Career Tools: Preparing for Crucial Conversations

Asking for a promotion. Questioning a process. Pointing out unprofessional behavior. 

These conversations may be more likely to induce sweaty palms than poise, said Ann Brown, vice dean for faculty at Duke's School of Medicine. But they are part of the landscape that all professionals are likely to traverse in any field.

"To maintain an environment where people are comfortable raising concerns about safety, ethics, personal behavior or other professional matters, we have to learn to approach these crucial conversations with confidence and respect," Brown said. "We do ourselves an injustice if we simply ignore them." 

Over the past year, Brown has hosted a series of speakers to offer Duke Medicine faculty and staff practical suggestions on how to approach conversations that have the three characteristics of crucial conversations: high stakes, high emotions, and opposing views. These sessions were part of the School of Medicine's Professionalism Initiative, a development program for faculty and staff within the school. 

Here are some tips offered: 

Prepare and practice. Know the facts and desired outcome before the conversation. "Practice your conversation ahead of time with a trusted friend," said Pam Somers, a senior faculty development consultant at Johns Hopkins University. She offered a "Crucial Conversations" workshop this year. "Once you've practiced, it will feel more familiar when you have the real conversation." 

Be curious. The attitude you take into a conversation is crucial. Somers suggested thinking about how you view the situation and imagining the story the other person may be telling themselves. "Then consider what you are willing to do to create a different story with a more positive ending," she said. Whether the conversation is about changing schedules, asking for additional resources, or confronting worrisome behavior, the idea is to create a safe place for differing opinions to be voiced. 

Acknowledge the other's view. Show respect by paraphrasing the other person's perspective, said Catherine Morrison, an associate faculty member at the Johns Hopkins Bloomberg School of Public Health. In her talk about "Difficult Conversations," Morrison described acknowledgment as similar to WD-40 oil. "It often gets things unstuck," she said.

Allow for more than one reality. "Saying 'you believe this and I believe this' allows the possibility that there is more than one way of seeing things," Morrison said. This can help identify "the third story" - the differences between two points of view - and help focus the conversation on issues, rather than personalities. A discussion about data collection procedures, for example, may be more productive if the focus is on the shared concern of attaining high quality data rather than who is championing any particular procedure.

Be prepared to put on the brakes. Even with preparation, conversations can spiral out of control. Somers, the senior faculty development consultant at Johns Hopkins University, suggested being prepared to ask for a time out if needed. "It's okay to say 'It seems like we are not hearing each other. Can we stop and start over?' " she said.

Anne Micheaux Akwari, a Duke physician who attended a session on Difficult Conversations, said she appreciated the reminder to focus on process rather than emotions. 

"It is all too easy to get personally and emotionally engaged in an issue and forget to step back and analyze what is really going on," Akwari said. "I teach this to medical students and clinicians every year, but it is always good to be reminded of the tools and techniques at our disposal."