So what we know is that at the heart of almost all chronic problems in our organizations
- in our teams, in our relationships - at the heart of almost all chronic problems are
crucial confrontations we're either not holding or not holding well.
There are issues we haven't stepped up and addressed.
So we've done this research across many many different problem areas.
Health-care, for example.
We went to health care organizations then asked the question “Are there chronic problems
here?”
And it turns out there are.
Patient safety problems, we have problems with mistakes and near mistakes, year after
year, that kill literally tens of thousands of people in the United States.”
And we wondered, “Is there something at the heart of that that we're doing that is
perpetuating these problems?”
Turns out there is.
It turns out that about eighty percent of health care workers say they work regularly
- hold your breath here - they work regularly with people they would describe as incompetent.
You think that would create problems?
We found it does, but that's not the problem.
The problem is not that we have people that work with those that they judge as less than
competent at times.
For example we worked in an emergency room one time where they said “there's a nurse
here who is terrible at assessing patients.”
Now what are they doing emergency rooms?
I know this, right?
We assess patients and we try to treat diagnose and so on.
They said “this nurse is terrible at assessment” and I said “Well play that out for me - Tell
me how this works out.”
This nurse said “Well just the other day I walked through the the hospital I saw that
she was in a treatment room with one of the little children here in the hospital.”
She is in a pediatric hospital.
She said “I walked by and I noticed she was checking him and later on when I came
back I saw her coming out of the room.
And so I stop.
When I said ‘how's the little boy doing?’”
This is the first sign of problems.
If in your organizations you have people double checking other people's work.
It's a sign that you haven't resolved the real issue.
She says, “How's little boy doing?
The other nurse says ‘I think he’s going to be fine.
I'm moving on to the next patient’ she said.
I walked off to start my next assignment and just had that little nagging doubt.”
Second sign of problems.
If you have nagging doubts about people's work, odds are that there is a more chronic
issue you haven't addressed.
She said, “So I went back into the room and I looked for the boy and he wasn't there”
she said.
“I turned around to look and see if he wandered off but then sort of a thought struck me.
I looked over the table and he'd fallen over backwards and had gone into cardiac arrest.
His heart had stopped.
I call for a crash car, we resuscitated him.
The boy was OK, and everything's going to be alright.”
And I said, “So how long has this nurse been working here?”
She said “About a year and a half” and then I asked her the crucial question.
Here's what we know from our research.
We know that if a nurse in a healthcare organization is judged as incompetent the odds are less
than one in eight that anybody is going to speak up and confront that confidence problem.
Do you think that contributes to errors?
Oh yes.
In fact this is what drives errors in many cases.
If the person judged to be in top it is a doctor the odds are less than one in a hundred
that anybody is going to step up and have the crucial confrontation with that person.
At the heart of almost all chronic problems in organizations are crucial confrontations
people have either not held or not held particularly well.
Now we're talking about health care but this carries on to many many other kinds of organizations
and this is the dynamic.
We asked them the question in these health care organizations - not just “have you
spoken up and dealt with the issue?”
but “how long is this issue gone on?”
With that nurse it was a year and a half.
Look at the statistics with doctors.
Does that trouble you?
Look at how many and how many cases the problems will persist for a year to five years or five
years or longer and how many patients are treated or touched during those intervals?
What we're talking about here is the heart of organizational effectiveness the heart
of personal effectiveness.
And if you in your organizations do not increase your capacity to confront discuss and resolve
these kinds of crucial issues we pay an enormous price year over year over year.
So then we started to ask the question “alright we know these issues have to be addressed
but how do you do it?
How do you do it how do you do it well?”
So we spent over ten thousand hours watching people in the course of crucial confrontations
trying to figure out what they do that makes it either work or not work.
Which ones go well and resolve problems which ones go poorly and end up causing the problems
to worsen or persist.
What we found is there are a handful of skills that you can use that predictably, repeatedly,
and sustainably create positive and effective crucial confrontations.
Here's the first.
If you can learn to do this one, there's almost nothing you can't discuss.
As we watch crucial confrontations we found that you could predict how the crucial confrontation
would end by watching just the first thirty seconds.
We call these the hazardous half minute.
