Courageous Conversations

Original Editor - Carin Hunter based on the course by Jason Giesbrecht
Top Contributors - Carin Hunter and Tarina van der Stockt

Introduction[edit | edit source]

A courageous conversations is thought of to be a discussion that is often difficult and uncomfortable. There are often emotions on both sides of the conversation and and can be awkward, stressful, or challenging situations. Usually the leader has an agenda or a desired outcome that needs to be achieved within the discussion. These outcomes may be a behaviour change, an action, or a change in attitude. The key is to be open, authentic, and honest while maintaining an atmosphere of trust and respect. Majority of people need to have a courageous conversation, find it most difficult to start the discussion off on the right foot or begin well.[1]

The Rehab Leadership Framework[edit | edit source]

RehabLeadership Model.png

According to the Rehab Leadership Framework there are three layers to consider.

  1. Personal values and beliefs. These lie at the centre of the framework. They are fundamental to who we are as humans and influence how we approach leadership situations.
  2. Emotional intelligence. The next key aspect to our leadership effectiveness is emotional intelligence or the way in which we recognise, understand and manage emotions in order to develop or maintain social relationships and cope with challenges[2][3].
  3. Seven leadership skills. On the outer layer of this framework there are seven leadership skills that can be utilised to conduct and effective courageous conversation. These leadership skills are essential to effective leadership in rehab.

The Bar-On EQ-i model by Reuven Bar-On[edit | edit source]

The Bar-On model[4] of emotional intelligence contains five main scales and 15 subscales[5][6][7][8][9].

  1. Self-perception
    1. Self-regard – Respect for oneself, self-confidence
    2. Self-actualization - Pursuit of meaning, Self-improvement
    3. Emotional Self-awareness - Understanding one’s own emotions
  2. Self-expression
    1. Emotional Expression - Constructive and accurate expression of emotions
    2. Assertiveness- Communicating feelings and beliefs in a non-offensive way
    3. Independence - Self-directed, free from emotional dependency
  3. Interpersonal  
    1. Interpersonal Relationships - Mutually satisfying relationships
    2. Empathy – Understanding and Appreciating how others feel
    3. Social responsibility - Social consciousness, Helpfulness
  4. Decision making  
    1. Problem Solving - Finding solutions when emotions are involved
    2. Reality Testing - Objective, see things as they really are
    3. Impulse Control - Resist or delay impulse to act
  5. Stress management  
    1. Flexibility - Adapting emotions, thoughts, and behaviours
    2. Stress Tolerance - Ability to cope with stressful situations
    3. Optimism - Positive attitude and outlook on life

It is important to note that the ideal is to be balanced within each subscale and not necessarily high in every one. Being very high or very low in a specific subscale can lead to dysfunctional behaviour.

Conflict Continuum[edit | edit source]

The principle of conflict is not binary. It occurs on a continuum. When assessing the situation always identify where the situation would likely land on the conflict continuum then consider whether the situation is the right fit for a courageous conversation, or whether a different approach may be required. The leadership approach must match the situation.

  1. Disagreement
    1. Focuses on negotiation and compromise[10]
    2. Coach the disagreeing parties to come to a win-win resolution[11]
  2. Dispute
    1. Shifts approach to that of a mediator than a coach[12]
    2. Try to find common ground between the two opponents by asking questions and making suggestions
    3. Often resolved at this stage and the two individuals find a way to move forward with an agreement
  3. Conflict
    1. Shift into a more directive and less coach-like approach
  4. Crisis situation
    1. The situation could become emotionally, psychologically, or physically unsafe
    2. The leader must be fully directive
    3. May shift into a formal arbitration approach where each of the participants has representation
    4. May or may not be able to stay in the same physical space

Courageous Conversation Calculation[edit | edit source]

All three elements of the courageous conversation calculation contribute to the three-phase journey of the conversation. Our values, beliefs and assumptions, underpin who we are and how we show up in these challenging situations. Our emotional intelligence determines how we cope with these uncomfortable situations. Our ability to skillfully navigate conflict, coach or mentor, and clearly communicate[13][14], dictate our actions and approaches to courageous discussions. These three aspects contribute to the outcome.

Phase 1: Opening the Conversation[edit | edit source]

  1. Name the issue and select examples that illustrate the behaviour or situation that you want to change.
    • If there are multiple issues to address, focus on the most important or the one or two that underpin the others
    • Avoid general accusatory statements such as, "you always", or "you never"
    • Focus on the behaviour in question, supported by an example
  2. Describe how the issue or behaviour has impacted you emotionally
    • The goal is that the other person has a clear picture of the results of their actions
  3. Clarify what is at stake
    • The goal is to make sure that the other person understands why their behaviour and the impact of this behaviour matters
  4. Share responsibility
    • What is your role in this situation or issue?
    • How will you address your contribution to the problem?
  5. Find a solution
    • Describe any changes or contributions you intend to make to resolve the issue
    • Open the conversational door for the other person to share their perspective

Example of an opening to a courageous conversation

"Hi John. Thanks for meeting with me today. I wanted to take a couple of minutes to chat about a concern that I have. In the last three or four staff meetings, I've noticed you and Dan talking and laughing while I'm speaking. Now, although this may not be intentional, this behaviour is disrupting the team meeting and creating a distraction. Now, when this happens, I feel disrespected as though the information that I'm sharing is not meaningful or valued or important. Further, this behaviour impacts my ability to communicate, collaborate, and engage with our team, which erodes team cohesion and could lead to an unclear direction or a miscommunication within the group. Now, I also accept that I could be more succinct and focused in our team meeting. Now in my effort to improve going forward, I will provide our team with a more detailed agenda ahead of time, and commit to being focused and staying on schedule. Now I would like our team meetings to be productive, efficient, and engaging. With that, I'd like to understand the situation from your perspective. How do you see it? What's happening for you in our team meetings?"

