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Page 1: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Crucial Conversations and Crucial Confrontations:

Professional Civility, Student Engagement, And

Patient Safety

Jan Boller, PhD, RN

College of Graduate Nursing

Western University of Health Sciences

Page 2: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Think of a situation….Assess your style

1. On the worksheet provided, write down a recent

situation that called for a crucial conversation or

confrontation. Describe the facts of the situation, your

story of why it happened, and your emotions.

2. Complete one of the following two assessments:

1. Style Under Stress: Crucial Conversations

2. Where Do You Stand: Crucial Confrontations

BollerCrucialConversations/Confrontations 2

Page 3: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Objectives

1. Explore opportunities and reasons for effective

communication in situations of conflict and holding

others accountable for performance.

2. Review and apply core practices and processes of

Crucial Conversations and Crucial Confrontations to a

real situation

3. Utilize the process of improvement as an action strategy

for resolving issues of conflict and accountability.

BollerCrucialConversations/Confrontations 3

Page 4: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Introductions

• Introduce yourself • Why is this important to you?

• One question?

• Jan Boller, PhD, RN • Director, Doctor of Nursing Practice Program/ Health

Systems Leadership

• The Fletcher Jones Foundation Endowed Chair for Nursing Quality and Safety

BollerCrucialConversations/Confrontations 4

Page 5: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

The Golden Circle: Start with Why:

How great leaders inspire action. Simon Sinek. (2011). http://www.ted.com/talks/simon_sinek_how_great_leaders_inspire_action.html

Why (Deep, Limbic, Inspiring, Emotional)

How

What (Cortex, Rational)

BollerCrucialConversations/Confrontations 5

Page 6: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Reducing Preventable Deaths in Health

Care

• To Err is Human (1999)

• Crossing the Quality Chasm

(2001)

• Health Professions Education

(2003)

• Keeping Patients Safe (2004)

• Preventing Medication Errors

(2006)

• Best Care at Lower Cost (2012)

Page 7: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Why Is This Topic Important?

7

Page 8: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

According to the Joint Commission, what was

the root cause of nearly 80% of all sentinel

events between 1995 and 2005?

Com

munic

atio

n errors

Inap

propria

te s

taff m

ix

Insu

ffic

ient

orie

ntatio

...

Lea

dersh

ip fa

ilure

0% 0%0%0%

1. Communication errors

2. Technology failure

3. Misdiagnosis

4. Leadership failure

Page 9: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Silence Kills: The Importance of Crucial

Conversations & Interprofessional

Collaboration

Page 10: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

The “Triple Aim” for Reshaping Health

Care (We’re not there yet.)

• 1. Better care

• 2. Better health

• 3. Lower costs per

capita

10 Shaping Future of Nursing - Boller

Page 11: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Core Competencies: Quality and Safety (Institute of Medicine; www.qsen.org)

Patient-Centered Care

Teamwork &

Collaboration

Evidence-Based

Practice

Quality Improvement

Safety

Informatics

Page 12: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

How: Cultivate a Community of Practice

Us

You

Lave and Wenger

BollerCrucialConversations/Confrontations 12

Page 13: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Definitions & Previews

Definition of Crucial Conversations: (Adapted from Patterson, Grenny, McMillan, & Switzler, 2012, pp. 3-4)

Holding a discussion between two or more people where (1) stakes are high, (2) opinions vary, and (3) emotions run strong, seeking successful resolution and action through respectful dialogue.

Definition of Crucial Confrontations (Adapted from Patterson, Grenny, McMillan, & Switzler, 2012, pp. 4-5):

Holding someone accountable for broken promises, violated expectations, or bad behavior through candid and respectful dialogue in a way that problems are resolved, performance improves, and relationships benefit.

BollerCrucialConversations/Confrontations 13

Page 14: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

When do you know it’s crucial?

Crucial Conversation

• Opinions Vary

• Stakes Are High

• Emotions Run

Strong

Crucial Confrontation

• Broken Promises

• Violated

Expectations

• Bad Behavior

BollerCrucialConversations/Confrontations 14

Page 15: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

You make me so….

BollerCrucialConversations/Confrontations 15

Page 16: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

PREPARATION:

Before the Conversation or

Confrontation

BollerCrucialConversations/Confrontations 16

Page 17: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

START WITH THE

HEART (LIMBIC – WHY?)

What do you really want for yourself, for

others, and/or for the relationship?

