Crucial Skills®

A Blog by Crucial Learning

Crucial Conversations for Accountability

Speaking Up to Problem Employees

Dear Crucial Skills,

I recently assumed the role of assistant nurse manager in a very busy procedural area of a hospital. I have learned that one of our technicians has been causing drama on the team for several years. Nurses have been known to cry because of her aggression and passive-aggressive behavior. Previous management didn’t know how to deal with her, as she incessantly denies accusations. How would you recommend I confront this person with a Crucial Conversation?

Tired of Drama

Dear Tired,

Several years ago we did a research study on the impact of interpersonal drama in healthcare. And the takeaway is probably no surprise to you—drama in healthcare isn’t reserved for nighttime television. Most caregiver teams experience predictable and toxic levels of drama in the form of slackers, timid supervisors, toxic peers, arrogant doctors, you name it.

We surveyed 1,200 physicians, nurses, and staff and found five interpersonal issues that are particularly pervasive and destructive: poor initiative, difficult peers, failure to hold others accountable, unresponsive physicians, and managers who play favorites. Let’s zone in on difficult peers.

Difficult peers were defined as colleagues who gossiped, spread rumors, gave people the cold shoulder, and are rude, sarcastic, and mean. Sound familiar? More than 56% of respondents said difficult peers were common and two of three said the resulting problems were costly—meaning difficult peers negatively affected patient safety, quality of care, patient experience, and employee engagement. (Download the full study.)

But I don’t need to convince you that a toxic colleague is detrimental to team health. It’s the other findings that will be key to helping you address this issue.

We didn’t just look at whether these challenges were common and costly, we also looked at whether they were discussable and solvable. What we found is that the real problem in healthcare isn’t drama—it’s silence. The real problem isn’t that these interpersonal challenges exist, because it’s rather unrealistic to think that a work environment characterized by long hours, extreme urgency, unbelievably high stakes, and large power differentials wouldn’t produce people problems. Rather, the problem is that when interpersonal challenges arise, people are unwilling to address them and solve them—much as you have described with your own team. In fact, when it came to difficult peers, 78% of survey respondents said this problem was barely or not at all discussable, and 79% said it was barely or not at all solvable.

So, how do you change the script? How do you speak up to a disrespectful team member—not to mention one who has gotten away with bad behavior for several years? Our research and experience suggest that dialogue is drama’s kryptonite. When people share their full concerns in ways that are frank, honest, and respectful, disputes are often solved before they become drama. We ultimately arrived at two conclusions:

  1. Having a leader who demonstrates strong and positive interpersonal skills is one of the best ways to not only eliminate the challenge but also mitigate the resulting costs.
  2. Teams that encourage and enable dialogue are more successful at eliminating drama and achieving positive outcomes.

When it came to skilled leaders, we looked specifically at those who had been trained in Crucial Conversations for Mastering Dialogue and/or Crucial Conversations for Accountability. We found that when managers had been trained in one of these programs, the five interpersonal challenges were significantly less common, more discussable, and more solvable. They also achieved significantly higher scores on patient safety, quality of care, patient experience, and staff engagement.

So, to address future difficult peers and other interpersonal challenges quickly and effectively, consider getting trained in Crucial Conversations. To help you with your immediate challenge, here are a few Crucial Conversations skills for speaking up to an unaccountable, toxic employee.

Communicate Respect

Communicating respect in the first 30 seconds helps others feel safe, which will help them listen to you. For example, begin with, “I want to be a loyal friend and a good teammate. I have some concerns and don’t want to let them get in the way of our working relationship. Do you have a minute to discuss them?”

Lead with Facts

When sharing concerns, don’t lead with accusations or judgmental language. Lead with facts. For example, replace, “I think you are rude to our teammates in staff meetings” with “In our last staff meeting, you cut off Ellen when she was speaking and then rolled your eyes.”

Share Natural Consequences

Motivate others by helping them see the natural consequences of their misbehavior in ways that matter to them. For example, “I’ve heard you expressing frustration that people aren’t friendly to you. I think I know some reasons why and would be willing to share them if you’d like.”

Invite Dialogue

Remember you are probably partly wrong about how you see things. After sharing your concerns, encourage the other person to share his or hers—and even to show you where you may be wrong. Others will be more open to your views if they are convinced you’re open to theirs.

Hold Superiors Accountable

If the Crucial Conversation fails, and if the bad behaviors continue to affect you and others negatively, your next discussion needs to be with superiors or even HR. Use these same steps to help them see that they need to do a better job dealing with this errant employee.

The research had a silver lining. We found a hopeful minority of hospitals where leaders have created cultures of open dialogue and where honest conversation is the norm when problems arise. They see not just markedly better behavior but also substantially improved results. These teams and departments scored 16% higher on patient safety, 18% higher on quality of care, 19% higher on patient experience, and 37% higher on staff engagement than teams where leaders chose silence.

Good luck in your Crucial Conversation. It will be worth it.


You can download the study here: Crucial Moments in Healthcare.

You can learn more insights and skills like this in Crucial Conversations for Accountability

3 thoughts on “Speaking Up to Problem Employees”

  1. Anisia

    This was very helpful, thank you.

  2. Steve Martin

    This is very helpful! Thank you for sharing the experiences of other health institutions, it helps knowing our team is not alone. I’ll be sure to have a respectful, but Frank, and honest conversation with the employee of concern. As her supervisor, her growth and the teams health matter to me.



  3. Jean

    Where is the part of dealing with supervisors who aren’t held accountable?

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