Difficult Conversations Aren't Optional. Here's How to Handle Them.
You've noticed the pattern.
A long-standing receptionist who's been increasingly short with patients.
A nurse who's late three times this week.
A team member who undermines decisions in front of others.
You know you need to say something.
But you keep putting it off.
Because it's uncomfortable. Because you're hoping it'll fix itself. Because you don't want to upset anyone or create tension.
So you wait.
And while you're waiting, the behaviour continues. The team notices. Resentment builds.
And the conversation you avoided last week is now twice as hard this week.
Here's the truth: avoiding the conversation doesn't make it go away. It just makes it worse.
Difficult conversations aren't optional. They're part of leading.
And they don't have to be brutal, confrontational, or dramatic.
They just have to be clear, respectful, and structured.
Why leaders avoid difficult conversations
Most leaders don't avoid hard conversations because they're weak or conflict-averse.
They avoid them because they don't know how to have them without it going badly.
They worry:
It'll damage the relationship
The person will get defensive or upset
They'll say the wrong thing
It won't change anything anyway
So they tolerate behaviour they shouldn't tolerate.
They hint instead of saying it directly.
They soften the message so much it loses all impact.
And nothing changes.
The cost of avoidance
Every day you don't have the conversation, something else happens:
1. The behaviour continues
If you don't address it, the person assumes it's acceptable.
Silence is permission.
2. The team loses respect
The rest of the team is watching.
They see the behaviour. They see you not addressing it.
And they lose trust in your leadership.
Because if you won't hold the line here, why would they believe you'll hold it anywhere else?
3. Resentment builds
Yours and theirs.
You resent them for not changing.
They resent you for not being clear about what you actually want.
And the longer it goes on, the harder the conversation becomes.
4. The issue escalates
Small problems don't stay small.
A receptionist who's occasionally short with patients becomes consistently rude.
A nurse who's late once becomes late every week.
A team member who undermines you once starts doing it openly.
And by the time you finally address it, it's a bigger, messier problem than it ever needed to be.
Real scenario: Long-standing receptionist with attitude issues
A practice manager has noticed that one of the receptionists — someone who's been with the practice for years — has been increasingly sharp with patients.
Not outright rude. Just... curt. Impatient. A bit dismissive.
A few patients have mentioned it. The team has noticed. The manager has seen it firsthand.
But the receptionist is experienced. She's been there longer than the manager. She knows the systems inside out.
So the manager doesn't say anything.
Instead, they:
Drop hints in team meetings about "tone and professionalism"
Send a group email reminding everyone to be polite
Hope she picks up on it
She doesn't.
Three months later, a patient complains formally.
Now the conversation is no longer about a minor attitude issue.
It's about a formal complaint, a potential disciplinary, and a defensive, hurt team member who feels blindsided.
All because the manager didn't have the conversation when it was still small.
What works instead: The five-stage model
Difficult conversations should never be improvised.
They need structure. Preparation. Clarity.
Here's the five-stage model:
Stage 1: First things first — Get clear on intent
Before you say anything to the other person, get clear with yourself.
Why are you having this conversation?
Not to punish. Not to vent. Not to prove a point.
To solve a problem.
Ask yourself:
What behaviour needs to change?
What's the impact of that behaviour?
What outcome do I want from this conversation?
If you can't answer those clearly, you're not ready to have the conversation yet.
Stage 2: Preparation — Facts, feelings, desired outcome
Write it down.
Facts: What actually happened? When? How many times?
Stick to observable behaviour, not interpretation.
Not: "You've been rude to patients."
But: "On three occasions this week, I've heard you respond to patient queries with short, dismissive answers. For example, on Tuesday, when Mrs. Jenkins asked about her appointment time, you said 'It's in the text' and walked away."
Feelings: What's the impact of this behaviour?
On patients, on the team, on the practice.
Not: "You're making everyone uncomfortable."
But: "When patients are spoken to dismissively, they feel unwelcome. That damages trust. And when the team sees it, they don't know what the standard is anymore."