Page 18: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Safety: Learn to Look

BollerCrucialConversations/Confrontations 18

Page 19: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Master Your StoryMy Story

See and hear

Tell a story

Feel Act

BollerCrucialConversations/Confrontations 19

Page 20: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Three “Sucker” Stories

1.Villain

2.Victim

3.Hopeless/Helpless

BollerCrucialConversations/Confrontations 20

Page 21: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Villain Stories http://www.youtube.com/watch?v=gwOMfb_-Aqk

BollerCrucialConversations/Confrontations 21

Page 22: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Victim Stories

BollerCrucialConversations/Confrontations 22

Page 23: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Helpless Stories

BollerCrucialConversations/Confrontations 23

Page 24: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Tell the “Rest” of the Story

• My role in the problem

• Reasonable, rational, and decent person

• Wants for me, others, the relationship

• What would you do right now if you really

wanted these results?

BollerCrucialConversations/Confrontations 24

Page 25: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Retell the Story & Path to Action

See and hear

Tell a Story

Feel Act

BollerCrucialConversations/Confrontations 25

Page 26: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Retrace Your Path

Action Feelings Story See and

Hear

BollerCrucialConversations/Confrontations 26

Page 27: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Analyze Performance

Motivation Enable

Self

Pain & Pleasure

Strengths &

Weaknesses

Others

Praise & Pressure

Helps & Hindrances

Things (Environment,

System, Gadgets Data)

Carrots & Sticks

Bridges & Barriers

BollerCrucialConversations/Confrontations 27

Source: Crucial Confrontations, pages 68-76

Page 28: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Prepare to STATE Your Path:

Make it Safe

• Have confidence that you have something important to

say (Why is this important?)

• Have humility: You do not have the whole picture but

can add something to the picture

• Be skillful: Seek coaching so that you can rehearse

what needs to be said in the right way.

BollerCrucialConversations/Confrontations 28

Page 29: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

DURING Holding a Crucial Conversation or Confrontation

BollerCrucialConversations/Confrontations 29

Page 30: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Make it Safe

• Apologize if appropriate

• Contrast

• CRIB

• Commit to seek mutual purpose

• Recognize the purpose behind the strategy

• Invent a mutual purpose

• Brainstorm new strategies

BollerCrucialConversations/Confrontations 30

Page 31: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Share your facts

Tell your story

Ask for other’s paths

Talk tentatively

Encourage testing

STATE Your Path

BollerCrucialConversations/Confrontations 31

Page 32: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Confrontation: Describe the GAP

• State the facts

• What was expected

versus observed

• Tentatively tell your

story

BollerCrucialConversations/Confrontations 32

Page 33: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

BollerCrucialConversations/

Confrontations 33

“The real voyage of discovery

lies not in seeking new

landscapes but in seeing with

new eyes.”

– Marcel Proust

Building Community - Boller 33

Page 34: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

BollerCrucialConversations/

Confrontations 34

Solar Eclipse Seen From the Earth:

Black Sun in India Pedro Ugarte / AFP - Getty Images

Page 35: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Explore Others’ Paths

• Be sincere

• Be curious

• Stay curious

• Be patient

• Encourage others to retrace their path

• Use inquiry skills: When? How? What?

BollerCrucialConversations/Confrontations 35

Page 36: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

AMPP: Four Power Listening Tools

•Ask to get things rolling

•Mirror to confirm feelings

•Paraphrase to acknowledge the story

•Prime when you are getting nowhere

• Tip: Write what you are hearing for better understanding

“Understanding does not equate

with agreement.”

BollerCrucialConversations/Confrontations 36

Page 37: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

37

BollerCru

cialConve

rsations/C

onfrontati

ons

37 Change Jan Bolller

Explore Others’ Paths: Mental Models

Ladder of Inference (Argyris/Senge)

• Actions

• Beliefs & Assumptions

• Conclusions

• Assumptions

• Meanings

• Select Data

• Observations & Experiences

Page 38: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Applying the Science of improvement:

PDSA on Crucial Conversations &

Confrontations

WHAT NEXT?

