Crucial conversations happen when there are opposing opinions, strong emotions, and high stakes. In order to effect a change and thereby the result, one must have the communication (crucial conversation) as a means, not an end. The goal of crucial conversations is dialogue and avoiding violence and silence. In crucial conversation there are facts that we need to consider:
The principles of crucial conversation include:
“Purpose” returns us to the goals discussed earlier. If people feel they are being manipulated, that you’re trying to win or look good, you want to punish them, etc., you can forget honest dialogue. What you’ll get is silence or violence. One strategy to get to mutual purpose is to commit, recognize, invent, and brainstorm (CRIB).
In this principle, there are five skills (STATE):
|Is it too forceful?||Is it too tentative?|
|“The fact of the matter is...”||“In my opinion…”|
|“That’s a dumb idea.”||“Maybe it would make more sense to…”|
|“The only reasonable option is to…”||“I believe that what we should do is…”|
|“If I agreed with you, then we would both be wrong.”||“I’m wondering if that example applies to us.”|
|Ask to get things rolling||"What's going on? I would like to hear your opinion, let me know if you see things differently."|
|Mirror to Confirm Feelings||Hint that emotions are inconsistent with words. "You seem ___."|
|Paraphrase to acknowledge the story||"Is it that you're feeling ___ because of ___?"|
|Prime when you're getting nowhere||Pour meaning into the pool so others will do the same.|
Crucial conversations involve opposing opinions, strong emotions, or high stakes. They're particularly common when discussing issues with patients and families, working out problems with other nursing staff, or discussing hiring more staff with human resources. In order to master these conversations, there are several principles.
First, it's important to get unstuck. To do that, think of content or a single instance of a problem, pattern, meaning a recurring problem that develops, and relationship or how the problem affects your ability to work with others.
Another principle is starting with the heart, meaning starting by clarifying your motives and then staying focused on that. It's also important to learn to look for signs that others feel unsafe in the conversation like silence and violence.
The most common forms of silence are masking, which refers to selectively showing opinions, avoiding, meaning not addressing the real issues, and withdrawing or exiting the conversation. Violence can present as controlling, labeling, or attacking others.
The sooner you notice these, the sooner you can make it safe. People feel safe when there's a mutual purpose and mutual respect. To achieve mutual purpose, commit to seek a common outcome. Recognize the real purpose behind the strategy. Invent a mutual purpose. And brainstorm new ideas.
For mutual respect, it's important to master your stories. To do that, separate objective facts from stories which involve judgment or associations. Next, watch for clever stories. These include victims stories like saying it's not my fault, I'm innocent, villain stories like it's all your fault, and helpless stories like I can't do anything. To turn these into useful stories, just tell the rest of your story.
Another important principle for mutual respect is stating your path. For this, share your facts. Tell your story. Ask for others' paths. Talk tentatively. And encourage testing or opposing views.
Next, explore others' paths by asking others to tell their stories. A nice way to do that is, please let me know your opinion on this. Mirroring to confirm feelings that are inconsistent with words is also useful. An example is, you say you're OK, but by your tone of voice, you seem upset. Paraphrasing to acknowledge others' stories can be done by saying something like, let's see if I got this right. You're upset because I voiced my concerns about your reliability. And if nothing else works, prime or pour meaning into the pool so others will do the same.
Finally, to turn crucial conversations into action, ask who, and assign a name to each responsibility, does what to define the exact responsibility, by when, establish the deadlines, and how will you follow up-- schedule a follow-up conversation.
Knowing that a conflict is at hand, it is beneficial to know how you manage your stress so that you can be objective in handling that situation and have a chance to improve your skillset. Crucial conversation has a self-assessment that assesses your style under stress. This will be an excellent activity for you to know how you are at handling stress.
Authored by Solimar Figueroa, PhD, MSN, MHA, BSN, RN, P-PCA
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