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
2. A dynamic external environment ensures constant organizational
3. Patient care processes call for many healthcare professionals, in
different disciplines, and working in different shifts, to function
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
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.
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
b. Unmanaged employee conflict responsible for 65 % percent of
work performance problems
(Dana, Conflict Resolution: Mediation Tools for Everyday
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
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
c. Deepen relationships
d. Discover problems sooner
e. Avoid group-think
1. Difficult Conversations Defined
a. Anytime we feel vulnerable, or when our self esteem is
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
2. Difficult conversations from your personal life?
b. Placing loved one in Nursing home
c. Raising children
e. Different values
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
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
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,
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).
ii. Anticipate, but do not attempt to control another’s
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
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
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
g. Practice! Practice! Practice!
Michael O. Bice