dimensional. You may have a leading identity, but that isn’t the whole story. (My identity = healer) iii. Not easy to discern. Takes time, patience, and active listening. 11.Preparation Tips a. Take the time to prepare (Using the worksheets as a guide). Don’t prepare 5 minutes before a meeting! b. Use Three Conversation Model with discretion c. Have a good opening line d. Be mindful of your advocacy time and inquiry time e. Anticipate, but do not try to control emotions f. Minimal return for your time investment? Improve Level One skills g. Practice! Practice! Practice! Michael O. Bice 5

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