BollerCrucialConversations/Confrontations 38

Page 39: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Move to action

This is the

easy part,

once you

get to

dialog

• Decide how to decide

• Document decisions

• Follow up

BollerCrucialConversations/Confrontations 39

Page 40: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Make it Motivating and Easy: ABC

A.Agree

B.Build

C.Compare

• Motivate & Enable

• Avoid Charisma &

Power

BollerCrucialConversations/Confrontations 40

Page 41: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Summarizing the Practices of Crucial

Conversations and Confrontations

Crucial Conversations 2-minute Summary

http://www.youtube.com/watch?v=qHRF8q3ltRw

Crucial Conversations 2-minute Summary

http://www.youtube.com/watch?v=-4f-74WbnsU

BollerCrucialConversations/Confrontations 41

Page 42: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

In Other Words: Traveling the “U” [Scharmer, 2008]

OPEN

MIND

OPEN

HEART

STIMULUS RESPONSE

OPEN

WILL

1. Suspend:

SEE with

fresh eyes

TALKING

NICE

DEBATE

DIALOGUE

PRESENCING

2. Redirect:

SENSE from the

field

3. Let go:

Connect to the

Source (Roots)

5. Let it come

forth:

UNLOAD the

unnecessary,

PLANT

your seeds

CRYSTALIZE vision &

intention

6. Enact:

PROTOTYPE: Co-

create strategic

microcosms

7. Embody:

4.

CARRY the

seeds of

future

Generate:

Emotions, Beliefs, Assumptions

BollerCrucialConversations/Confrontations 42

Page 43: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Rapid Cycle

Improvement

BollerCrucialConversations/Confrontations 43

Page 44: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

What Will You Do “By Next Tuesday?”

On the note card, please write down what you will commit

to do “By next Tuesday” to move to better communication

on your situation?

BollerCrucialConversations/Confrontations 44

Page 45: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

References • Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for

interprofessional collaborative practice: Report of an expert panel. Washington, C.S.: Interprofessional Education Collaborative.

• Lave, J. & Wenger, E. (2003). Situated Learning. New York, NY: Cambridge University Press.

• Nelson, E.C., Batalden, P.B., Godfrey, M.M. & Lazar, J.S. (Eds). (2011). Value by design: Developing clinical microsystems to achieve organizational excellence. San Francisco: Jossey-Bass. Chapter 9: Mental Models/Ladder of Inference, pp. 297-301.

• Patterson, K., Grenny, J., McMillan, R. & Switzler, A. (2005). Crucial confrontations: Tools for resolving broken promises, violated expectations, and bad behavior. New York, NY: McGraw-Hill.

• Patterson, K., Grenny, J., McMillan, R. & Switzler, A. (2012). Crucial conversations: Tools for talking when stakes are high. (2nd ed.). New York, NY: McGraw-Hill.

• Scharmer, C. O. (2009). Theory U: Leading from the future as it emerges: The social technology of presencing. San Francisco, CA: Berrett-Koehler Publishers.

• Sherwood, G. & Barnsteiner, J. (Eds.). (2012). Quality and safety in nursing: A competence approach to improving outcomes. West Sussex, England: Wiley-Blackwell.

• Sinek, S. (2011). Start with why: How great leaders inspire everyone to take action. New York, NY: Penguin Books.

• Wenger, E. , McDermott, R., & Snyder, W.M. (2002). Cultivating communities of practice. Boston, MA: Harvard Business School Press.

BollerCrucialConversations/Confrontations 45

Page 46: Crucial Conversations and Crucial Confrontations ... · Crucial Conversations and Crucial Confrontations: Professional Civility, Student Engagement, And Patient Safety Jan Boller,

Crucial Conversations and Confrontations Reference Sheet.docx Page 1

Crucial Conversations and Confrontations Reference Sheet & Worksheet

Jan Boller, PhD, RN The Fletcher Jones Endowed Chair for Nursing Safety and Quality

College of Graduate Nursing Definition of Crucial Conversations: (Adapted from Patterson, Grenny, McMillan, & Switzler, 2012, pp. 3-4) Holding a discussion between two or more people where (1) stakes are high, (2) opinions vary, and emotions run strong and seeking successful resolution and action through respectful dialogue. Definition of Crucial Confrontations (Adapted from Patterson, Grenny, McMillan, & Switzler, 2012, pp. 4-5): Holding someone accountable for broken promises, violated expectations, or bad behavior through candid and respectful dialogue in a way that problems are resolved, performance improves, and relationships benefit.

