1. 1 I want to meet your leadership needs. 2 My goal is to provide you with starter checklists you can use next week. 3 Please let me know whether I succeeded on your evaluation forms.

2. Why is this important? We all dread the tough conversations. Some things are hard to hear. Some things are hard to say. But uncomfortable things must be heard and said if we are going to achieve and sustain exceptional results. 1,2 We avoid these conversations and put them off—sometimes much too long. When we finally do what has to be done, we often think we could have done better. This presentation is about how to do that. After mastering the information in this presentation, you will be able to answer the following questions: –Why is communication so hard? –What are the toughest communication challenges for leaders? –Why are tough conversations so tough? –How can I listen effectively? –How can I speak effectively? Even a small improvement in your communication skills will make a big difference in your leadership effectiveness. 1 Don’t kid yourself; there is a price to pay for mastering tough conversations; you will not be loved. 2 Satisfaction in life comes from those who like us—and those who don’t.

3. 1 My cousin explained most of what I needed to know about riding a Harley Davidson ™. There are too many incoming messages. We don’t want to hear what others have to say. We suspect that others are “spinning.” Messages are frequently inconsistent. People talk too much. People don’t include all interested parties in decision- making. People only want to hear what they want to hear, when they want to hear it and how they want to hear it. Folks tell us more than we want to know. The message is not clear. The message keeps changing. Emotions get in the way. People forget to tell us how to do whatever it is. 1,2 And so on Why is communication so hard?

4. They are triggered by a problem. They usually result from poor attitudes, bad behavior or inferior results. They usually take place in the context of dramatically differing perceptions. All parties are typically emotionally aroused. Both parties are usually poorly prepared. We are inclined to confront others when we are angry; emotions eat content for lunch every day. 1,2 Feelings are going to be hurt. Mutual agreement is not likely. A joyful outcome is rarely possible. The aggrieved party will likely hate the confronter’s guts for life. Most of us have limited experience with these kinds of conversations. Most of us put them off too long. 1 Potentially-tough conversations need not be so tough. 2 I challenged a board decision about men visiting in the women’s dorms. 3 Amy challenged me about requiring a cardiologist to do his charts immediately. What makes tough conversations so tough?

5. What are some of the toughest conversations for leaders? Informing a sincere and well-intentioned colleague that he is not capable of doing the job Confronting a colleague who has body odor Telling a colleague that she is not practicing what she preaches Telling a superior the truth he does not want to hear Informing a colleague that she is net-negative Listening objectively to negative feedback Refusing to counterpunch when attacked or falsely accused 1,2 Listening quietly and respectfully to ignorant and stupid people Confronting colleagues about their disruptive behavior Informing upset people that they are over reacting Disagreeing with the group consensus. Speaking openly about “the elephant in the room” 1 Public humiliation is fairly unpleasant. 2 I have even been sued for saying, “Good Morning!”

6. How can you listen effectively during tough conversations? 1 Prepare – Accept that most complainers will be upset. – Expect them to be unreasonable. – Anticipate that they will erupt unexpectedly. – Know that your ability to remain detached will be tested. – Be prepared to insist on a certain amount of professionalism and civility. – Prepare to refuse to listen if the complainant will not behave appropriately. – Anticipate the immediate need for witnesses. Execute – Calm yourself. – Become genuinely curious. – Take notes. – Ask clarifying questions to make sure you understand. – Document evidence of the complainer’s emotional arousal. – Accept the speaker’s feelings. – Resist the urge to challenge the speaker’s perceptions, conclusions and demands. – Agree to investigate. – Insist on time to reflect. – Hold the complainer accountable with follow up documentation. 1 Most of these tough conversations will be angry complaints about others. 2 Containing the outburst will be your greatest challenge. 3 A surgeon complained that the director of surgery would not speak with him when a junior surgeon bumped him.

7. How can you speak effectively during tough conversations? Prepare – Take time to prepare, but don’t put it off too long. – Summarize your position in one simple sentence. – Make notes outlining each point you want to make. – Consider rehearsing your speech with an experienced colleague who will give you honest feedback. – Consider your communication type options and choose the best one. (Face-to-face is usually, but not always, the best way to communicate.) – Review your plan with a trusted mentor. Execute – Calm yourself. – Admit up front that this is a tough conversation to have. – Use notes to stay focused. – State your position in the fewest words possible. – Do not explain excessively. – Avoid all argument. 1,2 – Acknowledge the reality that your listener may disagree with you or have no interest in what you have to say. – Explain that your silence does not give consent. – Follow up your conversation immediately with appropriate documentation. 1 I decided I had to fire a physician for a pattern of disruptive behavior. 2 In the face of incredible pressure, I declined to explain why.

8. What have you learned? Communication is hard. Tough, mission-critical conversations are especially difficult. Following a leader-tested listening process will help. Complying with a talking checklist will also make these conversations easier. Tough conversations are meant to – Document perceptions, – Clarify expectations, – Suggest behavioral changes, and – Predict consequences. They are not meant to be fun. They are not meant to be perfect. They are meant to produce results. 1,2,3 1 A college professor confronted me about a speech on socialized medicine and changed my life. 2 The toughest conversations are those you have with yourself. 3 A patient with depression was poorly motivated and I required her to get out of bed.

9. Where can you learn more? 1 Patterson, Kerry and Others, Crucial Conversations: Tools for Talking When Stakes Are High, 2002 Patterson, Kerry and Others, Crucial Confrontations: Tools for Talking About Broken Promises, Violated Expectations and Bad Behavior, 2004 DK Successful Manager’s Handbook, 2002. Stewart, Kendall L. and Others, A Portable Mentor for Organizational Leaders, 2003 Recruit a personal mentor and ask for coaching. 1 Please visit www.KendallLStewartMD.com to download related white papers and presentations.

10. questions? Any questions? www.somc.org Safety  Quality  Service  Relationships  Performance