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Pharmacy Leadership-Crucial Confrontations

By Sara White posted 06-16-2013 10:09

  

As a leader is there someone(s) that you are putting off talking to about difficult but important issues?  Crucial Confrontations by Kerry Patterson, et al is a must read.  I am only going to touch on a few aspects to stimulate you to read the entire book.  Often times our fear of confrontation prevents us from resolving issues and unresolved they can grow into chronic problems.  I kept in mind that if I didn’t handle individual people issues I was being unfair to the rest of my staff. Key points to having these conversations are;

  • I kept in mind that the person was doing what made sense to them and unless I intervened they were going to keep doing it. Rarely do these issues correct themselves.
  • Chose what to focus on by reducing it to a clear sentence before you talk to the person. If you need to dismantle a bundle of problems such as poor performance, bad attitude, uncooperative break them into their component parts and choose the one that has the biggest impact. I found you had to be very specific with examples and if I had observed the example I was able to get the point across.
  • Your behavior during the first few seconds of the conversation sets the tone for everything that follows so you must master your stories which means fighting the natural tendency to assume the worst of others and engender genuine curiosity to ensure that the first words and deeds create a healthy climate.
  • During the confrontation describe the gap between what you expected and what actually happened. Then ask for their input on why it happened and listen carefully to see what the root cause might be such as lack of knowledge, skill, motivation, etc. Then ask what they think it will take to ensue it doesn’t happen again. Jointly agree on a documented plan and be specific about who is going to do what and by when leaving no detail to chance. Stay focused and flexible during the conversation as things may come up that are new to you.
  • Following the confrontation set yourself some check points so you monitor the performance and be sure if they improve you acknowledge it.
  • Your best approach is the first time it happens to talk about it and why it needs to not happen again thus focusing on a single event often it just entails clarifying expectations. The second time it happens you have a pattern and you need to remind the person that we have talked about this before and express your concern that you can’t count on them. The third time means you have lost trust in them so you move into a true crucial confrontation or progressive discipline.

Comments?  A similar great book is Crucial Conversations.



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06-20-2013 13:54

Sara
Another very timely topic for discussion. It ties into your recent “performing under pressure” essay.
As well as providing feedback the elements of crucial confrontations (conversations) are relevant for peer-to-peer discussions. Also for interaction with the boss (coaching up).
As a clinical coordinator I find the tools of crucial conversations helpful in my role interacting with fellow health care providers (physicians, nurses, NP, PA, managers). Issues such as new practices, odd med orders, and non-formulary drugs all fall under this umbrella.
Last March there was an interesting exchange on the Inpatient Care Practitioners discussion blog. It involved when a pharmacist disagrees with a provider over a dose. Several people weighed in with ideas. ISMP had an article in the March 13 2008 issue regarding resolving human conflicts when questions about the safety of medical orders arise. The SBAR approach was reviewed.
The skill of crucial confrontations (conversations) is a tool that can be used on multiple levels and is worth the time invested in learning it.

06-18-2013 11:47

Ron
Thanks for sharing your experience which I also found to be true. These come with being a Leader and while never easy but with experience not as challenging.

06-18-2013 09:04

I've often struggled in my career with confrontation. Initially I avoided it but soon learned as a manager I needed to manage confrontation, not avoid it. When dealt with directly, and correctly, it can be turned in to a positive experience for all involved. At the very least it's a learning experience for all involved. Great overview of a problem I see all too often!