Navigating Crucial Conversations

Communication is rooted in everything we do.

How well we work with colleagues, patients, family members and community partners is greatly dependent on how effectively we are able to communicate with individuals in a variety of situations on different levels.

As many of you know, I have always been a proponent of learning. Regardless of someone’s tenure at an organization or within a particular field, I believe there are always opportunities to learn, reflect and apply new skills in situations in the workplace.


An area I believe which always stands to benefit from new learning is the way in which we manage and communicate with people. In particular, how we communicate with staff, colleagues, patients, and family members around difficult topics or in less than ideal circumstances is, in my opinion, a skill that can always be enhanced.
The ability to navigate effectively through a crucial conversation is, indeed, a learned skill.

The book ‘Crucial Conversations: Tools for Talking When the Stakes are High’ is a wonderful resource for anyone addressing conflict and even preventing conflict that presents a barrier to communication.

The book defines a crucial conversation as a discussion between two or more people where (1) stakes are high, (2) opinions vary, and (3) emotions run strong.

In the healthcare world, crucial conversations occur every day with our managers, teammates and our patients.  The environment we create in our workplace impacts how we can be with our patients.  If you don’t feel heard by your manager or teammate you can feel frustration and anger that gets in the way of being the best practitioner you can be.

The differences we all have in terms of skillsets, personalities and career ambitions in the office or unit can make it difficult for colleagues and managers in the workplace.

In the book, which was written by New York Times best-selling authors Kerry Patterson, Joseph Grenny, Ron McMillan and Al Switzler, encourage the controlled use of emotions and storytelling to navigate through a crucial conversation.

Regardless of the nature of the conflict—a difference of opinion about how to manage patient care; your work schedule; or not being selected to fill new position the framework outlined in the book will guide you in having a “crucial conversation.”

Start with heart
Stay focused on what you really want. Ask yourself: "What is the outcome I'm looking for in this conversation?" Are you simply trying to win the argument, seek revenge, or keep yourself safe? Your motivation is not to simply watch someone squirm-it's to encourage the free flow of information that is at the core of every successful conversation.

Learn to look
Be conscious of when a crucial conversation is needed. It's best to plan for these discussions, rather than suddenly discover you're in one. During the discussion, constantly assess your behaviour: "Am I becoming silent or violent? Are others?"

Make it safe
State your mutual purpose and establish respect by making it clear to the other person that you value her or his perspective and experience. Avoid ambiguity, which sometimes leads people to assume the worst, at which point they may become scared, defensive, or both. Feeling defensive can prevent a person from listening to important information.

Master your story
Take charge of your emotions by "telling your story"; for example, think about and rationalize what you're feeling and why. Retrace your path to action for the listener - explaining how and why you've come to these conclusions-so she or he can better understand your point of view. Be sure to separate the known facts from your story, and remember to ask yourself how you've contributed to the problem.

State your path
Share the facts as you see them and tell your story, while also asking others how they've reached their conclusions and about their feelings and stories. Ask yourself, "Am I clearly communicating why this conversation is taking place?"

Explore others' paths
To learn about other people's perspectives, use four "power listening skills": (1) ask questions to encourage others to share their views; (2) mirror how others look or are acting to confirm that you understand how they feel; (3) paraphrase what they've said to acknowledge that you understand their story; (4) prime, or encourage, them to share details they may not otherwise reveal. Ask yourself, "Am I actively exploring others' views?"

Move to action
Decide together how you will make decisions about the issue being discussed, document these decisions, and follow up.

This type of structured conversation is a vital tool that facilitates active listening, clarifies the perspectives of others; allows solutions to emerge and facilitates the free flow of information. 

Signs that we are in conflict include finding yourself upset or angry at a person or a situation; feeling a sense of injustice about something that has happened to you (or hasn’t happened); avoiding specific individuals and not attending team meetings or events in your workplace. These are the times when a crucial conversation can bring positive breakthroughs for you, your colleagues and patients. Best of all having crucial conversations is one of those strategies that you can try at home!