8 Tips for Communicating When the Stakes Are High

By Shelley Simon, RN, DC, MPH, EdD

Running a successful practice requires a broad array of skills including clinical, business, leadership, management, and – probably the most important one of all – communication skills. To be effective with patients, staff, and colleagues, you must be able to engage in meaningful dialogue, addressing not only day-to-day concerns, but also serious issues that inevitably arise. If your tendency is to avoid challenging conversations, you are not alone. Frequently, the cause of such avoidance is either lack of skills or an aversion to conflict and confrontation.

In low-risk situations, communication is easy. It's when the stakes are high that our ability to communicate effectively is put to the test. Asking an employee to run a report or follow up on a supply order is no big deal. Having to tell that same staff member that their performance is subpar (or worse, that you're terminating their employment) is an entirely different story, one that requires high level skills, self-awareness and presence.

High-stakes communication comes in many forms. You may have to deliver a difficult message, ask a tough (or delicate) question, give feedback, or address an unwanted behavior. This type of engagement makes most of us uncomfortable, whether we're dealing with an underperforming staff member, noncompliant patient, or our spouse or significant other. Human beings engage in a variety of unique strategies to address or avoid confrontation and conflict.

Communication: What Not to Do

Here are some common ineffective behaviors that people use when faced with the potential for uncomfortable encounters. Do you or one of your staff members ever do any of the following?

  • Avoid situations by not responding to calls or e-mails, or dodging encounters with someone you're having a problem with.
  • Hold back saying what's really on your mind, come across as ambivalent when you actually have a strong opinion, or say yes when you mean no just to keep the peace.
  • Use sarcasm or jokes instead of taking an issue seriously to get to the bottom of it.
  • Cut people off or change the subject when a conversation doesn't go in the direction you'd like.
  • Become competitive and attempt to "win" or be seen as "right" at all cost, making it hard for the other person to express their views.
  • Become defensive and redirect the conversation toward what's "wrong" with someone, their stance or their style in dealing with an issue.
  • Use sweeping generalizations in an attempt to get your point across or make another person wrong (e.g., "You always ..." or "You never...")
  • Hurl personal insults in an attempt to shut another person down.
  • Be unwilling to look critically at your own position or behavior and how it's impacting the situation.
  • Go silent (or become quietly angry) and justify doing so by concluding that the other person has no clue, will never be open to your point of view, or isn't smart enough or interested enough to participate in resolving the issue.

These types of behavioral patterns may be habitual, unconscious or stress-triggered default styles. At some level, these strategies work or may have worked in the past, so you continue using them without really thinking about whether they are effective. But at what cost? If you are interested in having healthy relationships, less drama in your practice, and more positive outcomes when sticky situations arise, then cultivating effective techniques for engaging in challenging conversations is a skill worth developing.

How can you embrace challenging encounters, rather than avoid them or turn them into arguments? How can you engage under difficult circumstances so that no one walks away feeling lousy about the exchange or the outcome? How can you learn to effectively solve problems, create mutual understanding and shared purpose, and maintain quality relationships? Here are eight tips that will help.

8 Tips for Effective Communication

  1. Determine exactly what you are addressing. Are you dealing with an isolated event, a pattern of behavior or a relationship issue? A single incident, such as a patient being an hour late for one appointment, needs to be addressed, but not in the same way that you would deal with a patient who has missed three appointments over the course of one month. Or with an employee, is the issue at hand related to a habitual pattern that is causing problems, or has something occurred over time that has soured a relationship that now needs to be repaired? The nature and severity of the issue will determine, in part, how the conversation should be framed and how it unfolds.

  2. Know your purpose for having the conversation. When approaching what could be a challenging or confrontational dialogue, it's important to know why you're having the conversation and what you desire in terms of an outcome. Going into a discussion, ask yourself what you hope to accomplish. What is your intention or goal? Do you need a definitive answer on an issue? Is an apology in order or expected? Does clarity need to be brought to an issue that has become confused? Do you just need to clear the air? Stay focused on and true to the purpose of the conversation, even when your buttons are being pushed or emotions run high.

  3. Choose the right time and place. Trying to resolve a difficult issue when neither party can devote their full attention to the conversation (in the middle of a hectic day at the office, for example) is a recipe for failure. Set aside enough time and choose an appropriate venue to engage in any demanding dialogue. At the outset of the conversation, ask if this is still a good time for the other person to talk. Gaining this "permission" commits both parties to the conversation. If, despite your best efforts, it becomes apparent during the course of the meeting that the timing really isn't right, be prepared to step back and address the issue later. Sometimes, retreating to neutral corners for a cooling-off period is the best path. Just don't stay in your own corner, hoping that the issue will somehow magically disappear.

