how to have difficult conversations with learners...how to have difficult conversations with...
TRANSCRIPT
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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!