Posted on Tue, Dec 16, 2014

Since 2010, EmCare has maintained a strong partnership with Studer Group to improve clinical and operational results for our client hospitals. As a result of this partnership, Studer Group has provided access to exclusive content only available on Each month, one of Studer Group's insightful articles will be made available to blog readers. For more information about EmCare's partnership with Studer Group, click here. For more exclusive content, including webinars, learning labs, networking opportunities and more, visit

By: Lynne Cunningham, MPA, FACHE

After spiders, snakes and public speaking, people seem most afraid of having difficult conversations. It doesn't matter if the conversation needs to occur with an employee, peer, boss, spouse or child; we all shy away from these critical communications. Why? It's likely because we don't understand the seriousness of biting the bullet and having the conversation and don't have the skills to have these difficult conversations successfully.

Click here to watch Lynne Cunningham's video!

At Studer Group®, we have three models for difficult conversations which are part of a leaders' toolkit. The key is to learn about the models, practice them, and pick the appropriate model for the situation. More about that in a minute. First, let's look at why it's so important to have these conversations.

One key to having a difficult conversation successfully is to be a good listener. Studies show us that we spend 9% of our time writing; 15% reading; 35% talking and 40% listening. It's time we focus on learning to listen. We need to listen for the tone of an individual's voice in addition to their words and observe their body language. We need to practice active listening.

Now back to the difficult conversation models. The first difficult conversation model is the Impact Messagedeveloped by Studer Group and my colleague Beth Keane. Beth has shared this model with audiences across the country and talks about it in her popular "Spinach in your Teeth" webinar. There are four steps to this model:

  1. Describe the behavior
  2. Describe the impact
  3. Indicate the desired change
  4. Get a commitment

When using this model for a difficult conversation, it can sound like this:
  • When you interrupt me while I'm talking...
  • The result is that I don't feel as if I've been able to explain myself adequately
  • I need you to let me finish before you respond
  • Do you agree that you can do this?

This model is ideal for a leader-to-employee conversation, a conversation between a team or committee chair and a member of the committee, or between colleagues.

The second model is "Cup of Coffee Conversations" which is based on research and curriculum developed by the Center for Patient and Professional Advocacy at Vanderbilt University. Although the model was originally developed for conversations with physicians, it is easily adapted to all employee groups and is a conversation that can be held with peers, employees, or even your boss. Many organizations utilize this model and have made it their own, such as "Cup of Tea" or a "Glass of Pop/Soda" conversations.

A "Cup of Coffee Conversation" is typically precipitated when you see or hear a colleague exhibiting behaviors that are contrary to your Standards of Performance or Behavior. This is a conversation that occurs at the time you witness the behavior to make the individual aware that their behavior is not consistent with your standards.

Start by telling them you value them as a colleague or appreciate their skills. Then let them know you heard or saw something that was uncharacteristic and not consistent with your Standards. For example: "Donna, let's go have a "cup of coffee." I noticed that you didn't wash your hands when you entered the patient's room. This doesn't live our values or standards and is concerning to me." Then pause – thus the cup of coffee – and take a sip.

The typical reaction from the person is appreciation for bringing this to their attention. If they deny or justify the behavior, be patient and ask them to "look in the mirror." You're not telling the person they are "bad"; you are merely relating what you experienced.

The third model is the Low Performer conversation. This is part of Studer Group's highmiddlelow® evidence-based leadership tool and is designed for use with someone who persistently demonstrates inappropriate behavior that is inconsistent with policies, procedures, Standards or other work rules. This is a conversation that typically a leader would hold with an employee on their unit or team.

Start the conversation on a serious and professional note. This is probably a conversation you've had with this person before and performance hasn't improved. Then use the DESK model:

D: Describe what has been observed.
E: Evaluate how you feel.
S: Show what needs to be done.
K: Know the consequences of continued same performance.

With proper training and skill building in the non-threatening Leadership Development Institute or team meeting environment, leaders and staff can successfully have difficult conversations using these models. One method for experiential training is to role play in triads with one person being the conversation initiator, one person is the individual you're having the conversation with, and the third person is an observer who provides feedback to the first two people. Then rotate so everyone gets a chance to play each of the three roles. Use real scenarios that individuals in the LDI or team meeting have created. That keeps the conversation focused on real-life situations and makes sure everyone is serious about the skill development.

Difficult conversations can be uncomfortable, but with training and practice, you too can hold difficult conversations – successfully.

To learn more about conducting difficult conversations, including guidelines, tracking logs and more, visit the Tools tab at

Blog post currently doesn't have any comments.