Ever been paralyzed with fear during those hazardous half minutes, ever had that happen
to you?
You just sort of sat there with your mouth opening and closing in not sure what to say.
So we put our microscope on those first thirty seconds when the crucial confrontation came
out well and the first thing we found you have to do is this: is create safety.
Your first job during a crucial confrontation, in fact the job which if you do it well will
give you a ninety seven - write this number down - ninety seven percent probability of
a positive outcome.
You do this one well and so much good follows.
Your job is to create safety.
Let me illustrate what I mean by this.
I have studied this for many many years but there have been a few instances where it sort
of found its way into the marrow of my bones.
Personal experiences I've had.
One of them was a life threatening situation in an airport in Bangladesh.
I spent a couple of weeks there on an assignment and I was exhausted - road weary, anxious
to get back home and I got to the airport in Dhaka an hour and a half before.
I was feeling very very responsible and as I walked into the airport feeling responsible,
feeling confident about my prospects for getting home and everything,I noticed the airport
was just jammed packed with people.
Ever had that happen?
Just a mess, a giant mass of humanity.
And I started looking around a little bit more panicked and I found my carrier and there
are only two people doing check-ins and the line was snaking out the door and I thought
“Oh my goodness”, but I got to the end of the line and and started dragging my bag
forward a little bit at a time and trying to hurry the process along and since I had
nothing else to do I thought I would start a time and motion study.
So I started calculating every five minutes how many people move - counting the people
in line dividing by the minutes left - then and after about an hour in the line, my spirits
started to lift.
I started thinking I may actually make it actually get there.
Well as I was feeling a little bit more confident, a woman comes into the airport pushing a big
giant disorganized cart covered with luggage and shoves her way in line just a few people
up in front of me.
I looked at her and kind of as it's kind of annoying and she's probably going to take
a lot extra time because you've got to reorganize all of her junk there and was feeling a little
resentful about this when the guy that she cut in line right in front of just explodes.
He just goes ballistic.
He screams at the back of her head.
“Get out of line!”
She turns and looks at him and she says “no I'm not going to get out of line.”
And now he says “you get out of line right now!”
She says “Look I've got to make my flight.
My children are going to be waiting for me in San Francisco.
There’s not another flight you could get on for another three days.
Please just cut me some slack and let me stay here in line.”
To which he said “If you want to get in line, you get in line like the rest of us.
You go back to the end of the line.”
She said, “I am not getting out of line!” and turned back around.
Now he yells again at the back of her head, “You get out of line or I'm pushing you
out of line!”
Now she turns looked him full in the face and says, “YOU WILL NOT!”
He steps out of line and he starts to push your luggage cart out of the way.
So she goes to the other side of the luggage current starts to push it back in.
He starts to push, she starts to push, and pretty soon it's getting pretty energetic
and I'm standing back here watching this whole thing escalate thinking “oh my goodness”,
when all of a sudden he pulls his leg out of the way so her luggage cart slides down.
She starts to trip downward he lifts his hand up and starts to swing it down to slap her
on the way down on to the ground.
Now again I'm just a few feet away from this commotion and I looked at my watch and I thought
to myself “I've got nothing better to do.
I think I'll get involved.”
It actually wasn't a conscious process, it was just sort of a reflex.
I rushed forward and positioned myself right between him and her.
Is this good idea?
This is not a good idea, but I don't know what else to do and I didn't want her to get
hit.
And so I'm standing here and this man at first is sort of caught off guard.
He steps back a couple steps and he looks a little bit confused and I thought I had
the element of surprise going for me but he very quickly recovered.
He lifts up both his hands.
His eyes bug out of his head.
His face turns purple.
Is this a crucial confrontation?
Yes!
So here's my question to you.
You're the nurse in this emergency room and have what you believe to be an incompetent
colleague.
How do you start that crucial confrontation right?
You've got a colleague who continually lets you down.
You have a spouse or a loved one who's behaving in ways that are creating problems in your
family.
How do you start that crucial confrontation?
Well let me tell you how you don't start.
My temptation in this situation is to start by diving into the issue.
My temptation is to start by telling my complaint.
That's how we want to begin.
