Navigating Difficult Conversations

people talking

Effective strategies and real-world examples to help you handle difficult moments.

By Jenna Gourlay PT, DPT* and Phil Plisky, PT, DSc*

As a private practice owner, or as part of the leadership team, you spend an incredible amount of time preparing for everything to come.

You have financial plans in place, growth strategies, and policies and procedures to ensure you are successful. You strategize how you’ll react, respond, and recover in hard situations. You recognize that you cannot possibly anticipate every scenario, but you have faith in your ability to adjust and adapt. You try to prepare for nearly every unknown (and now even pandemics). But what happens when you have to respond to a hard situation with an employee? What happens when the variable is human and hard to understand or unpredictable?

When difficult situations arise, whether business related or human and performance related, we have to take employees along for the ride. When we find ourselves in hard situations, we are usually on the verge of a difficult conversation. How we approach that conversation can ultimately affect the outcome more than any solution. We call these crossroad conversations. During any difficult conversation is an intersection — a crossroad — and how that conversation goes determines which road the relationship and solution eventually follow. Hard situations are inevitable in business, but relationships and loyalties suffering from them are not.

Crossroad conversations often revolve around five main themes or five hard situations: finances, performance, behavior, requests, and logistics. Some of these hard situations are driven by business performance and some are driven by human performance. Whether the crossroad conversation revolves around something at the personal level or something at the organizational level, the approach is no different. Let’s look at these five hard situations and the approach for each crossroad conversation.

Hard Situation: Struggling Finances

Mark owns Motion PT, a general outpatient private practice. With new changes in reimbursement and a struggling economy, Mark recognizes that his company will need to generate more revenue. He knows any solution will affect his staff. Whether he tries to cut costs, freeze raises, or increase productivity demands, he knows that he will upset his employees. Knowing there is not going to be a perfect choice, he decides to increase productivity demands and calls a staff meeting to discuss how employees will do this. He tells his staff how much he cares, how upset he is to make this change, and offers words of encouragement that things will get better and they will get through this point. He leaves the meeting exhausted but finds relief in the fact that he is doing this to stay in business and keep his employees working, getting raises, and having continuing education opportunities.

Yet Mark’s employees leave the meeting very differently. They feel they are being taken advantage of and these new changes seem nearly impossible to achieve. One employee tells another, “He’s doing this to make more money.” Another employee adds, “If it’s really about staying open, I’d rather take a pay cut or find another way to increase revenue than increase my caseload this significantly.”

Crossroad Conversation: Transparent Inclusion

Mark is completely justified in his solution choice. The problem is that his employees do not truly grasp the problem and do not understand everything that went into his proposal. Mark did not have an honest conversation with his employees. In fact, he didn’t have a conversation at all. He told them what they needed to do without first explaining why and second without allowing for input.

Instead, Mark could have started the meeting by overtly discussing the state of the company’s finances and how the current state of reimbursement is affecting revenue. Vague statements like, “We need to do this to keep the lights on” create a wedge of distrust between employee and employer. But transparency allows the employee to not only recognize where the employer is coming from, but also play a role in the solution. After discussing the current finances, Mark could have opened the conversation to employees and come to a solution together. They may come to the same decision to increase productivity, but this way the employees feel heard and included in the solution. This transparent inclusion fuels loyalty and camaraderie during a hard financial situation.

Hard Situation: Low Performance

Marie owns Community PT, an outpatient private practice dedicated to helping keep the community active. A large part of their practice model requires physical therapists to help build and maintain their own caseload by being active in the community. Most physical therapists in her company are great at getting referrals, but Jamie has been struggling for months. Her capacity has yet to reach 70% even after being with the company for months. Marie sits down with Jaimie and explains that she needs to increase her capacity. She shares what other physical therapists have done at the company and gives examples of how Jamie can get involved. Marie leaves the meeting feeling like she gave Jamie concrete steps to follow for success. Jamie leaves the meeting feeling frustrated because she’s already tried all of these things. Jamie does want a bigger caseload but feels helpless to create one.

Crossroad Conversation: Find the Cause

Marie’s efforts come from a truly caring place, as with most owners and managers when they are forced to address low performance. They want their employees to be successful and they come up with solutions to help. Yet, sometimes these solutions address the wrong problem. Sometimes an employee has a low caseload because she doesn’t keep patients, not because she can’t get referrals. Jamie had a confidence problem. She felt she lacked skills to get patients better and that was felt by her patients. Jamie also struggled to get new patients when she’d show up to running events because she didn’t believe she was the best one to help them. While Marie’s suggestions were sincere and with good intention, she didn’t find the cause of the problem. When it comes to addressing performance and so many other situations, it is essential to figure out the cause before developing a solution.

Hard Situation: Undesired Behavior

Jason manages R&R physical therapy. He has weekly status calls with the owners and other clinic directors. A portion of that call discusses weekly productivity. Jason has to track the productivity of the 15 therapists at his location. Therapists report their numbers on a status sheet that they turn in at the end of the day. This allows Jason to be prepared for his weekly meeting. However, Ann rarely turns in her status sheet on time. This makes tracking much more difficult for Jason and he gets frustrated with her lateness.