Definition of Dialogue (Dialog): (From Patterson, Grenny, McMillan, & Switzler, 2012, pp. 23) The free flow of meaning between two or more people. Generative Dialogue: The free flow of meaning that leads to positive and productive results through collective wisdom. (Briskin, A., Erickson, S., Ott, J., & Callanan, T. (2009), The power of collective wisdom and the trap of collective follyThe power of collective wisdom and the trap of collective folly. San Francisco, CA: Berrett-Koehler Publishers, Inc. Independent Study – These are useful references that faculty can provide to students as preparation for introducing

Crucial Conversations and Crucial Confrontations. Read and reflect on 2 or more of the following:

a) Wenger summary on Communities of Practice: A Brief Introduction. Accessed from: http://www.ewenger.com/theory/

b) Banja Interview regarding Medical Arrogance and Impact on Medical Errors c) Patient Safety: Josie King video: http://qsen.org/videos/the-josie-king-story/ d) Patient Safety: Lewis Blackman video: http://qsen.org/videos/the-lewis-blackman-story/ e) AACN Creating Healthy Work Environments:

Silence Kills: http://www.aacn.org/WD/Practice/Docs/PublicPolicy/SilenceKillsExecSum.pdf

Silent Treatment: http://www.silenttreatmentstudy.com/Silent%20Treatment%20Executive%20Summary.pdf f) Patterson, K. Grenny, J., McMillan, R. & Switzler, A. (2012). Crucial conversations: Tools for talking when stakes

are high. (2nd ed.) New York, NY: McGraw-Hill. View 2-minute introduction at: Crucial Conversations Skills: http://www.youtube.com/watch?v=qHRF8q3ltRw

g) Patterson, K., Grenny, J., McMillan, R., & Switzler, A. (2005). Crucial confrontations: Tools for resolving broken promises, violated expectations, and bad behavior. New York, NY: McGraw-Hill. View 2-minute introduction a: Crucial Confrontation Skills: http://www.youtube.com/watch?v=-4f-74WbnsU

PreAssessment/Preparation a) Crucial Conversatoins: Complete your Style under Stress Inventory: http://rleeconsulting.com/wp-content/uploads/2011/11/Style-Under-Stress-Survey.pdf. (Also see PDF provided). b) Crucial Confrontations: Complete the Crucial Confrontations: Where Do you Stand? Self Assessment. http://cms.vitalsmarts.com/d/d/workspace/SpacesStore/5a76c335-a53a-4cb4-9c6b-e76bb1d7f539/Where%20Do%20You%20Stand%20Assessment.pdf?guest=true

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Crucial Conversations and Confrontations Reference Sheet.docx Page 2

Crucial Conversations/Confrontations PDSA Worksheet

During this session, you will be asked to address the following questions as you prepare for your crucial conversation and/or confrontation.

PHASE I: PRE-INTERVENTION 1. Describe a recent (or pending) situation where you had (or need to have) a crucial confrontation or conversation. Describe the facts of the situation, your story of why it happened, and your emotions. 2. What do you want to happen based on your pending conversation? (Chapter 2, Crucial Conversations) a. For yourself b. For the other person c. For the relationship 3. What do you NOT want to happen? Avoid the “Sucker’s Choices”: 1. I am the victim or they are acting like a victim. 2. They are the villain; 3. It’s

hopeless. Nothing can be done. 4. What do you think are the safety issues here? (Chapter 4, Crucial Conversations) a. For the other person b. For yourself c. Ultimately for patients 5. Is this important enough to have a crucial conversation? a. What are the good reasons to have this conversation? b. What are the good reasons not to have this conversation?

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Crucial Conversations and Confrontations Reference Sheet.docx Page 3

6. Master Your Story: Now, go back to Question #1 and answer the question again. (Chapter 6: Crucial

Conversations; Chapter 2: Crucial Confrontations) a. What were the facts? b. What is your interpretation or story about what why it happened? c. What were your emotions? PHASE II: INTERVENTION 6. Make it Safe (Chapter 5, Crucial Conversations) a. Find a safe place to meet (think about neutral territory) b. Apologize when appropriate (and there’s almost always something you can apologize for!) c. Contrast to fix misunderstanding, eg…”.What I didn’t want to happen or don’t want to happen…..” d. USE CRIB to get to mutual purpose

Commit to seek mutual purpose

Recognize the purpose behind the strategy

Invent a mutual purpose

Brainstorm new strategies

7a. Master Your Story: Stay in dialogue…even when you are angry, scared, or hurt (Chapter 6, Crucial Conversations) & State your Path. (Crucial Conversations, Chapter 6

Share your facts; Tell your story, Ask for others’ paths, Talk tentatively, Encourage testing Path to Action: See & Hear, Tell a Story, Feel, Act Analyze your stories