“You screwed it up with that little boy - you almost killed him!”
That’s how we want to begin.
My temptation right now might be to say “Back off buddy, you know you're not going to hit
her.
Just slow down take a breath here.”
What I want to start doing is describing my complaint or concern - wrong place to begin.
We know from our research that if you do that the odds of the crucial confrontation going
well drop precipitously.
So what do you have to do?
Well first the promise.
Here's what we know - what we know from ten thousand hours of observation is something
very very remarkable - something counterintuitive.
What we know is that the riskiness of the issue that you have to address does not predict
your success or failure.
Think about that for a moment.
Most of us labor under the misconception that if something is just too hard to talk about
- if something is just too difficult to discuss - that the conversation just can't go well.
We think the size of the issue that the difficulty of the topic itself is the predictor of success
or failure.
We know from our research, that just isn't true.
How many of you, in your personal lives with a loved one or spouse, have found yourself
arguing over the stupidest most trivial little issue before?
Has that ever happened to you?
Raise your hand if you’re with me.
“How the toilet paper hangs!”
You know, we blow up here.
Whether we should break a one dollar bill or not ,you know it doesn't matter.
Which restaurant we had to go to - some trivial thing can amplify into some huge conflagration.
The size of the issue does not predict your success or failure.
What predicts your success or failure is your capacity to create safety.
Period.
How do you do that?
There are two things you have to do in those first thirty seconds and if you learn to do
these, there's almost nothing you can't discuss.
Your first responsibility is to create what we call mutual purpose.
It's to help the other person know - now please don't miss this - that this isn't a trick.
This isn't a technique.
This isn't a gimmick.
Your first responsibility during that crucial confrontation is to help the other person
know in their guts that you care about their problems.
That's your job.
And if you do that well, I'll tell you what, you'll see if you do that really well you'll
watch them physically do this…They’ll go….ahhh..
And then you start telling them the truth about your concerns and they'll be able to
hear you.
They may not like what you're saying.
They may not agree with what you're saying but they'll be able to hear you.
Your second responsibility is to help make sure, not just that they know that you care
about their problems, but that you care about them.
When they know those two things their defenses drop and they start to hear you.
When they don't believe that, the defenses go up and it doesn't matter what you have
to say - they won't hear it, they won't hear it.
So I'm standing here and his fists are up and his eyes are bugging out of his head in
his face is turning purple.
And the first thing I said to him was “That was unfair for her to cut in line in front
of you.”
He looked a little confused.
I said “You've been standing here in line for over an hour and she comes and cuts in
line and puts your flight at risk I said that's unfair.”
And his hands dropped down.
I said “She cut in line in front of me too.
and that's not working for me either.”
His face turns back to a normal color.
I said “I could get somebody from the airport over here we can try to figure out how to
solve the problem, I think we can make this work,”
His eyes go back into his head.
And what just happened?
Now did I take him off the hook for his misbehavior?
No I didn't.
I'm about to put him on the hook, but I can't put him on the hook until he can hear me.
I can't hold him accountable for what he's done until he feels safe enough to hear me
describe what he's done that isn't working.
Does that make sense?
So now he can hear me and that's when I said - and this was life changing for me - that’s
what I said,
“And sir I can't go ask for help until I have your word that you're not going to hit
her.
You had your hand up, you were swinging down on her,” and I said, “and that's just
wrong.
You don't get to do that.”
Now I don't know that the way I said that was the right way to say that.
But what I want you to hear was his response.
He went like this, “I’m sorry.
I’m sorry.
It's it's been an awful week.”
He said “it's just been horrible.
I've got to get home.”
And then he didn’t even want to look at me.
He tried to look past me to this woman over here and he says, “Ma'am please forgive
me.
I wouldn’t have done anything.
I just I just - this is not me.”
Now here's my question to you.
How safe would you have to feel to be able to publicly admit that you were an idiot?
How safe would you have to feel?
How safe would you have to feel to be able to hear from somebody that you were incompetent
in your job?
How safe would you have to feel to be able to hear from somebody that some of your behavior
was inappropriate or ineffective?
The predictor of your success or failure in a crucial confrontation is not how risky the
issue is, it’s your capacity to create safety.