BOOK REVIEW: Crucial Conversations: Tools for Talking when Stakes Are High

Third edition

Joseph Grenny, Kerry Patterson, Ron McMillan, Al Switzler, and Emily Gregory

McGraw-Hill; 2022

Reviewed by Johny Van Aerde, MD, PhD

Crucial Conversations by Grenny and colleagues might be known by many already, but the third edition released in October 2021 deserves a new review. A fifth author, Emily Gregory, who initially trained as a physician, has joined the four original authors, and the book now has sections on conversations in the virtual environment. Five million copies have been sold since the first edition almost 20 years ago, and, for the last 10 years, the related two-day course for learning and practising crucial conversations has been offered face-to-face and online by certified facilitators of the PLI/CSPL partnership.

A conversation turns crucial when the stakes are high, opinions vary, and emotions are strong. The book makes it clear that much of a conversation’s outcome is determined inside our own mind, before even one word has been said. We should stay focused on what we really want for ourselves, for the other party, and the relationship, rather than lose ourselves in our emotions.

Clues are given on what to look for and how to listen when conversations turn crucial, and what signs and statements indicate that others feel unsafe. Simple but efficient skills allow us to step out of the original conversation and recreate safety, so that we can continue to talk about the issue at hand.

The model uses a number of mnemonics, which are easy to remember when a crucial conversation takes place. My favorite is STATE, where S stands for state the facts, T for tell your story, A for ask others to share their information and perception, all the while talking tentatively (T) and encouraging testing (E). Several others help us to remember steps that maximize the chance others will share their information, in particular when they are hesitant to do so. Ultimately, the intention of any conversation is to get all the necessary information into the shared pool of knowledge, safely and completely.

While the content of the book has changed little since the first edition, this third version has more practical examples and sections on virtual communication have been added to several chapters. The last two chapters — “Yeah, but: advice for tough cases” and “Putting it all together: tools for preparing and learning” — are particularly important as they give invaluable examples of real-life situations and how to deal with them.

This book makes it clear that self-awareness and self-management are foundational to a conversation, crucial or not. The tools used in crucial conversations contribute to creating an environment of psychological safety, constructive solutions, and the prevention of negative conflicts. Some health organizations in Canada have embedded the philosophy of, and skill development for, crucial conversations throughout their system, from the board level to that of frontline providers. This book should be on everyone’s bookshelf.

Author

Johny Van Aerde, MD, PhD, FRCPC, is executive medical director of the Canadian Society of Physician Leaders and founding editor of the Canadian Journal of Physician Leadership.

Correspondence to:

johny.vanaerde@gmail.com