Crucial Conversations Tools for Talking When Stakes Are High (15 page)
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Authors: Kerry Patterson,Joseph Grenny,Ron McMillan,Al Switzler
Finally, as is the case with most complicated problems, don't aim for perfection. Aim for progress. Learn to slow the process down when your adrenaline gets pumping. Carry a few of the questions we're suggesting with you as you go. Pick the ones that you think are most relevant to the topic at hand. And watch yourself get better a little at a time.
My Crucial Conversation: Dr. Jerry M.
On Monday, a woman was admitted to my hospital for same-day, vascular bypass surgery to repair a painful extremity below the knee that wasn't adequately circulating blood. She lived in Mississippi and had traveled two hours to Memphis to see a doctor. The
surgeon skillfully performed the procedure and the outcome was excellent. The next day, the patient and her husband were deliriously happy because the terrible pain in her foot was gone.
The case manager and physician had tentatively agreed that if everything was fine, the patient could be discharged Thursday afternoon. As the patient continued to improve, the case manager made arrangements for a Thursday discharge.
On Thursday morning, the case manager told the patient's husband to come and pick up his wife, unaware that the doctor had written the following note:
Patient doing fine, foot warm, pulse excellent, patient stable. Plan: Discharge Friday A.M
.
Seeing the note, the case manager attempted to reach the surgeon and finally contacted him late that afternoon as he frantically rushed to his office. Running late he bluntly said, “I need to see this patient before discharge. I won't be in until tomorrow. The patient is not going home today, and that's that.”
Around 3:00 p.m., the case manager contacted me for help. I immediately called the surgeon and began our conversation by praising his success and offering my assistance. I explained that the patient's family had driven two hours to pick her up and she was ready to go.
I offered to do the paperwork while he gave instructions to the couple over the phone, but he persisted, “No. I need to see this patient and I can't be in until tomorrow.” And then defensively he raised his voice, “Is the insurance company putting you up to this? I mean, why are you pressuring me?”
Taken back, I responded by using the Contrasting skill: “Honestly, I don't even know who the payer is. This isn't about the insurance company; this is about meeting the needs of the patient and the family. They've had a wonderful experience. They think you walk on water. They were told they could go home, and I'm afraid cancelling
the discharge could sully an otherwise wonderful clinical outcome.”
Floundering a bit, he responded, “Tell them I'll be in, but it won't be until 7:00.”
Reaching agreement, I promised to communicate his willingness to make a special trip back and personally give instructions. He came in that night, discharged the patient, and avoided tarnishing an otherwise wonderful episode of care.
In the health care environment, crucial conversations are real, they're up front, and they happen all the time. This conversation was successful because I followed two of the quintessential rules: Mutual Respect and Mutual Purpose.
âDr. Jerry M.
Step Out
When others move to silence or violence, step out of the conversation and Make It Safe. When safety is restored, go back to the issue at hand and continue the dialogue.
â¢
Mutual Purpose
. Do others believe you care about their goals in this conversation? Do they trust your motives?
â¢
Mutual Respect
. Do others believe you respect them?
⢠When you've clearly violated respect, apologize.
⢠When others misunderstand either your purpose or your intent, use Contrasting. Start with what you don't intend or mean. Then explain what you do intend or mean.
⢠When you are at cross-purposes, use four skills to get back to Mutual Purpose:
â¢
C
ommit to seek Mutual Purpose.
â¢
R
ecognize the purpose behind the strategy.
â¢
I
nvent a Mutual Purpose.
â¢
B
rainstorm new strategies.
It's not how you play the game, it's how the game plays you
.
How to Stay in Dialogue When You're Angry, Scared, or Hurt
This chapter explores how to gain control of crucial conversations by learning how to take charge of your emotions. By learning to exert influence over your own feelings, you'll place yourself in a far better position to use all the tools we've explored thus far.
How many times have you heard someone say: “He made me mad!”? How many times have you said it? For instance, you're sitting quietly at home watching TV and your mother-in-law (who lives with you) walks in. She glances around and then starts picking up the mess you made a few minutes earlier when
you whipped up a batch of nachos. This ticks you off. She's always smugly skulking around the house, thinking you're a slob.
A few minutes later when your spouse asks you why you're so upset, you explain, “It's your mom again. I was lying here enjoying myself when she gave me that look, and it really got me going. To be honest, I wish she would quit doing that. It's my only day off, I'm relaxing quietly, and then she walks in and pushes my buttons.”
“Does she push your buttons?” your spouse asks. “Or do you?”
That's an interesting question.
One thing's for certain. No matter who is doing the button pushing, some people tend to react more explosively than othersâand to the same stimulus, no less. Why is that? For instance, what enables some people to listen to withering feedback without flinching, whereas others pitch a fit when you tell them they've got a smear of salsa on their chin? Why is it that sometimes you yourself can take a verbal blow to the gut without batting an eye, but other times you go ballistic if someone so much as looks at you sideways?
