1. Crucial Conversations
Duke University School of Medicine
Office for Faculty Development
June 9, 2017
8AM-12N
Ann Brown MD MHS
Vice Dean for Faculty
Cathie Siders PhD
Psychologist, Executive Coach
Introduce speakers
Review Schedule (4 hr workshop, breaks)
Bio Breaks okay
Interactive and lecture
Electronics on Vibrate

2. Crucial Conversations
Conflict of Interest
None

3. Goals of Session Define “crucial conversations”
And to acknowledge that, skillfully done, they are a normal part of healthy human interaction
Introduce Crucial Conversations concepts
Demonstrate
Invite observations on what worked and what did not
Discuss common situations and neutral rejoinders
Practice
Session designed to be interactive
Plan to revisit book(s)
Difficult and Crucial Conversations will be used interchangeably
Plan: observe crucial conversation and watch for what works.
Then: Debrief as a group
Then: Review concepts in Crucial Conversations
Then; Practice your own
Crucial Conversation, SOM Office for Faculty, 6/9/17

4. Pre-work: worksheet on your own crucial conversation (sent by email prior to workshop)
Describe a recent (or pending) situation where you had (or need to have) a crucial confrontation or conversation. Describe the facts of the situation, your story of why it happened, and your emotions.
What do you want to happen based on your pending conversation? (Chapter 2, Crucial Conversations)
What do you NOT want to happen?
Do you see any safety concerns?
Crucial Conversation, SOM Office for Faculty, 6/9/17

5. Three Good Resources
Crucial Conversation, SOM Office for Faculty, 6/9/17

6. “discussion between two or more people where 1) the stakes are high, 2) opinions vary, and 3)emotions run strong”
Crucial Conversations: Tools for Talking When the Stakes are High. Patterson, Grenny, McMillan, Switzer
Crucial Conversation, SOM Office for Faculty, 6/9/17

7. Why this topic Professionalism
Support a culture of trust, respect, empowerment
Diversity
Make it possible to talk about differences and explore assumptions
Patient care and safety
Encourage dialogue to support effective information exchange about patient care
Research integrity
Normalize discussions about ethical conduct of research
Learning Community
Support an environment where personal growth can happen
Personal belief
Sweeping conflict under the rug creates a toxic environment
Crucial Conversation, SOM Office for Faculty, 6/9/17

8. Examples of Crucial Conversations
Addressing disruptive behavior
Giving a negative performance review to a junior colleague or student
Giving boss feedback about her performance
Talking with a co-worker about a terrible hygiene problem
Asking in-laws to stop interfering
Crucial Conversation, SOM Office for Faculty, 6/9/17

9. All people and organizations have problems
The difference between the good and the best is not how many problems we have
It is how rapidly and respectfully the problems are solved.
Crucial Conversation, SOM Office for Faculty, 6/9/17

10. Role Play (Demonstration)
Watch for language that
moves the conversation forward,
stalls conversation
Debrief
What worked well?
What could have been done differently?
Crucial Conversation, SOM Office for Faculty, 6/9/17

11. What Makes a Conversation Crucial?
Law of Crucial Conversations:
“Anytime you find yourself stuck, there are either crucial
conversations you are not holding, or not holding well that are keeping you there.”
-Deborah Marshall, Crucial Conversations consultant
Talk about barriers to having open dialogue
Source:
Crucial Conversation, SOM Office for Faculty, 6/9/17

12. “discussion between two or more people where 1) the stakes are high, 2) opinions vary, and 3)emotions run strong”
Crucial Conversations: Tools for Talking When the Stakes are High. Patterson, Grenny, McMillan, Switzer
Crucial Conversation, SOM Office for Faculty, 6/9/17

13. Recognize a Crucial Conversation
Stuck Conversation – having same one over and over
Stuck issue- despite attempts, no change
Feelings of
Anxiety
Fear
Judgment
Anger
What were the issues that were “stuck” for Dr. Gastro? pattern of behavior that doesn’t change, perception of lack of respect for him, his time, or the pressures he faces. Could be talking about violated trust, broken agreement, negative feedback.
Crucial Conversation, SOM Office for Faculty, 6/9/17

14. Watch for your own (and other’s) reaction to tough situations
Silence
Masking, Avoiding, Disengaging
Violence
Controlling/coercing, Labeling, Attacking, Belittling
Open, Honest and Effective Communication
Crucial Conversation Skills
Masking: Sarcasm, Sugarcoating, Couching
Avoiding: Changing the subject, shifting the focus to others
Withdrawing: Not engaging in the conversation any longer
Controlling: trying to force people to your point of view, cutting others off, overstating the facts, speaking in absolutes, dominating the conversation
Labeling: stereotyping or categorizing people
Attacking: belittling or threatening the other person
The mistake most of us make in our crucial conversations is we believe we have to choose between telling the truth and keeping a friend…between candor and kindness..
-Kerry Patterson

