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How to Have Difficult

Conversations with Learners

Fall Refresher Workshop

November 30, 2017WTCC Halifax

Joan Evans PhD, RN

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I have no conflict of interest to disclose

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• Identify the effects of stress/emotion on communication

• Identify challenges to giving and receiving feedback in difficult conversations

• Describe and practice strategies that manage challenges and create effective learning conversations

Session Objectives

What would you like to take away

from this session?

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Why Difficult Conversations are

Difficult…3 Components

FactsTruth - 3 stories

FeelingsFrustration, anger, anxiety

MeaningsAm I competent/incompetent, liked/not liked?

Self-esteem and identity/ego

(Stone, Patton, Heen, 1999)

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Transforming ‘Difficult’

Conversations

Requires a shift in emphasis from merely delivering a message to…

• Learning about and understanding what has happened from the other’s perspective

• Sharing information and your own perspective

Re-framing Difficult Conversations

as Learning Conversations

Benefits

• Helps us avoid pitfall of making assumptions about what the other person is thinking

• Helps us separate impact from intention

• Prevents or de-escalates conflict

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Communication Skills for

Difficult Conversations

Active listening

• For eliciting and understanding the other’s perspective…not replying

Assertive speaking

• For sharing your own perspective

Feedback skills

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Active Listening Skillsfor understanding the other’s perspective

Clarifying• “I’m not sure I understand, can you explain what

do you mean by…?”

Paraphrasing• “So if I understand correctly, you’re …”

Probing• “What would help your learning?”

Asking open-ended questions

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Assertive Speaking Skills for sharing your own perspective

Use “I” vs “You” statements“I am concerned that you’ve been late for rounds four days this week.” vs “You have been late for rounds four days this week.”

Connect “I” statements with “feeling” verbs

“I feel disrespected when you …”

“I really appreciate that you shared that with me.”

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Feedback

An interactive process that involves the sharing of information for the purpose of guiding learning and future performance

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How Feedback Guides…

CONFIRMS behaviour

by encouraging repetition

CORRECTS behaviourby encouraging change

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Challenges to Giving

Corrective/Negative Feedback

Self-assessment

Emotions

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How Well Do We Self-Assess?

How often does our self-

assessment agree with an

external assessment?

20%

35%

50%

65%

Davis et al 2006)

The Emotions Challenge

We have difficulty hearing & accepting negative feedback, and feedback that does not agree with our self-assessment.

We react emotionally

• Defensiveness, anger, denial, discouragement

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Stress Impacts Our Ability to Process Information

• Process less information

• Process at a lower education level

• Focus on the negative

• Recall what we hear first and last

(Mental Noise Theory)

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In Difficult Conversations…

Trust is Key

We want to know that the other person

cares about us before we care about what

they know or have to say

• Being treated with respect

• Being heard and understood

(Platt & Gordon, 2004)

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Trust Factors (Covello, Centre for Change/Risk Communication)

Low Stress High Stress

Destructive Modes of

Communication

Interrupting

Criticizing

Telling others what to do

Commanding

Moralizing

Arguing

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Feedback Skills

1. Engage the receiver

2. Be supportive - build trust

3. Be descriptive

4. Balance your feedback

5. Coach for change

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Engage the Learner

Get an invitation to talk

Ask the learner to assess their own

performance

Why:

• Establishes a respectful tone

• Identifies differences in perception

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Be Supportive - Build Trust

Empathize

• Be mindful of your body language

• Avoid confrontational and judgmental language:

“Why”“But”“Should”

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Be Descriptive

Comment on specific observations and

behaviors

• Avoid making assumptions

• Avoid overload (1-2 points)

Speak assertively

• Describe how you feel and what you think

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Balance Your Feedback

Comment on what the learner might:

Continue to do

Start to do, or do more often opportunities

Consider doing for

Stop doing, or do less improvement

Avoid the feedback sandwich

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Coach for Change

Establish a plan for moving forward• Discuss next steps

Check understanding

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Case-Based Practice

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Scenario #1 Tasks

1) Engage the receiver

2) Build trust

3) Be descriptive/assertive

4) Balance your feedback

5) Coach for change

Preventing & Resolving Conflict

What’s important…

• Focus on interests/needs rather than positions

• Work towards identifying a common need/interest

• Identify solutions/options

(Lamoureux & Seifert, 2009)

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Reframing Positions:

Interests and Needs

He isn’t trustworthy: I can’t trust him to come to me when he’s in over his head.

Being able to trust a learner is essential for you

She’s unreliable: she’s often late and unprepared.

I need assurance that a learner is reliable, prepared, and always professional

(Lamoureux & Seifert, 2009)

SituationA learner has ignored your feedback

Position• She’s defiant and disrespectful: I know more than a

resident.

Need/Interest• I need to know that my perspective/experience is valued

and respected by learners.

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“I feel that my perspective isn’t valued or respected when your practice doesn’t change after I give you feedback.”

If Your Perspective Isn’t

Being Heard

Two Challenge Rule

• Voice your feeling/assertion at least two times to ensure it has been heard

The Stuck Record Technique

• Continually repeat your feeling/assertion until it is acknowledged

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Scenario #2 & #3 Tasks

1) Engage the receiver

2) Be supportive - empathize

3) Be descriptive/assertive• State your need/concern - repeat as needed

4) Balance your feedback

5) Coach for change• Identify a common interest

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What one thing will you start to

do, or do differently, after

participating in this session?

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A Final Message

The key to effectively managing difficult

conversations is to…

• Anticipate what to expect

• Prepare mentally

• Practice – rehearse

• Envision success

Resources

Lamoureux, H., & Seifert, E. (2009). Resolving

Conflict Improving Communication. A Guide for

Healthcare Professionals. Calgary: Kingsley

Publishing.

Stone, D., Patton, B., & Heen, S. (1999). Difficult

Conversations: How to Discuss What Matters

Most. New York: Penguin Group.

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Thank you!