To answer these questions, we'll start with two rather bold (and sometimes unpopular) claims. Then, having tipped our hand, we'll explain the logic behind each claim.
Claim one
. Emotions don't settle upon you like a fog. They are not foisted upon you by others. No matter how comfortable it might make you feel saying itâothers don't
make you mad
. You make you mad. You make you scared, annoyed, or insulted. You and only you create your emotions.
Claim two
. Once you've created your upset emotions, you have only two options: You can act on them or be acted on by
them. That is, when it comes to strong emotions, you either find a way to master them or fall hostage to them.
Here's how this all unfolds.
Consider Maria, a copywriter who is currently being held hostage to some pretty strong emotions. She and her colleague Louis just reviewed the latest draft of a proposal with their boss. During the meeting, they were supposed to be jointly presenting their latest ideas. But when Maria paused to take a breath, Louis took over the presentation, making almost all the points they had come up with together. When the boss turned to Maria for input, there was nothing left for her to say.
Maria has been feeling humiliated and angry throughout this project. First, Louis took their suggestions to the boss and discussed them behind her back. Second, he completely monopolized the presentation. Consequently, Maria believes that Louis is downplaying her contribution because she's the only woman on the team.
She's getting fed up with his “boys' club” mentality. So what does she do? She doesn't want to appear “oversensitive,” so most of the time she says nothing and just does her job. However, she does manage to assert herself by occasionally getting in sarcastic jabs about the way she's being treated.
“Sure I can get that printout for you. Should I just get your coffee and whip up a bundt cake while I'm at it?” she mutters, and rolls her eyes as she exits the room.
Louis, in turn, finds Maria's cheap shots and sarcasm puzzling. He's not sure what has Maria upset but is beginning to despise her smug attitude and hostile reaction to most everything he does. As a result, when the two work together, you could cut the tension with a knife.
The
worst
at dialogue fall into the trap Maria has fallen into. Maria is completely unaware of a dangerous assumption she's making. She's upset at being overlooked and is keeping a “professional silence.” She's assuming that her emotions and behavior are the only right and reasonable reactions under the circumstances. She's convinced that anyone in her place would feel the same way.
Here's the problem. Maria is treating her emotions as if they are the only valid response. Since, in her mind, they are both justified and accurate, she makes no effort to change or even question them. Besides, in her view, Louis caused them. Ultimately, her actions (saying nothing and taking cheap shots) are being driven by these very emotions. Since she's not acting
on
her emotions, her emotions are acting on herâcontrolling her behavior and fueling her deteriorating relationship with Louis. The
worst
at dialogue fall hostage to their emotions, and they don't even know it.
The
good
at dialogue realize that if they don't control their emotions, matters will get worse. So they try something else. They fake it. They choke down reactions and then do their best to get back to dialogue. At least, they give it a shot.
Unfortunately, once these emotionally choked folks hit a rough spot in a crucial conversation, their suppressed emotions come out of hiding. They show up as tightened jaws or sarcastic comments. Dialogue takes a hit. Or maybe their paralyzing fear causes them to avoid saying what they really think. Meaning is kept out of the pool because it's cut off at the source. In any case, their emotions sneak out of the cubbyhole they've been crammed into and find a way to creep into the conversation. It's never pretty, and it always kills dialogue.
The
best
at dialogue do something completely different. They aren't held hostage by their emotions, nor do they try to hide or suppress them. Instead, they act
on
their emotions. That is, when
they have strong feelings, they influence (and often change) their emotions by
thinking them out
. As a result, they choose their emotions, and by so doing, make it possible to choose behaviors that create better results.
This, of course, is easier said than done. It's not easy to
rethink
yourself from an emotional and dangerous state into one that puts you back in control. But it can be done. It should be done.
Where should Maria start
? To help rethink or gain control of our emotions, let's see where our feelings come from in the first place. Let's look at a model that helps us first examine and then gain control of our own emotions.
Consider Maria. She's feeling hurt but is worried that if she says something to Louis, she'll look too emotional, so she alternates between holding her feelings inside (avoiding) and taking cheap shots (masking).
As
Figure 6-1
demonstrates, Maria's actions stem from her feelings. First she feels and then she acts. That's easy enough, but it begs the question: What's causing Maria's feelings in the first place?
Figure 6-1. How Feelings Drive Actions
Is it Louis's behavior? As was the case with the nacho-mother-in-law, did Louis
make
Maria feel insulted and hurt? Maria heard and saw Louis do something, she generated an emotion, and then she acted out her feelingsâusing forms of masking and avoiding.
So here's the big question: What happens between Louis acting and Maria feeling? Is there an intermediate step that turns someone else's actions into our feelings? If not, then it has to be true that others make us feel the way we do.
As it turns out, there
is
an intermediate step between what others do and how we feel. There's always an intermediate step because actions themselves can't and don't cause emotional reactions. That's why, when faced with the exact same circumstances, ten people may have ten different emotional responses. For instance, with a coworker like Louis, some might feel insulted whereas others merely feel curious. Some become angry and others feel concern or even sympathy.
