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manager's desk: effective communication in difficult
conversations By Jacquelyn Polito, MHA, RPSGT, REEGT
A
quick Google search of “difficult conversations” produces
about 1.5 million hits. Clearly, this indicates strong interest
in the skills of conducting difficult conversations. Theories
and strategies abound, yet none seems to have found the magic
formula with universal appeal and success.
Suppose a skilled sleep technologist has an annoying habit of
drumming her nails. Should you overlook it or ask her to stop
the behavior? Or maybe a technologist failed to perform an
indicated split-night study, causing the patient to be retested.
These types of issues are often faced in health care, yet we have
a hard time trying to decide whether to avoid or confront. If
we avoid, our annoyance will worsen and nothing will improve.
If we confront, feelings may get hurt, damaging relationships
and making the situation worse.1 However, quality improvement is dependent upon effective communication, even when
difficult.
This discussion will offer some suggestions for strategies to
manage difficult conversations with employees. Three popular
and effective theories are outlined, ideas on how to handle
resistance from employees are presented, and an overview of
the themes that are common to these theories is discussed. You
may find that one particular technique may be more compatible
with your own communication style than the others.
Communication Strategies
Leebov’s Caring Feedback Model
Wendy Leebov focuses on preparing simple, clear statements
that will handle employee resistance, alibis and excuses with
backbone and heart.2 Be supportive without backing down.
1. State your purpose in positive terms, such as, “I know
you care… I want to be helpful…”
2. State the situation and specific behavior in clear, simple
terms.
3. State the consequences for you, your team, your
patients, and/or your organization.
4. Use a touch of empathy, such as, “I know you work hard
and had a lot of patients that day...”
5. Make it a dialogue. Let the employee respond as you
ask questions and listen.
6. State your request or expectation in clear terms.
Jacquelyn Polito, MHA, RPSGT,
REEGT,
Jacquelyn Polito, MHA, RPSGT, REEGT,
has been in the sleep field since 1985
and is supervisor of the Neurology
Department at South Shore Hospital
in Weymouth, Mass., and president
of the New England Society of END
Technologists (NESET)
Ury’s Breakthrough Strategies
Using a negotiation model, Ury proposes that there are certain
barriers to cooperation when facing a problem.3 Strategies for
breaking through these barriers are:
1. Your natural reaction in a conflict is stress, which makes
you feel under attack. “Go to the balcony” and imagine
looking down on your conversation to regain your
mental balance.
2. Their negative emotions of defensiveness or fear may
induce further argument. To defuse their emotions,
do the opposite of what they expect by listening,
acknowledging their viewpoints and feelings, and
showing respect.
3. Understand their position by asking questions about
why they have that position.
4. If employees are dissatisfied and unconvinced of
the benefits of your expectation, “pushing” may only
produce more resistance. Do the opposite by bridging
the gap between your interests and theirs.
5. Use power to educate. Let employees know that
resistance will not give them the win. Educate them
that only together, with you, will they win or be
successful.
Crawford’s Workplace Issue Discussions
Crawford emphasizes confronting an issue before it affects the
employee’s or the organization’s performance.4 Therefore, timely
and thoughtful feedback is important. Use the body language of
a leader, such as sitting up straight and not turning away. Speak
calmly, firmly and unapologetically. Be brief and concise.
1. Describe the purpose of the meeting, avoiding chatty
conversation. (“I want to talk to you about our charting
policy.”)
2. Describe the behavior. (“I noticed you didn’t fill in all
the information on your patient yesterday.”)
3. Listen to the reaction. (Does the employee deny or
offer excuses?)
4. Agree on a resolution while setting the expectation
for the employee. (“It’s our policy to fill out charts
completely for safe patient care. I expect you to make
notations during the test. If you’re called away, you
must note the reason for the delay. If you don’t, it
will lead to increasing disciplinary action, up to and
including termination. Can you agree to do this?”)
5. Hear the employee’s explanation.
6. The focus is not punishment, but communication and
collaborative problem-solving. (“What ideas do you
have to manage your time to get this done?”)
7. Document the discussion.
8. Reinforce the desired behavior with follow-up
meetings.
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Handling Resistance
Most employees want to do a great job. Occasionally, their
performance may be substandard and require addressing. A
natural reaction to hearing negative feedback is to resist and
deny responsibility with excuses (“I don’t have time”). You
should respond with “fogging,” which is a partial agreement that
is presented in a nondefensive and caring way to handle the
resistance statement.1 For example, you may respond by saying,
“I realize that may be frustrating, yet…”
Similarly, other tactics may help when employees fail to be
cooperative. Respond nondefensively and actively listen to their
needs and frustrations. Enforce the rules, yet enable employees
to think through how best to achieve those results. Ask employees to provide justification for demands that are unreasonable;
their demands will lose power when employees are unable to
justify their behavior. Finally, point out consequences as inevitable rather than as a threat.5
Take-Aways
The following summary of some underlying themes common
to these three strategies offers further help in how to conduct
successful communication during difficult conversations.
Prepare: Collect facts to make sure there were no extenuating
circumstances. Maybe the employee was never informed of
the policy or was called away and unable to follow proper
protocol. Deal in facts, not opinions.6
Purpose: Analyze the purpose or goal of what you hope to
achieve, such as improving communication and quality of
work.4 Good communication is essential to help employees
understand the organizational culture and to contribute the
best they can.
skills actually may help to avert confrontation by enhancing
employee commitment. Effective communication also improves overall performance. A leader who leads by example and
demonstrates an effective, unemotional communication style
will be more successful. It is important for every leader to exert
diligent effort to become more proficient at conducting difficult
conversations.
References
1. Stone D, Patton B, Heen P. Difficult conversations. New
York: Penguin Books; 1999.
2. Leebov W. The quality patient experience [Internet].
Leebov Golde & Associates; c2011. Available from: www.
quality-patient-experience.com
3. Ury W. Getting past no. New York: Bantam Books; 1993.
4. Crawford D. We need to talk [Internet]. Society for Human
Resource Management; c2008.
5. Leritz L. Negotiating with problem people. In: Working
woman. New York: McGraw Hill; 1988. p.408-411.
6. Zofi YS, Meltzer S. Delivering negative feedback in a
positive manner [Internet]. Nursing Homes Magazine. Oct.
2007.
7. Polumbo R, Schrum B, Sweet J, Schmitt S. Best practices
for communicating effectively during difficult conversations.
ExecBlueprints. Books24x7; 2010. 
Practice: Role-play with a peer. Choose someone outside your
department so that you can feel free to air emotions that may
appear inappropriate, without fear of it being repeated within
your department. Role-playing will help you prepare answers
for many possible reactions from employees.
Manage Emotions: Role-playing has great benefit in calming
your emotions, which is so crucial to conflict management.
Additionally, understanding how to say something is just as
important as knowing what to say.
Listen: Facilitate listening and understanding by asking
questions to clarify the problem. Give the person a chance to
explain.
Timely Feedback and Follow-up: Set expectations and be clear
about the desired behavior. Document the conversation and
expectations in writing to help employees understand what is
expected of them. Follow up with employees, because behavior
is rarely changed with one conversation.
Conclusion
Rather than simply talking to or at employees, true communication involves building rapport, empathy and cooperation
through the art of asking questions.7 Successful communication
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