  4. Maintain a positive environment. It can be especially difficult to deal with anger, silence, tension or resistance on the part of a staff member or patient. When someone you need to have a conversation with takes one of these stances, you may feel like you're in the dialogue alone. Dealing with an individual who is highly sensitive, defensive, or already "knows it all" also presents challenges. When these conditions are present, conversations can become emotionally charged in short order and result in an unsatisfactory resolution, or no resolution at all. To avoid having an encounter go south, do your part to maintain a positive environment. Use your best listening techniques, acknowledge what the other person is saying as they go along, and don't interrupt. If the conversation takes a negative or overly emotional turn, acknowledge that fact and try to direct that energy toward a useful purpose.

  5. Strive for mutual understanding with heightened awareness. Engage your compassion gene at the highest possible level and remember that the challenging conversation is as difficult for the person you're speaking with as it is for you. Go in assuming that you have something to learn. Don't presume that you know what someone else thinks or how they feel in a given situation. Listen carefully, ask questions, and observe your own thoughts as they pass through your mind over the course of the conversation. Stay fully present.

  6. Separate evidence from interpretation. Having a fruitful conversation requires that all parties involved understand what is being discussed. In a conversation with your office manager, for example, are you addressing the fact the collections have been down for three months running, or your general sense that the practice is not holding its own financially? Or with a patient who questions whether they're achieving results from the course of treatment, are you talking about objective data, or a feeling on the part of the patient that their expectations are not being met? Getting to the core of an issue by separating fact from perception early on during a conversation will result in a more successful (not to mention shorter) dialogue.

  7. Question the question. What does a patient or staff member really want to know when they raise a challenging question or concern? Don't assume you fully understand the nature of a question just because you've heard some variation of it hundreds of times before. Before getting too far into a conversation, and especially before coming to conclusions, dig a little deeper by saying, "Tell me a little more about that" or by simply keeping silent for a few seconds to allow the other person to elaborate. Often times, there is an important or sensitive issue underlying what is initially presented as the primary concern.

    For example, a mother brings in her colicky newborn and tells you as soon as you enter the treatment room that her husband doesn't believe in chiropractic. In this situation, it would be tempting to jump into justifying chiropractic, explaining the efficacy of treatment for colic, or detailing the mechanism by which chiropractic is useful until the mother's eyes glaze over. Instead, set aside the comment about the husband's beliefs, and ask deeper questions to discover what's necessary here. Does this couple really need to hear more about science and/or research, or do they want to know about outcomes they could expect for the baby, and thus for their peace of mind? Or, perhaps the underlying question or concern is more pointedly about the safety of chiropractic for babies and their need for reassurance.

  8. Manage your own emotions. The higher the stakes, the more difficult it is to keep your own emotions under control during difficult conversations. Failing to do so, however, can derail a situation and make matters worse. Becoming angry or defensive, taking what someone says too personally, or going into sulk mode serves no one.

    For example, you might be giving feedback to a staff member about the need for them to improve their overall attitude, only to be met with sarcasm and negativity – the very thing you're trying to address. Instead of flying off the handle ("See, that's exactly what I mean!"), remain calm. Point out to the employee what you're observing about the dialogue, and ask them to assess how the exchange is unfolding from their point of view. Then get back to the issue at hand with a focus on your desired outcome.

Build Confrontational Tolerance for Improved Outcomes

Becoming comfortable with having difficult conversations is not an event, but rather a process. The first step to building confrontational tolerance is simply to reflect on how you typically respond under trying circumstances, and evaluate your own level of effectiveness. A second step might involve asking for feedback from people you trust about how they view your ability to handle challenging or stressful situations. And the final step is practice, practice, practice.

Choose one or two of the tips from this article that seem the most relevant to you and begin experimenting. Every time you engage in a difficult conversation and emerge feeling successful (or at least realizing that the experience was not life-threatening), you'll be more inclined to take a risk the next time the potential for conflict arises. As your tolerance builds and you become more skilled at engaging in high-stakes conversations, you'll find that the results you achieve improve with each encounter.

Click here for previous articles by Shelley Simon, RN, DC, MPH, EdD.

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