Jason sits down for a meeting with Ann and discusses how she needs to take more initiative and shares that he feels she is disrespecting him by not meeting the deadline. He doesn’t explicitly say it, but he alludes to the fact that she has been lazy. Ann apologizes, but leaves the meeting feeling dejected.

Crossroad Conversation: Discuss Behavior, Not Intention

While Jason is not wrong in sharing how he feels, he needs to discuss her behavior, not question her character. Being accused of being disrespectful and lazy hurts; even when that wasn’t the intention. Ann doesn’t hand in her log sheet at the end of every day because she often has notes she hasn’t finished and doesn’t know what her billing numbers are until she completes the note. She wasn’t trying to be lazy and gets hurt by her boss implying this.

Jason has the right to be frustrated, but if he wants a different behavior, he needs to describe the unwanted behavior. Jason could have told Ann that handing in her status sheet late is a problem and prefaced the conversation by stating she is a good employee. The behavior makes her seem uninterested, but he recognizes she tries hard in the clinic. Separating who Ann is as a person and the behavior she is demonstrating gives Ann an out. She has the ability to say she isn’t lazy and instead just behind on notes. Going forward Ann understands that she needs to prioritize the status sheet and doesn’t feel like her boss thinks she is lazy or disrespectful. Her actions are the problem and not her character.

Hard Situation: Unjustified Requests

Kendra is the owner of Prosper PT. Her company is successful and has a comprehensive bonus and raise system to ensure her employees are paid fairly and generously. Peter is one of the employees that has been there for a few years, but his performance and leadership in the clinic are average. He does what he needs to do and nothing more. He’s seen bonuses and raises that reflect his average performance. Peter comes to Kendra asking for a raise. Surprised by him even asking, Kendra tells him that a raise is not in the budget right now. She leaves the meeting thinking, “Peter does not deserve the raise for which he’s asking.” Peter leaves feeling frustrated and underappreciated. He’s been loyal, done whatever is asked of him, and never complained. He predicted the meeting going much differently.

Crossroad Conversation: Provide Benchmarks

Going into the meeting it is important to recognize two things. First, Peter probably knows that the company is successful and second, Peter is asking for a raise because he thinks he deserves it. By offering an empty statement like, “It’s not in the budget,” Peter either thinks the company isn’t being honest or Peter believes that it is the company’s fault he’s not getting a raise and not something in his control.

Peter needs benchmarks or something to work toward if a raise is a financial possibility and needs an explanation if it is not. Peter feels he does everything asked of him, which may be true but not in line with a circumstance that the company will offer a raise. While difficult to discuss performance, the conversation would have been much more productive for Peter if Kendra outlined what he needed to do. Give Peter benchmarks such as reduce your cancel/no show rate to less than 12%, a timeframe to do this, and set a meeting to discuss in the future. This way Peter knows where he stands and where he needs to go. He leaves with action rather than frustration and an understanding rather than skepticism.

Hard Situation: Personal Logistics

Brendan hates the holidays. He’s not a scrooge but figuring out time off requests is a lose-lose situation. He’s bound to make someone unhappy and hates that he can’t let everyone leave for the holidays. He’s juggling requests and eventually sends out the approvals. Jim wanted to visit his family that is a plane ride away and didn’t get any days off to do so. He confronts Brendan and Brendan tells him that he had Christmas off last year so he couldn’t again this year. Jim argues that Julie got Christmas off two years in a row, and Jonathan is less senior than him and has Christmas off too. It took Brendan two weeks to come to this holiday schedule and he gets frustrated at how unappreciative Jim is. He ends the meeting with, “Everyone can’t get what they want, and we do our best.”

Crossroad Conversation: Consistent Openness

There is no good way to plan for the holidays or other logistical things in the clinic. Brendan is right in saying, “Everyone can’t get what they want.” So, the solution is not one of making everyone happy. Instead, the solution must make sense to everyone. To do this, companies need to have a clear decision-making process and be consistent and open with it. Should it be based on seniority? Should it come down to who travels the farthest? Should it be multiple factors? It is less important about which ranking system you choose and more important that you always uphold the system and ensure your employees understand. Employees may not like certain decisions, but if they understand where you’re coming from and know how you arrived at the answer, they will respect it.

With all of these crossroad conversations, being honest and transparent is key. Your team members may not like the ultimate result of them, but they will appreciate that you are working hard to make decisions with their best interests in mind. The point is not to please your employees with these conversations, but rather appeal to their need to be heard, understood, and valued. These conversations allow open communication and the opportunity to deepen a relationship as you navigate hard situations.

Even in challenging circumstances your team will respect you because of the diligence and compassion you display during the crossroad conversation. 

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Jenna Gourlay and Phil Pilsky

Jenna Gourlay, PT, DPT, and Phil Plisky, PT, DSc, are the co-founders of Professional Rebellion, a company dedicated to guiding and mentoring professionals on the path to their ideal careers. They may be reached at and

*The authors have a professional affiliation with this subject.

Copyright © 2018, Private Practice Section of the American Physical Therapy Association. All Rights Reserved.

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