1 I want to meet your leadership needs.

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 masteringthe 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. Why is communication so hard? • 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 1 My cousin explained most of what I needed to know about riding a Harley Davidson ™.

4. What makes tough conversations so tough? • 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.

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 accused1,2 • 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. 1Please visit www.KendallLStewartMD.com to download related white papers and presentations.

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