The four-step process when having difficult conversations

Business Coach Chris Barrow takes you through the four-step process to follow when having difficult conversations with both patients and the members of your team

No one likes to have difficult conversations in their lives – however, from time to time no matter what profession you work in it is inevitable that you will have to at some point. In a dental practice it might be that you need to have a tough conversation with a member of your team because they are, for example, consistently turning up late for work.

Or it could be with a patient who is missing regular appointments which is then having a knock-on impact onto other patients and their appointments. They aren’t nice conversations to be involved in and nobody relishes them, however there is a process you can use to break them down and come to a resolution, and this is it…

The four-step process

The four-step process was a technique that I learned about in the 1990s in the role that I was in at the time. It is something that has stuck with me ever since and still to this day, I use it when I need to have a difficult conversation, whether that be in or out of work.

The four steps are:

PERMISSION

PERCEPTION

FEELINGS

CHANGE

Permission

The first thing you need to do when you have an issue with someone that needs addressing is to ask their permission if you can have a conversation with them. So, if it’s me and I need to have a tricky chat with someone about something serious, I will approach them and I say: ‘Do I have permission to have a very direct conversation with you?’ If the answer is positive, we can move to step 2 below.

If the answer is negative, then I’ll ask ‘Ok – would you please let me know when I have that permission and we will continue our dialogue.’

And then I walk away.

Frequently, they will want to find out why I need to talk to them and they will give me permission to have a chat with them.

Either way, the direction behind this part of the process is to make sure you ask their permission to have this chat.

Perception

In this section, what you need to do is bring up the topic that you want to address with this individual and explain how you view the situation. So, for example, say it is a patient who has turned up late to their appointments on the last three occasions and each time they have turned up at least 15 minutes after they were due to see you.

’Mr Patient, my perception is that you have arrived at least 15 minutes late for each of your recent appointments.’

And when you’re going through this, it is really important to reiterate that what you are talking about is just your perception and how you see the situation – and you need to do that because the reality may be a bit different.

It might be that they keep getting given the wrong appointment time by the receptionist and the issue should be with her. In that case, you may need to stop this difficult conversation and have a chat with her to see what has been going on.

Feeling

Once you’ve looked at perception, you then need to explain how the situation is making you feel. So, staying with the ‘late’ patient, let’s say, the lateness is all down to them, you can explain that you are feeling upset because it is hitting your practice financially and it is making the staff anxious because other patients are late, you and your staff are being left in a position where you’re worried about not being able to give everyone a top-level service.

Change

That then rolls nicely into the fourth part of the process and that is looking at and discussing what you want to change. So, in this scenario, it is very simple in the fact you want the patient to turn up on time to prevent that long term impact on other patients and your team.

So, wrapping up the conversation you need to say, ‘this is what I want to happen’ and it may be that you say, ‘if this continues to be a problem, we might have to look at whether we will be able to meet your customer service expectations going forward.’

And it is as simple as that.

They aren’t nice conversations to have but using this structure and breaking them down will make it seem less daunting and easier to manage and it will help you nip issues in the bud before they become any bigger.

About Chris

Chris Barrow has operated his own businesses for 35 years and has been a trainer, consultant, coach and mentor to the UK dental profession for 25 years.