Desired outcome: What needs to change?
Be specific.
Not: "I need you to be nicer."
But: "I need you to respond to every patient query with patience and professionalism, even when you're busy. If you're feeling overwhelmed, let me know — but the patient should never feel dismissed."
Stage 3: Planning — Structure the conversation
Don't wing it.
Plan the conversation in three parts:
1. Open with the problem
State it clearly. No preamble. No small talk first.
"I need to talk to you about something I've noticed. Over the past few weeks, I've seen you respond to patients in a way that's come across as curt and dismissive. I want to talk through what's going on and how we fix it."
2. Share the facts and impact
Be specific. Be calm.
"On three occasions this week, I've heard you give short, impatient responses to patient queries. For example, on Tuesday, when Mrs. Jenkins asked about her appointment, you said 'It's in the text' and walked away. That's not the standard we hold here. And it's affecting how patients feel when they interact with us."
3. Listen
This is critical.
You've shared your perspective. Now listen to theirs.
Ask:
"What's going on? Is there something I'm missing?"
Don't interrupt. Don't defend. Just listen.
Because sometimes there's context you didn't know.
And even if there isn't, listening shows respect.
Stage 4: The conversation — Calm, clear, respectful
When you're in the conversation:
Stay calm
If you're emotional, they'll get defensive.
Calm isn't cold. It's steady.
Be direct
Don't soften it so much that the message gets lost.
Not: "I just wondered if maybe you might want to think about perhaps being a bit more..."
But: "I need you to change how you're speaking to patients. It's not acceptable."
Focus on behaviour, not character
Not: "You're being rude."
But: "The way you responded to Mrs. Jenkins was dismissive."
Behaviour can change. Character feels like an attack.
Get agreement
Don't assume they've understood or committed.
Ask:
"Are we clear on what needs to change?" "Can you do that?"
If they say no, you need to know now — not two weeks later when nothing's changed.
Stage 5: Follow-up — Confirm expectations and next steps
The conversation doesn't end when you leave the room.
Summarise in writing
Send a brief, professional email:
"Just to confirm what we discussed: I need you to respond to all patient queries with patience and professionalism. If you're feeling overwhelmed, let me know — but patients should never feel dismissed. I'll check in with you next week to see how it's going."
Check in
Don't assume it's fixed.
Follow up. Observe. Give feedback.
If it's improved, acknowledge it:
"I've noticed a real shift this week. Patients have commented on how helpful you've been. That's exactly what I needed to see. Thank you."
If it hasn't improved, address it immediately:
"We talked about this last week, and I'm still seeing the same behaviour. We need to talk again."
What if they get defensive?
They might.
And that's okay.
Defensiveness is usually fear — fear of being wrong, fear of being judged, fear of consequences.
Your job isn't to make them feel comfortable.
Your job is to stay steady.
If they get defensive:
Don't back down
Not: "I mean, it's not that bad, I just thought I'd mention it..."
But: "I understand this is hard to hear. But the behaviour needs to change."
Acknowledge their feelings without agreeing
Not: "You're right, I'm probably overreacting."
But: "I hear that you're frustrated. And I still need this to change."
Bring it back to facts
If they argue or deflect, return to observable behaviour.
Not: "Well, everyone thinks you're rude."
But: "On Tuesday, you said 'It's in the text' and walked away. That's the behaviour I'm addressing."
What to do this week
Think about a conversation you've been avoiding.
Ask yourself:
What's the cost of waiting another week?
Then prepare the conversation using the five stages:
Get clear on intent — Why am I having this conversation?
Prepare — What are the facts? What's the impact? What's the desired outcome?
Plan — How will I structure the conversation?
Have the conversation — Calm, clear, respectful
Follow up — Confirm in writing, check in, give feedback
Difficult conversations don't get easier by waiting.
They get harder.
So stop avoiding it. Structure it. Have it.
Because communication determines culture.
And if you won't hold the line, no one else will.
