Session: Managing difficult conversations—How to respond effectively to your team

Editor's Note

In this panel discussion, Cindy Hess, MSN, RN, FNP-C, CNAMB, director of nursing at Northeast Missouri Ambulatory Surgery Center; Vikram Tiwari, PhD, senior director and associate professor of anesthesiology, biomedical informatics, and biostatistics at Vanderbilt University; and Brian Dawson, MSN, RN, CNOR, CSSM, senior perioperative and healthcare consultant and former system VP of perioperative services at CommonSpirit Health, discussed several strategies for handling challenging interactions and organizational dynamics with employees. They offered to OR Manager Conference attendees insights into managing difficult conversations, dealing with disruptive behavior, and fostering a collaborative workplace culture.

Dawson, for instance, shared how he made multiple attempts to support an employee struggling to meet expectations. Despite providing direct feedback, bringing in union representatives, and exploring potential reassignments, the employee ultimately left the role. “I wanted the union to hear that I was doing everything possible for him to be successful,” he said, stressing the importance of transparency and showing a commitment to support. He advised other perioperative leaders to exhaust all options and document steps taken to improve employee performance before making final decisions.

Similarly, Tiwari highlighted an approach to managing behavioral issues that involved working with HR to document and address inappropriate comments from a staff member. After multiple discussions and escalating the concern to HR, it became evident the behavior was part of a larger pattern, leading to the employee’s departure. “Often, people just don’t want to speak up,” he said, noting that fostering a safe space for staff to communicate concerns is essential. Tiwari emphasized how important it is to create a culture where employees feel empowered to speak up about inappropriate behavior.

Navigating multigenerational and personality-based workplace conflicts also emerged as a key topic. Hess shared her experience managing a team composed of experienced professionals used to doing things their way and newer staff with innovative ideas. She described initial resistance from one more seasoned nurse, who stood by traditional methods. Hess facilitated discussions between that nurse and another staff member who was questioning why the work had to be done a certain way. While the process required several meetings, it helped each side understand the other’s perspective. “The main thing to remember is, the OR is a team,” she stressed. “If we can’t work together, the patient is the one who suffers.” Her advice to fellow leaders was, focus on shared outcomes and remind the team that their work ultimately supports patient care.

Physician interactions were another area of discussion, with all panelists addressing the challenge of managing strong personalities while maintaining staff morale and respect. Dawson shared a story about a surgeon known for throwing instruments in the OR, which unsettled staff and affected the team’s focus. To address this, he intervened directly, informing the surgeon of the impact on staff and establishing clear behavioral expectations. “‘If you feel you need to do that again, you can come to my office,’” is what Dawson said he told the surgeon back then. “I’d rather he punch a hole in my wall rather than act like this in front of the staff.” Since then, the surgeon has not had another violent incident.

Lastly, the conversation turned to handling communication from upper management when conveying decisions to teams, particularly when those decisions may not align with the leader’s personal views. The panelists discussed strategies for approaching these situations, including reframing organizational decisions in the context of patient care and communicating transparently about financial pressures or operational changes. One example required leading discussions around productivity improvements to prevent layoffs. By bringing staff into the conversation about operational challenges, a sense of responsibility and teamwork was established, which ultimately helped to avoid job cuts. Staff appreciated the transparency and rallied around the productivity goal.

In summary, some best practices from the panel for managing difficult conversations include:

• Give opportunities for improvement with clear expectations: Before escalating, ensure employees have support and resources. Communicate clearly what is expected and how success is measured, involving union reps and/or HR if applicable.
• Invite input and collaboration: Ask employees directly what they need to be successful. This gives them ownership of their improvement process and helps prevent misunderstandings.
• Handle conflict with direct, open communication: Bring challenging issues to the forefront by having direct discussions with those involved. Make it clear how their behavior impacts the team and, ultimately, patient care.
• Separate personal and professional relationships: Be friendly but maintain professional boundaries. Avoid becoming too close to staff socially, which can complicate performance evaluations and conflict resolution.
• Set an example of respect and accountability: Leaders should demonstrate respectful interactions, even in high-stakes situations. Show that disrespectful behavior will not be tolerated, particularly from physicians or those in high-power roles.
• Ensure alignment with organizational goals: When communicating decisions from senior management that you may not agree with, frame them in terms of patient care, team stability, and organizational success.
• Understand and address root causes: Approach conflicts by asking “why” repeatedly to dig into the underlying issues. This process can reveal personal or systemic issues that need to be addressed.