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Crucial Conversations QA

No Time for Dialogue

The following article was first published on September 12, 2007.

Dear Crucial Skills,

I am a first-line supervisor at a hospital and was fortunate enough to attend a Crucial Conversations training. I enjoyed it thoroughly and got some good tips on dealing with crucial conversations.

The problem we run into in the hospital is that we do not always have the luxury of spending time on dialogue when a crucial issue arises due to circumstance that require immediate intervention. These often are situational and necessary to prevent less than optimal patient outcomes.

How do we relay this to the people we are communicating with? It is always our goal to keep the trust of our staff members, but often things become clouded with their emotional response to a situation that had to be addressed immediately.

Thanks,
No Time to Talk

Dear No Time,

To begin, I’d like to take a moment to thank you—not only for your question, but for the incredible work that you and your fellow healthcare professionals do each day. Your concern for the patients you care for reminds us all of the best that is in us.

Most of us have seen enough emergency room TV dramas to know that healthcare professionals don’t always have the luxury of time. There are life and death choices that must be made without sufficient information or time for consideration and discussion.

People across numerous industries face a similar problem—not enough time to fully dialogue when, and sometimes because, the stakes are so high. We may find ourselves in positions where we feel compelled to make a decision without enough time or input. In these situations, when dialogue is limited and not every concern can be addressed before acting, team members may feel left out or marginalized. So what do you do when there isn’t time for dialogue?

Let me share a couple of thoughts with you.

First, decide how you will decide ahead of time. Most people typically understand that because of time constraints or pressures, dialogue is not always possible. ICU nurses, anesthesiologists, and respiratory technicians all understand that they will be involved in life or death situations when seconds make a difference.

However, although we realize such situations will inevitably occur, we often do a poor job of planning for them. We don’t set clear expectations around how decisions will be made in those critical moments—will this be a consensus decision with everyone agreeing before we implement it? Are key decision makers merely going to consult with the rest of the team and then announce the decision? Will the decision already be made and be passed on as a command? If we haven’t carefully considered, chosen, and then communicated how we will make decisions in time-sensitive moments, we create situations in which team members feel resentful and undervalued because their input was not considered. By clarifying up front how decisions will be made, and inviting dialogue about the decision-making process before a crisis, we make sure that all team members are confident in the process for handling crises.

Next, never use the refrain “we don’t have time” as an excuse not to dialogue. Most of us are hurtling through life at a pace that would astonish and exhaust our great-grandparents. As we pick up our pace, we tend to overestimate both the time it will take to effectively dialogue and the cost of slowing down. We think, “I just don’t have 45 minutes to sit and talk to her about this,” not realizing that, with effective skills, many issues can be resolved much more quickly.

We also begin to think that if we take the time, the consequences will be severe. When a patient is lying on a stretcher bleeding out, the costs of slowing down are as high as they can get. But, more often than not, we think to ourselves, “I can’t take time for this right now because I have eight patients waiting to be seen and I need to get through in time to pick up my son from soccer practice and make it home in time to change clothes before going to parent-teacher conference night at my daughter’s school.” While occasionally whether or not we have time for dialogue is a factor of our circumstances, it is also often a reflection of our motive. Make sure you’re not making excuses when you should be holding a crucial conversation.

Finally, use your skills for good, not for avoidance. I’d like to make this last important point of clarification. Those who are skilled at dialogue never use their skills to avoid conversations, but rather to hold them effectively. Sometimes that may mean effectively delaying a conversation until a more appropriate time, but it never means dismissing the issue altogether. As people practice and use dialogue skills, they commonly find that they are holding fewer and fewer “crucial” conversations because they handle problems quickly and effectively as they arise, rather than waiting for them to simmer and erupt.

Best of luck,
Emily Hoffman

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Emily Hoffman

Emily has consulted and trained with non profit, start-up ventures, and major national corporations such as Eli Lily and The Chicago Board of Trade. Additionally, Emily has taught finance courses at Brigham Young University and trained corporate clients in Crucial Conversations. read more

4 thoughts on “No Time for Dialogue”

  1. Ms. Hoffman
    As an EM doc in my 4th decade, I can assure you, there is time to talk.
    Several ways: Table tops/practice scenarios; all the experts do these, especially those of us in emergency command.
    Talk while you work. Saying out loud why you are doing something will communicate your intent; that intent is catching and soon team members will think your good ideas are their own good ideas
    Speak reflexively and directly. Say what your observing (I am seeing a blood vessel spurt.) and ask directly (name a name) what you want (Jane, where is that Henway?) and, to close the sale, why (I need it to stop this bleeding.)
    Pretty soon, your team will be ahead of you; how great is that!?

  2. As a veteran, I formerly made life and death “air traffic control” type decisions. Sometimes you HAVE to tell someone to tell people what to do, and they must obey immediately. I spend the rest of my time carefully collaborating with people. As long as I continually make deposits in their emotional bank accounts, they let me “get away with” the ocassional withdrawal.

    Thanks for all that you do.

  3. I read this particular post with great interest as a nurse with 30 years of experience. I have been at the bedside and I have been in leadership roles. I have seen/participated in countless critical life or death events. In healthcare, there is a chain of command – there are licensure and scope of care parameters detailed in state laws. When the stakes are high, that chain and licensure drives some decision making. We look for patterns of poor behavior and/or communication skills with our team members. That is often where we seek to impact change.

  4. I could not agree more with everyone! As a healthcare professional, I find that we often make excuses for not communicating… before, during or after events. May I suggest simple tools for these forums, from an excellent resource, mirroring the sports world in some respects. Briefs (before), huddles (during), and debriefs (after) as tools to structure communication across all team members. Happy to provide the source offline.

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