Awareness wheel[edit | edit source]

The awareness wheel is a tool to help structure the opening of a challenging conversation. When using the awareness wheel, focus on using "I" statements and avoid using "you" statements. This translates our internal experience into words so that other people can understand what's happening for us. It comprises of a few simple questions to help us understand our unseen internal experiences and prepare for a successful opening of a courageous conversation.

  1. What am I hearing or seeing?
  2. What do I think?
  3. What is my emotional response?
  4. What do I truly want?
  5. What will I do, or what actions will I take to achieve the desired outcome?

Phase 2: Interaction[edit | edit source]

In this phase the main goals are to listen, ask questions or inquire and clarify. If you disagree with with a statement made, resist the temptation to build a stronger case or react. Remember the main goals and dig for understanding. A useful technique to employ is a mirroring technique.

For example:

  • "I hear you saying..."
  • "Do I have that right?"
  • "Please tell me more about this"
  • "I'd like to understand your thinking and how you came to that conclusion"

Phase 3: Resolution[edit | edit source]

In this phase the participants in the discussion come to an agreement on the next steps. Some useful questions before ending the conversation:

  • What have we learned in this discussion today?
  • Where are we now?
  • Has anything been left unsaid that needs saying?
  • What is needed for resolution?
  • How can we move forward from here given our new understanding?
  • What have we committed to?
  • How do we hold each other accountable?

When Things Don't Go As Planned[edit | edit source]

What could go wrong?

  • The other person could refuse to admit there's a problem
  • You could be accused of some wrongdoing
  • They could blame someone else for the issue
  • They could storm out of the room
  • A serious personal problem could be revealed

In these situations, ultimately managing your emotions, staying calm, seeking clarity, and ensuring the space remains safe are your primary responsibilities. Attempt to diffuse the emotions to prevent the conversation from moving further down the conflict continuum unexpectedly. This might require you, to shift your approach to one that is more directive or assertive. It may be necessary to discontinue the discussion and regroup at another time or on a different day. It is important to consider the "what ifs" prior to launching into a discussion, so that when the discussion does go off the rails, you have a plan for that too. .

The Gibbs Reflective Cycle[edit | edit source]

This is a simple tool that can guide you through the reflective process. The answers to these questions in this sequence will help you quickly reflect on the interaction, extract the learnings and prepare for the next time.[15][16]

  1. Describe your situation by asking yourself, what happened?
  2. Reflect back on what you were thinking and or feeling during the interaction.
  3. Evaluate the situation by asking what was good or bad about the experience?
  4. Analyse the conversation by asking what sense can I make of this situation or interaction?
  5. Ask yourself, what else could I have done to achieve a better outcome?
  6. Finally, consider the question, if a similar situation arose, what would I do? .

References[edit | edit source]

  1. Jason Giesbrecht. Courageous Conversations Course Slides. Physioplus 2021
  2. Codier E, Codier DD. Could emotional intelligence make patients safer?. AJN The American Journal of Nursing. 2017 Jul 1;117(7):58-62
  3. Kotsou I, Mikolajczak M, Heeren A, Grégoire J, Leys C. Improving emotional intelligence: a systematic review of existing work and future challenges. Emotion Review. 2018:1754073917735902.
  4. Bar-On R. The impact of emotional intelligence on subjective well-being. Perspectives in Education. 2005 Jun 1;23(1):41-62.
  6. Kanesan P, Fauzan N. Models of emotional intelligence: A review. e-Bangi. 2019 Aug 22;16(7).
  7. Measuring Emotional Intelligence (EQ): A construct comparison between the BAR-ON EQi and the OPQ 32i Report.
  8. Bar-On R. The Bar-On model of emotional-social intelligence (ESI) 1. Psicothema. 2006 Dec 31:13-25.
  9. Bar-On R. The Bar-On model of emotional-social intelligence (ESI) 1. Psicothema. 2006 Dec 31: 13-25.
  10. Rethorn ZD, Pettitt CD. What Is the Effect of Health Coaching Delivered by Physical Therapists? A Systematic Review of Randomized Controlled Trials. Physical therapy. 2019 Jul 16;99(10):1354-70.
  11. Garvey R, Garvey B, Stokes P, Megginson D. Coaching and mentoring: Theory and practice. Sage; 2017 Oct 23.
  12. Bayley H, Chambers R, Donovan C. The good mentoring toolkit for healthcare. CRC Press; 2018 Apr 17.
  13. Guttman OT, Lazzara EH, Keebler JR, Webster KLW, Gisick LM, Baker AL. Dissecting Communication Barriers in Healthcare: A Path to Enhancing Communication Resiliency, Reliability, and Patient Safety. J Patient Saf. 2018 Nov 9. Epub ahead of print.
  14. Iversen ED, Wolderslund MO, Kofoed PE, Gulbrandsen P, Poulsen H, Cold S et al. Codebook for rating clinical communication skills based on the Calgary-Cambridge Guide. BMC Med Educ. 2020;20(1):140.
  15. He KN, Parkinson L, Doyle AK. Gibbs’ Reflective Cycle.
  16. Tawanwongsri W, Phenwan T. Reflective and feedback performances on Thai medical students’ patient history-taking skills. BMC medical education. 2019 Dec;19(1):1-8.