Difficult Conversations

This resource guide is based on the webinar given by Dr. Robert Steele on December 7, 2021, at the Center for Optimizing Rural Health. The goals of the presentation are to describe pieces of difficult conversations, discuss common styles of conflict, and convey strategies that improve the delivery and outcome of difficult conversations.

What is Conflict?

Conflict is present in different ways, to different degrees, and in nearly all situations (work, home, friends). Though conflict is probably necessary for growth, the stress caused by conflict can make difficult conversations even harder. Systems can be implemented in your healthcare facility to navigate these situations better. When conflict is managed well, moving “forward” is more manageable. Contrarily, sub-optimal handling of conflict can lead to issues festering further.

Difficult Conversations

The Elements of a Difficult Conversation

• Opposing Views
• Emotions- Usually Negative
• Differing Degrees of the Importance of the Problem to Each Party

5 Common Modes of Conflict

• Withdrawal/Avoidance
• Directing/Competing
• Smoothing/Accommodating
• Compromising
• Collaboration/Problem Solving
• There is no “right” way to deal with difficult conversations, and some situations may require multiple strategies to diffuse the situation.

Major Conflict Styles Based on the “5 Common Modes of Conflict”

Managing Conflict in 5 Steps (PATSS)

1. Prepare- for the discussion by thinking about your approach and examining your feelings (be intentional!).

• • Think about your Positions vs. Interests (discussed later in this guide)
  • Think about the power dynamics at play

2. Ask- for their (and listen to) side of the story.

• • Consider more your Positions vs. Interests
  • Look for the ladder of inference (discussed later in this guide)
  • Use reflective listening

3. Tell- them our side of the story.

• • Use neutral or low-intensity words
  • Consider your conflict styles (discussed later in this guide)

4. Summarize- what is currently happening in the situation and come to a mutual understanding, regardless of whether you agree.

• • Preserve the relationship!

5. Seek Solutions- TOGETHER.

• • Generate options

The Ladder of Inference

The ladder of inference can be used to work through problems in a way that mitigates the integration of your opinions into actions you might take—work from step 6 to step 1. Worked-through examples of this strategy can be found here.

1. Take Actions- this underlines the importance of ensuring the conclusions you draw are correct in the context of the situation AND that you do not apply your own beliefs to these situations.
2. Form Beliefs- developing your own opinions of the situation based on the conclusions you draw from the data
3. Draw Conclusions- from the meaning of the data
4. Interpret the Data- determine the meaning of what data you have
5. Selected “Data”- When there is a lot of information on a situation, we tend to “pick” and “choose” data that support our arguments rather than taking everything into account.
6. Observable “Data”- the facts of the situation

Climbing Down the Ladder to Reassess How you Handled a Situation-

• What data did I select?- Did you cherry-pick data, or did you look at all of the data in front of you?
• What assumptions did I make?- Did you assume anything based on your own beliefs rather than data?
• What conclusions did I draw?- Did you draw incorrect or far-fetched conclusions based on the assumptions you made?
• How did those conclusions influence my subsequent observations?

Improving Difficult Conversations

• Separating Interests from Positions
  • Positions– what we want/need/think/feel, drawing a line in the sand, concrete ideas, and those that serve as a basis for debate (i.e., your political party); usually very apparent
  • Interests– the motivations for our positions, needs, desires, concerns, fears, aspirations, and serve as a basis for dialogue; not always as apparent as someone’s positions
    • Low-Intensity Words: concerned, unsettles, puzzled, and frustrated. Using low-intensity words can yield a better response during difficult conversations
    • High-Intensity Words: mad, angry, shocked, and disappointed. These words can elicit strong responses from the person you are talking with.
• Separate the Person from the Problem
  • Listen Carefully- Ask and Listen reflectively/actively to the other’s perspective: consider any assumptions you might make or existing emotions you feel. Respond with compassion.
  • Relationships can color discussions (and vice-versa): our perceptions of someone or a situation can become a reality. Considering facts rather than emotionally reacting can reduce the intensity of your words. Ask questions to understand their interests better.
  • Identify what about this conflict is process-based versus people-based.
    • Process-based: system problems can become personalized as someone’s fault. Are they doing what they think the system wants from them rather than what YOU think they should be doing?
    • People-based: problems that an individual has with the interpretation of instructions or might be dealing with on a personal level
• Build Relationships
  • The Five Dysfunctions of a Team (Lencioni, 2005)
    • The Absence of Trust- the foundation of the remaining dysfunctions
    • Fear of Conflict- the topic of this resource guide- acknowledge conflicts and take the time to handle them correctly
    • Lack of Commitment
    • Avoidance of Accountability
    • Inattention to Results
• Request What You Want Without Demanding
  • Distinguish between what you are requesting versus demanding. Demands can cause someone to rebel or submit.
  • Use positive language to request what you want, such as “I want us to spend more time together” vs. “You should spend less time at work.”
  • Watch the response when the need is not met. It is a demand if the speaker then criticizes or attempts to guilt-trip you. On the other hand, a request shows empathy toward the other person and their needs.