We do a lot of work in healthcare and we were called into a hospital that was having problems. In addition to high turnover rates with nurses, they had very high infection rates among patients.

It all came to a head when a woman came in for surgery. She’d had a flawless foot amputation. Everything went according to plan. After coming out of surgery her anaesthesia wore off and she looked at her foot and started to scream. The nurse tried calming her down without success. The doctor came in and tried to calm her, but the woman just kept screaming.

When they looked over her medical chart, they realised that she had been checked in for a tonsillectomy, and they had incorrectly amputated her foot. What would it have taken to stop that from happening? What would it have taken to keep this woman from spending the rest of her life with a fake foot? It would have taken just one person speaking up, saying, “this isn’t the right surgery.”

When we went into the hospital, we found that seven people had seen something wrong but said nothing. From the anaesthesiologist wondering “why am I administering these kinds of drugs for this kind of surgery?”, to the nurse’s assistant wondering “why am I putting these knives out for this kind of surgery?”, they still said nothing. Instead, they said to themselves “I don’t want to be the one to have the surgeon yell at me and hold up the surgery – we have five more to go today.”

These well trained, well-educated, and well-intentioned people thought about the cost of speaking up, rather than the cost of staying silent.

What do you do? In that moment, what do you say?

Most of us stay silent. We don’t say anything because we’re thinking about the cost of speaking up. If we speak up, we might draw extra attention to ourselves or you might get the wrath of your boss’s temper. We stay silent.

We rarely think about what the costs are if we don’t speak up. There’s a real cost when we don’t ask ourselves the question, “Can I afford to resort to silence?”

Where To Start

Make it safe. One of the key rules to holding an effective crucial conversation. When we feel safe with those who we are talking to we open ourselves up to be able to speak to them about almost anything. This will help remove defensive reasoning and emotionally charged comments.

Mutual Respect

Making it safe starts by showing respect. The challenging piece here is that often our crucial conversations are with people who have let us down, missed deadlines or behaved badly. We’re not feeling very respectful of them in the moment. So, how do you respect somebody you simply don’t respect?

One of our authors, Joseph Grenny, was sitting next to a gentleman who was a hostage negotiator. He asked the gentleman what he had to do to prepare for something like that.

He answered, “The first thing I have to do is to think about the person I’m negotiating with as somebody’s mother, somebody’s brother, or somebody’s daughter or son. If I can’t find it in my heart to humanise that person and find respect for them, they’ll hear it in my voice. They’ll pick up on the disrespect in the first 20 seconds and hang up the phone without talking to me. I have to find a place in my heart to humanise them so we can actually hold a conversation. I’m not saying that I let these people off the hook or overlook what happened, but to hold them accountable, we need to be able to talk. We can only talk if I can find a genuine respect for them.”

Mutual Purpose

The second part of making it safe is finding mutual purpose. How can we convey that we care about what the other person cares about as well? Again, the challenge here is that often we say, “We don’t want the same things. That’s why we’re struggling here. That’s why we’re in a crucial conversation – we care about totally different things.”

How can we create mutual purpose? How can we find common ground? It might be as simple as saying, “We both want to get out of here by five o’clock tonight.” This is mutual purpose. “Now we both want to do what’s best for our customers.” See? We’re already creating mutual purpose!

When you can do that and combine it with genuine respect, you’re going to be well on your way to making it safe which is absolutely necessary for beginning a healthy crucial conversation. There are many challenges in crucial conversations. If you can make it safe you can talk to almost anyone about almost anything, and be on your way to getting the results to solve your problems.