Confront the elephant

Confront the elephant

Life is one extended conversation, but are there talks you're not having? Learn to lay issues on the table and push that pachyderm out of your practice and your life.
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Mar 01, 2008




Hem and haw, dance around the issues all you like, but first acknowledge this simple truth: Practices derail when people don't say what they're thinking. So ask yourself how often you say things you don't mean. "I'm fine." "No, that didn't bother me." How many meetings have you attended where the real issues weren't being discussed? These are signals your team needs to have more fierce conversations.

So what is a fierce conversation? Think passion, integrity, authenticity, collaboration—think practice or cultural transformation. Sounds pretty good, doesn't it? And amazingly, the right conversations can help you get there.

Where are you today?

Take a few minutes to evaluate where you are. Practices that successfully tackle fierce conversations can focus on results. These teams agree on goals and priorities, and they collaborate and execute change. When fierce conversations don't happen, the team's focus shifts to activities. Initiatives stall, and there's an "us versus them" or "me versus you" culture.

Here's a quick look at the four types of fierce conversations:

1. Team conversations. These are frictionless debates that interrogate reality and ignite dialogue around clarifying goals, solving problems, and evaluating opportunities. The result: impeccably executed decisions for the practice. For example, "This March, we're going to focus on presenting estimates for dental exams. Our goal is to increase dental exam compliance by 15 percent."

2. Coaching conversations. Fierce coaching conversations engage people to increase clarity. They improve understanding, provide impetus for change, and encourage professional development, project advancement, and accelerated results. These conversations address positive or negative behavior. Tell the team member what he or she did, offer your response, and explain how the behavior affects the business. For example, "You arrived late today. That frustrates me because when you're late, the team can't complete necessary tasks before appointments begin." Coaching conversations are successful when employees take responsibility for their job performance.


Fig. 1
3. Delegation conversations. These conversations assign and clarify responsibilities and raise the level of personal accountability. If you're the delegator, explain team members' new responsibilities and how you'll measure their performance, then create an action plan. For example, you might say, "Inventory is now the team's responsibility, because we all need to help manage drug and supply costs to control them. Here are your individual responsibilities."

Then you're freed to assume more complex decisions. For every task, ask yourself, "Who can assume this task and free me to accomplish something no one else can?" If you're the team member who receives the extra responsibility, this opens a new path for growth.

4. Confrontation conversations. These discussions engage people to successfully resolve attitudinal, behavioral, and performance issues. We name and address tough challenges, we provoke learning, and we enrich relationships.


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If you're a manager, you might initiate this conversation when you notice unacceptable behavior. "I witnessed your conversation with Sarah. I observed you rolling your eyes. Is that the message you wanted to send?" Then the team member should acknowledge her behavior. If she doesn't, you'll say, "Maybe you didn't intend to be rude, but that's the message you sent. Your behavior isn't in line with our practice's core values. If it occurs again, you'll face the consequences outlined in the employee handbook."