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 Crucial Conversations

        Communication is the foundation for everything that goes both right and wrong in the world today. We are taught to use words not fists from a very young age. As a parent, we teach our children to settle conflict through communication. As a healthcare provider, we reiterate how important good communication is to elicit cooperation from our patients and their family members. As an employer, we try to use transparency and communication to evoke cooperation among our employers. It is very easy to say, just talk it out. What they don't tell you is that not everything we need to talk about is easy. I am willing to bet that anyone that has ever had to have a conversation in life has at many points found themselves in the middle of a crucial conversation.  This is the intersection of opposing opinions, strong emotions and high stakes combined as defined by Grenny et al.


Learning to navigate these conversations with style, confidence, and grace in order to not spark the flame of discontent and anger can be challenging to say the least. Grenny et al has created a useful guide in order for you to have these crucial conversations.

  •   Start with the heart!- Be sure to begin with the end in mind. Do not let your passion for the subject change your motive. It is more important to accomplish the goal than to be right.

    • What do I want for myself?​

    • What do I want for others?

    • What do I want for this relationship?

  • Master my story- If emotions have you stuck you may have to try these steps (Patterson,2022,p104)

    • Retrace your path-examine your behavior, put feelings into words, identify your story, separate fact from fiction, watch for clever stories.​

    • Tell the rest of the story-Be reasonable, figure out what you really want and own your role in the problem.

  • Learn to Look!- Pay attention to yourself and the person you are talking to ensure that the conversation doesn't go off the rails. Sometimes passion makes you and others begin to feel unsafe and they may respond with silence or violence.  Actively look for when this could be happening and stop and make it safe again before you resume.

  • Make it safe-​ If people feel safe, they will tell you anything. If you notice that the emotions have heated up (violence) or the other person has shut down (silence) then it is time to  stop and make it safe again Don't sacrifice purpose or respect just to win. They have to believe you care about them (mutual respect) and you care about their concerns (mutual purpose) (Patterson,2022,p. 135. So, apologize if necessary, contrast by restating what they think you are saying with what you are intending to say or create a mutual purpose by using the CRIB method.(Patterson, 2022, pp. 148-152)​​

    • CRIB Method

      • Commit to seek mutual purpose

      • Recognize the purpose behind the strategy

      • Invent a mutual purpose

      • Brainstorm new strategies

  • STATE my path-If you are convinced you are right and think you may not be able to objectively communicate then STATE your path (Patterson,2022,p186)

    • Share the facts​

    • Tell your story

    • Ask for others' paths

    • Talk tentatively

    • Encourage testing-make it safe for different opinions

  • Explore others' paths

    • Ask-express interest​

    • Mirror-acknowledge their emotions

    • Paraphrase-restate to show you understand

    • Prime-Take your best guess at what they are thinking

    • Agree-agree out loud when you share views

    • Build-build on those shared views

    • Compare-compare your two views

  • Retake your pen- reminding yourself that you control your emotions when receiving difficult feedback.

  • Move to Action- Once you have made a decision you must move to action (Patterson, 2022, p244).

    • Decide How to Decide-​

      • Command- Decision does not include others​

      • Consult- Ask others for input

      • Vote-decide parameters to pass the decision

      • Consensus- Everyone supports the final decision

    • Finish Clearly​

      • Who does what by when​

      • Deliverables made clear

      • Schedule follow-up

      • Record commitments and follow-up

      • Accountability

Although there are many steps to having a crucial conversation effectively, it is the constant practice of these steps that will transform you into a leader that can communicate the difficult issues with ease.  It is also a key element in becoming a self-differentiated leader as discussed in Friedman's Theory of Differentiated Leadership Made Simple. The key is to not be emotional in difficult situations when the emotion can infect the group.  As the leader, it is imperative to move your people to action even if they don't all agree with the action that is needed. Giving them a voice to get their feelings and story out. In healthcare, emotions are typically high because frequently decisions can be life or death. I will be using this methodology to implement my innovation plan because with all change comes pushback. Pushback happens in my program because we do things well already by most standards and people don't like change. Change always seems to ignite emotion and anxiety even when the change is considered a good move by most. Using these strategies will be key to a smooth transition. 


Bardwell, M. (2010, November 10). Friedman’s theory of differentiated leadership made           simple. Youtube. Retrieved April 28, 2023, from    v=RgdcljNV-Ew

Grenny, J., Patterson, K., McMillan, R., Switzler, A., & Gregory, E. (2022). Crucial                       Conversations: Tools for talking when stakes are high. McGraw Hill.

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