15. Contribute to the pool of shared meaning
At the core of every successful crucial conversation is the ability of all members to feel safe to contribute to the pool of shared meaning or add the piece to the “puzzle” of understanding
Crucial Conversation, SOM Office for Faculty, 6/9/17

16. Get more “legos” on the table
Crucial Conversation, SOM Office for Faculty, 6/9/17

17. Core Principles of Crucial Conversations
Start with Heart: Focus on what you really want
Learn to Look: How to Notice When Safety is at risk
Make it safe
Master [your own] stories Learn how to effectively share your own views
STATE your path
Encourage others when they are emotional to share their own views and get back to the facts: AMPP skills
Move to Action
Relationship, pattern, value- violated

18. “Stay Focused on What You Want”
Start with Heart
“Stay Focused on What You Want”
What do I really want for myself? for others? the relationship?
How would I behave if I really wanted these results?
What do I NOT want to happen?
Starting with Heart is helpful both when you realize your are in the middle of a crucial conversation vs. when you are know you need to have one and you are trying to decide what the core issue is (remember C-P-R)
*Sucker’s Choice: EITHER/OR mentality (thinking that I had no choice but to “flight or fight”) keeps us from staying in the dialogue to get us to yes. Dialogue is always an option
How do you get there? Present your brain with a more complex situation…combine what do what with what you don’t want…”Is there a way for me to express my concerns without “fill-in-the-blank-of what-you-don’t-want”? (ex given in the book. Your boss fails to keep commitments. Is there a way to tell my boss how this makes me feel without making him/her defensive?”
*Talk about things that make us fall for the “sucker’s choice”:
-Wanting to win
-Seeking revenge
-Hoping to remain safe
-Saving face
-Avoiding embarrassment
-Winning
REFUSE THE SUCKER’S CHOICE
Crucial Conversation, SOM Office for Faculty, 6/9/17

19. Learn to Look When Safety is at Risk
In the midst of a conversation, learn to recognize when things are not going well
Step out of the content conversation and observe how the conversation is going
How many people have been in crucial conversations and have been paying so much attention to getting your point across that you failed to realize until it is too late that the other person has either shutdown or gotten mad?
Content: What people are discussing
Conditions: What people are doing in response to what is being talked about. Looking for Conversation Killers
The conversation turns “crucial” when the interpretation of the content assumes mal-intent.
Crucial Conversation, SOM Office for Faculty, 6/9/17

20. Make It Safe Conditions of Safety Mutual Respect Mutual Purpose
If you recognize that either mutual purpose or mutual respect are at risk, step out of the content of the conversation and re-establish safety.
Image source for “Stay in the Game”:
Image source for picture of Alec Baldwin:
The point of this slide is to think about ways to keep others talking and not shutting down.
In a conversation when someone is speaking there is always a sender and receiver of the message. What tends to get people upset is NOT what is being said but the interpretation of the intent.
Crucial Conversation, SOM Office for Faculty, 6/9/17

21. Make it Safe Re-establish Mutual Respect and Mutual Purpose Apologize
Contrast to repair misunderstanding
Use CRIB as a tool to find mutual purpose
Commit to seek mutual purpose (shared goal)
Recognize the purpose behind the strategy
Invent a mutual purpose
Brainstorm new strategies
Crucial Conversation, SOM Office for Faculty, 6/9/17

22. Master [your own] stories
See and Hear
Tell a Story
Feel
Act
Facts
Interpretation
Emotion
Behavior
Silence or Violence
Dialogue
Path to Action
One of the most interesting parts of the book is when Dr. Patterson discusses the ideas that our actions are a function of our perception and our perception of a situation is related to the “stories” we tell ourselves. This concept seems very similar to the idea in cognitive behavioral therapy called “cognitive distortions” and “testing your assumptions”. What this means is that if we can re-program or re-think about the stories that we are telling ourselves we can compel ourselves to act.
The stories we tell keep us acting badly. The stories that are listed here are used to justify our current behavior and lead us to act ineffectively or excuse ourselves from taking any personal responsibility for how things turned out.
Villain stories: “Its All Your Fault”: Overstating the other person’s guilt or stupidity. Labeling. It helps us feel justified in blaming others for less than stellar results and helps us feel justified in ineffective behavior we do to get them back.
Victim stories: “Its Not My Fault”: we are innocent sufferers. “The other person is bad, wrong, dumb and we are good, right or brilliant. Other people do bad or stupid things, and we suffer as a result” . Most tales of victimization are not so clear-cut and one-sided. You are ignoring the role that you played in the problem.
Helpless stories: “There’s Nothing Else I can Do” We make ourselves out to be powerless to do anything healthy or helpful. We tell ourselves that we have no other choice but to choose an ineffective action. A lot of time “we turn others behavior into fix unchangeable traits” [Patterson]
How many times have we told “stories” that have kept you from speaking up or doing the right thing?
Dr. Patterson describes this model as the “Path to Action”. In the book he states that the only way to be able to keep yourself in the game and keeping “cool” and focused in a crucial conversation is to learn how to re-frame your interpretation of events (stop the stories you are telling yourself).
Key Skills for Mastering Your Stories: Emotional regulation so you can problem solve. Trace the path BACK To ACTION
Notice your behavior: Am I in some form of silence or violence?
Get in touch with your feelings: What emotions are encouraging me to act this way? Is it anger? Embarrassment? Shame? Feeling violated? Cheated?
Analyze the stories: What story is creating these emotions?
Get back to the facts: What evidence do I have to support this story?
The questions is…when are you supposed to do this? You should do this when you are “learning to look” (Principle 3): If you notice that you are starting to re-sort to silence or violence then take a step back.
Getting to Dialogue:
Turning villains into humans: “Why would a reasonable, rational and decent person do what this person is doing?” [Empathy]
-This will help you to get a place where you could come up with enough other explanations so that you can have courage to go and talk to the other person
2) Turning the helpless into the able: Go back to starting with heart. Want do I really want? For me? For others? For the relationship?
3) Turning victims into actors: What am I pretending not to notice about how I contribute to this problem? Am I minimizing my role while exaggerating the role of others?
VillianHuman
VictimEmpowered
HelplessAble
Crucial Conversation, SOM Office for Faculty, 6/9/17

