Case Management&

Crucial Communication

Objectives

• Identify the elements of a crucial conversation.• Identify different styles of communication.• Learn generational differences and how that

knowledge can improve your communication.

“We know that communication is a problem, but the company is not going to discuss it with employees.”

- Supervisor, Fortune 100 Company

Definition of aCrucial Conversation

A discussion between two or more people where:

• Stakes are high • Opinions vary • Emotions run strong

Why Increase Your Focus on Communication?

Improved Communication

• Increases customer satisfaction scores.• Decreases patient mortality.• Improves staff perception of:

• Unit conflict management. • Collaboration amongst the team. • Staff quality. • Overall quality of patient care.

The Static of Communication

What causes the static?

Communication that is being delivered is not the same as, or connected with, the message being received.

Causes of Static Communication

• Ambiguity• Confusion• Inconsistency• Conflict• Distrust

What contributes to the static?

Technology that was meant to improve and ease communication has inadvertently created miscommunication.

Barriers to crucial conversation

• PDAs (i.e. Blackberries) used in meetings. • Personal conversations in public areas.• Speaker phones in public areas.• Ringing cell phones.• Co-workers behaviors (loud talking).• Micro-managing.• Public reprimands.• BEING SPOKEN TO IN A CONDESCENDING

MANNER.

Communicating Through Technology

•E-Mail •Cell Phones

•Text Messaging •Pagers

•Voicemail

Communicating Through Technology

• Email• Use of all capitals can be misinterpreted as

being angry.• Misuse of exclamation points• Misspellings - No use of spell check• Font size

• Text Messaging• Use of abbreviated words• Misspellings

Communicating Through Technology

• Voicemail– No out of office message.– Message too lengthy.– No information about how to reach for emergency.

• Cell Phones– Weak cell phone signals.– Dropped calls.

• Pagers– No response. Is that deliberate or did the page go

through?

Communication is a two-way process

We need to think of communication as an

outcome.

At a minimum, our objective should be for others to

understand ours.

Communication

in a

Caring Context

Communication Using Caring Behaviors

• Warmth• Respect• Empathy• Genuineness• Trust

Communication Using Caring Behaviors (Cont’d)

• Essential to the practice of healthcare.• Are team members focused?• Does not involve more time.• Promotes health.

Communication Using Caring Behaviors (Cont’d)

• Need to cultivate a sensitivity to one’s self and

others.• Builds relationships of trust.

Communication Styles

• Passive• Aggressive• Assertive

Passive Style of Communication

Passive Style

• Stems from fear, timidity, inhibition, feelings of helplessness.

• Stems from fear of rejection.• Leads to internalized anger and tension.

Passive Style (Cont’d)

• Can lead to internalized anger and tension.

• Problems are not faced or solved.• Suppresses feelings.

Aggressive

Communication

Aggressive Style

• Can take unfair advantage of others.• Can be used to intimidate.• May be used when angry and thus could be

construed to be anger.

Assertive Communication

Assertive Style (Cont’d)

• Communication is direct when there is a problem.

• Builds trust.• Does not infringe on anyone else’s rights• Creates a win-win outcome.• Values self and others.

Negative Outcomes of “Out of Control Conflict”

• Relationships are damaged.• Discourages cooperation.• Results in defensiveness and hidden

agendas.• Wastes time, money, and human resources.

Negative Outcomes of “Out of Control Conflict” (Cont’d)

• Focuses on fault finding and blaming others.• Creates enemies, hard feelings, and hostility.• Is frustrating, stress producing, and energy

draining.

Negative Outcomes of “Out of Control Conflict” (Cont’d)

• Is often loud, hostile, and chaotic.• Leads to burn-out.• Leads to lack of collaboration.• Results in poor quality patient care.• Encourages gossip.• Impedes professional growth.

Negative Outcomes of “Out of Control Conflict” (Cont’d)

• Can lead to destructive behaviors.• Can lead to frequent job changes.• Can lead to mistrust within the team.• Staff leave.

Words to Live By

• Incorporate a sense of humor.• Always assume the posture of warmth,

respect, empathy, and genuineness.• Treat others as you want to be treated.