Get back to the facts Watch for the “clever” stories: Villain, Victim, Helpless, View u-tube: Villain: http://www.youtube.com/watch?v=gwOMfb_-Aqk

Find a new story. 7b. Describe the Gap (Crucial Confrontation, Chapter 3) State the facts What was expected versus what was observed Tentatively tell your story 8. Explore Their Stories and Paths AMPP: Ask, Mirror, Paraphrase, and Prime Ladder of Inference:

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Crucial Conversations and Confrontations Reference Sheet.docx Page 4

PHASE III: MUTUAL DECISIONS FOR ACTION 9. Make it Motivating & Make it Easy (Crucial Confrontation, Chapter 4) ABC: Agree, Build, Compare Motivate and Enable - Avoid Charisma and Power (manipulative and disrespectful to the other) Self: What gives them pain and pleasure Others: Praise and pressure Things: Carrots & Sticks See the Six-Source Diagnostic Questions in Crucial Confrontations (Appendix B) 10. Move to Action (Crucial Conversations, Chapter 9) Decide how to decide (Compliance, Adherence, or Concordance???) Agree on a Plan (Suggest using one-page PDSA worksheet) Follow Up. See PDSA Worksheet on Next Page In summary: Crucial Conversations u-tube: http://www.youtube.com/watch?v=qHRF8q3ltRw Crucial Confrontations u-tube: http://www.youtube.com/watch?v=-4f-74WbnsU Additional recommended references to the PowerPoint reference listing: Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, C.S.: Interprofessional Education Collaborative. Lave, J. & Wenger, E. (2003). Situated Learning. New York, NY: Cambridge University Press. Nelson, E.C., Batalden, P.B., Godfrey, M. M., & Lazar, J.S. (Eds.). Value by design: Developing clinical microsystems to achieve organizational excellence. San Francisco, CA: Jossey-Bass. See PDF on Ladder of Inference. Patterson, K., Grenny, J., McMillan, R. & Switzler, A. (2005). Crucial confrontations: Tools for resolving broken promises, violated expectations, and bad behavior. New York, NY: McGraw-Hill. Patterson, K., Grenny, J., McMillan, R. & Switzler, A. (2012). Crucial conversations: Tools for talking when stakes are high. (2nd ed.). New York, NY: McGraw-Hill. Scharmer, C. O. (2009). Theory U: Leading from the future as it emerges: The social technology of presencing. San Francisco, CA: Berrett-Koehler Publishers. Sherwood, G. & Barnsteiner, J. (Eds.). (2012). Quality and safety in nursing: A competence approach to improving outcomes. West Sussex, England: Wiley-Blackwell. Sinek, S. (2011). Start with why: How great leaders inspire everyone to take action. New York, NY: Penguin Books. Wenger, E. , McDermott, R., & Snyder, W.M. (2002). Cultivating communities of practice. Boston, MA: Harvard Business School Press.

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Crucial Conversations and Confrontations Reference Sheet.docx Page 5

PDSA Worksheet

From: www.IHI.org

Title of the Project: Background/Facts:

1. What are we trying to accomplish? 2. How will we know that change is an improvement? 3. What changes can we make that will result in improvement? PLAN I PLAN TO: MY INTENT IS TO PRODUCE: STEPS TO EXECUTE: DO WHAT WAS OBSERVED? STUDY WHAT DID I LEARN? DID I MEET MY GOAL? ACT WHAT CAN I CONCLUDE FROM THIS CYCLE? WHAT WILL I DO DIFFERENTLY NEXT TIME? AM I READY TO SUSTAIN OR SPREAD THIS IN MY PRACTICE?

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Crucial Conversations and Confrontations Reference Sheet.docx Page 6

The worksheet was adapted from: Dartmouth Clinical Microsystems Academy. (www.clinicalmicrosystem.org). Institute for Healthcare Improvement PDSA Process (www.ihi.org) Nelson, E.C., Batalden, P.B., Godfrey, M. M., & Lazar, J.S. (Eds.). Value by design: Developing clinical microsystems to achieve organizational excellence. San Francisco, CA: Jossey-Bass. See PDF on Ladder of Inference. Patterson, K., Grenny, J., McMillan, R. & Switzler, A. (2005). Crucial confrontations: Tools for resolving broken promises,

violated expectations, and bad behavior. New York, NY: McGraw-Hill. Patterson, K., Grenny, J., McMillan, R. & Switzler, A. (2012). Crucial conversations: Tools for talking when stakes are high.

(2nd ed.). New York, NY: McGraw-Hill.


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