23. Learn how to effectively share your views
Confidence
Humility
Skill
Image source:
Now let’s focus on how you would begin to express yourself effectively:
Confident that your ideas are worth contributing so that they can be placed in the pool of meaning
Humble enough to realize that someone else may have a valid point
Skill: to have a healthy conversation and avoid the Fool’s Choice.
Crucial Conversation, SOM Office for Faculty, 6/9/17

24. Effective communication: “What” vs. “How” Skills
Share Your Facts: Start with what has been said or done
What
Skills
Tell Your Story: Talk about your
conclusion. Consider adding contrasting.
Ask for Others Path: Encourage others to express their facts and stories.
Talk tentatively: “Perhaps you were unaware” “In my opinion” “I’m beginning to wonder if”
How Skills
Start with facts because they are less controversial and less insulting
Then talking next about your conclusion (tell your story). If the person starts getting confrontational then add contrasting.
Remember: It can be really hard to do this when you care passionately about what you are saying. Remember to use your “How skills”.
If you are starting to get defensiveness or feeling indignant or people are becoming silent then…watch out…you might be entering into the danger zone….
Encourage testing: Invite opposing views and mean it.
“Does anyone see it differently?”
“I’d like to hear the other side of the story”
Play devil’s advocate.
“Hold to your belief but soften your approach” –Kerry Patterson et al

25. Explore Other’s Path by Inviting to Share their Path to Action
See and Hear
Tell a Story
Feel
Act
Facts
Interpretation
Emotion
Behavior
Explore Other’s Path by Inviting to Share their Path to Action
Ask to Get Things Rolling: “What’s going on?” “I’d like to hear your opinion” A M P
Mirror to Confirm Feelings: Suggest that a person’s tone of voice or gestures are inconsistent with their words.
Remember: Others have their own stories, path to action. How do you get them to break the cycle and trace their own path to action?
A few words about priming: This doesn’t mean that you agree with their particular perspective.
Paraphrase to Acknowledge the Story: State back the message that you have gotten in your own words.
Prime when you are getting nowhere: If the person is still not talking take a guess about what they might be thinking.

26. Explore other’s path using ABC
Agree – agree where you can!
Build – build on that!
Compare
Crucial Conversation, SOM Office for Faculty, 6/9/17

27. Move to action Decide how you’ll decide
Document decisions and follow up
Crucial Conversation, SOM Office for Faculty, 6/9/17

29. Drive-by feedback and others…
Situations….
Drive-by feedback and others…

30. Table Exercise Review “neutral rejoinders” handout
Identify one verbal response from any of the five behavioral categories that you might find helpful
Discuss with your table group your selection and why you find it useful

31. Role Play- Groups of three
Identify initial roles
A Dr. Young, Junior Faculty
B Dr. Smart, slightly more senior colleague
C Observer and time keeper
Review roles (2 min)
Role Play Dr. Young initiates conversation with Dr. Smart (10 min)
Debrief (5 min)
Rotate roles, repeat, rotate roles, repeat
Crucial Conversation, SOM Office for Faculty, 6/9/17

32. Key points
The ability to have difficult conversations is a key to building a healthy environment and healthy relationships
Strive to keep “in dialogue”
Add to the pool of shared meaning
Check yourself if you are leaping to conclusions without enough information
Crucial Conversation, SOM Office for Faculty, 6/9/17

33. Next Steps Revisit your scenario and add ideas from this workshop.
Read the book
Talk to your group about these concepts
Teach a concept to your group
Rehearse
Crucial Conversation, SOM Office for Faculty, 6/9/17

34. Thank You! Please fill out evaluations
Crucial Conversation, SOM Office for Faculty, 6/9/17