Understanding Generational Diversity and It’s Impact on

Communication

The Age Cohorts

• The Veterans… 1939-1945

• Baby Boomers… 1946-1959

• Cuspers… 1960-1965

• Generation X… 1965-1975

• Generation Y… 1975-1981

Key Events in the Lives of Veterans

Current Ages: 61- 86

• Great Depression• World War II• Korean War • Military and National Pride

Communicating with Veterans

• Build trust through inclusive language.• A leader’s word is their bond, focus more on

words than body language.• Face-to-face or written is received best.• Use more formal language.• Don’t waste their time, they have a job to do.• Don’t expect them to share their innermost

thoughts immediately.

Key Events in the life of Baby Boomers

Current Ages: 42-60

• Television• Rock and Roll• Era of affluence, credit cards• Racial unrest • Vietnam War• Assassinations• Space Exploration• Scientific and Medical Advances

Communicating with Boomers

• Boomers are the ‘show me’ generation, so use body language to communicate.

• Speak in an open and direct style.• Answer questions thoroughly, and expect

to be pressed for details.• Avoid controlling or manipulative language.• Present options to show flexibility in your

thinking.• Use face-to-face or electronic

communication to reach out to them.

Key Events in the life ofGeneration X

Current Ages: 26 -41

• End of Cold War, Soviet Union collapse.• Introduction of Personal Computers.• Portable CD players.• Video games, microwaves, cordless phones.• AIDS.• Economic instability.• Single parent families.

Communicating with Gen X

• Learn their language and speak it.• Use e-mail as a primary communication

tool.• Talk in short sound bytes to keep their

attention.• Present the facts and use straight talk.• Ask them for their feedback.• Share information with them immediately

and often.• Use an informal communication style.• Listen! You just might learn something!

Key Events in the life ofGeneration Y

Current Ages: 7-27

• Terrorism• Environmental Concerns• Global political realignment• Multiculturalism• Era of high technology

Communication with Gen Y

• Let your language paint visible pictures.• Use action verbs to challenge them.• Don’t talk down to them, they will resent it.• Show respect through your language, and they

will respect you.• Use e-mail and voice mail as primary

communication tools.

Communication with Gen Y (Cont’d)

• Use visual communication to motivate them and keep them focused.

• Constantly seek their feedback.• Use humor, reassure them that you don’t take

yourself too seriously.• Encourage them to break the rules and explore

new paths or options.

Generations at Work

Managing the Clash of Veterans, Boomer’s, Xer’s, and

Yer’s

Veterans …On the job…

ASSETS• Stable• Detail-oriented• Thorough• Loyal• Hard working

LIABILITIES• Inept with ambiguity and

change• Reluctant to buck the

system• Uncomfortable with

conflict• Reticent when they

disagree

Boomers…On the job…

ASSETS• Service oriented• Driven• Willing to ‘go the

extra mile’• Good at

relationships• Want to please• Good team players

LIABILITIES• Not naturally ‘budget minded.’• Uncomfortable with conflict.• Reluctant to go against peers.• May put process ahead of

result.• Overly sensitive to feedback.• Judgmental of those who see

things differently.• Self-centered

Gen Xer’s…On the Job…

ASSETS• Adaptable• Techno literate• Independent• Unintimidated by

authority• Creative

LIABILITIES• Impatient• Poor people skills• Inexperienced• Cynical• Job hoppers• Bore easily

Gen Yer’s…On the Job…

ASSETS• Collective action• Optimism• Tenacity• Heroic Spirit• Multitasking

capabilities• Technologically

savvy

LIABILITIES• Need for supervision

and structure.• Inexperience,

particularly with handling difficult people issues.

Where do I go from here?

• Know that generational differences are real!• When working with doctors, nurses,

patients, families, and other team members, using this information can make a difference in getting to the outcome you want.

• Try to think how the generation you are speaking to thinks.

• Take the time to learn more about this subject – its FASCINATING…and rewarding.

Reference Material

• Self Awareness Assessment:• “Crucial Conversations Tools for Talking When

Stakes are High”• www.vitalsmarts.com - Sign up for emails to help

you improve your own communication• www.aacn.org/hwe - Standards for Establishing

and Sustaining Healthy Work Environments: A Journey to Excellence

• The Case Manager’s Survival Guide; Cesta, Tahan, Fink (1998) Mosby

Review Questions

1. What are the three styles of communication?

2. Which two generations are uncomfortable with change?

Answer Key

1. Passive, Aggressive and Assertive

2. Veterans and Boomers