Crucial Conversations

What is a crucial conversation? A discussion between two or more people where either the stakes are high, opinions vary, and emotion runs strong (Greeny, McMillann, Patterson, & Switzler 2012).  When I think of a crucial conversation I think back to a moment when I had to sit down with an employee who was also, a friend. I was always told to try to let your friends understand when you walked into work; work became work. When approaching this situation I knew that emotions were going to run high and I was most probably going to lose a friend. Why? Because here opinion of me changed at that moment. She considered that because I was her friend that no matter what she did at work she was forgivable. She wanted to tell the clever story as they talk about in the book to get justification.

Greeny, McMillann, Patterson & Switzler state: In truth, when we face crucial conversations, we can do one of three things: 

  • We can avoid them.
  • We can face them and handle them poorly
  • We can face them and handle them well. 

When my boss told me we needed to have this conversation for days I wanted to avoid it because why? I didn’t want to lose my friend. And if I faced it I knew she would handle it poorly.

Crucial conversations are not fun but they need to happen and we sometimes think these are only left up to the important bosses, elected officials, parents, and administration. That is not always true. Sometimes, to full fill ones goals we must have conversations that makes us uncomfortable. Such as, if you are feeling as if you are fitted for a position but keep getting passed over for it. You need to approach your boss and see why no one has asked you about your interest in that position. It might be something as simple as you haven’t officially applied or he or she didn’t know that you had an interest.

I believe when you are in a meeting you tend to see high stakes, opinions vary, and strong emotions like they state (Greeny, McMillann, Patterson, & Switzler 2012). When this happens it is hard to see others or yourself handle those conversations well. That is why preparing yourself for the conversation prior helps to calm the situation prior.

Patterson, K.,  Grenny, J.,  McMillan, R. & Switzler, A. (2012). Crucial conversations:

           Tools for talking when stakes are high, second edition. McGraw-Hill.

The 4 Disciplines of Execution


When considering a new innovation to implement in the respiratory care program there were many. E-portfolios stood out mostly to me, when I created my innovation plan I provided a plan to implement e-portfolios into respiratory care education. Students are constantly on the internet. They choose to use google over books for research, they have their phones constantly in their hands, apps are just a click a way, and they have ease of access to the world wide web. That is why I believe e-portfolios could be a great reflection piece for the students to document day to day assignments and competencies. I want to pilot e-portfolios with a focus group in my clinical III course Summer I 2019 with a full roll out to the new incoming students Fall 2019.

The problem we lack with implementing change is getting others on board, keeping ourselves accountable, and not getting stuck in the whirlwind. With this change comes accountability and with accountability is making sure we implement in a timely manner, set certain goals, and produce an effective product. If we look at the five stages of McChesney, Covey, and Huling’s The 4 Disciplines of Execution it will help us implement our plan of change effectively.

The 5 Stages of Δ

Stage1: Getting Clear                                

This is the stage where we set the foundation. We organize our team come up with our Wig, lead, and lag measures. Also, we would develop a way to score our plan and set up a time for weekly meetings as a group to attend!

My team will either get together via phone, email, or via clinical site for a short meeting and develop a plan to set the foundation on how we will get this done.

Stage 2: Launch

This is the kick-off meeting! Recognize your resistors, models, and potentials in this stage. This stage requires more focus from the leader to gather the group and organize the required meeting times.

This meeting will be held on campus for an organizational meeting to see where we go from here. This will be the following week and we will then see who is willing to put in the time and effort to push this forward.

Stage 3: Adoption

In this stage we can see resisters tend to adopt the change and be more enthusiastic about the plan.  They will become accountable for the new level performance despite the demands of the whirlwind.

By this stage I will have started weekly meeting either on site or via video meetings to see who is willing or are we stuck and not pushing forward.

Stage 4: Optimization

At this stage we will see how we are winning and if we aren’t what we need to do to make a change. We will use a scoreboard to make sure we are reaching our goals effectively.

I will have posted the scoreboard via a network drive such as google that we could share since none of my instructors are in the same place at the same time or on campus by my office. We will know who is pushing the idea forward or is staying behind.

Stage 5: Habits

When your ideas get implemented successfully they should be rewarded consistently. We should help individuals become high performers and celebrate their accomplishments. Once, one wig has been completed the leader needs to move on to the next wig and repeat the stages.

I should reward the high performers consistently. Therefore once one goal has been accomplished successfully come up with a plan for a reward and push them on to the next goal. That way we can be successful as a team.

4 Disciplines of Execution

Discipline One: Focus on the Wildly Important

The 4 DX model pushes us to focus and stick to one to two WIGS (Wild Important Goals) at a time to prevent getting lost in the whirlwind.  We sometimes have many goals, but we need to focus on one to two goals that need to be done now and can be successfully implemented. Brainstorming with your team, peers, and alone to see which goal is important could give you great perspective. I tend to want to get everything done at one time. Therefore this statement is very helpful to me. I think focusing on the important goal is the best thing to do. That way you get the most important thing done first and then move on to the next and you do not get as overwhelmed.

MY WIG: To fully integrate E-Portfolios in Fall of 2019 Respiratory Care Program students  that will enable students to document and reflect on their learning experiences.

In the beginning I will be the only one involved in the implementation. The students will be posting one lesson or clinical blog a week for reflection. After, the 2019-2020 implementation I will work with my clinical instructors as well as my program director to achieve similar goals and actions. This brings us to the lag measure that tells us if we have achieved our goal, they mark  a precise finish line for the team (McChesney, Covey, & Huling, 2012). For E-Portfolios the lag measure is developing a plan to give effective feedback by the end of each week. I will have to put lead measures in place to hold myself accountable.


To fully integrate E-Portfolios to the incoming Fall of 2019 Respiratory Care Program students to help students document and reflect on their learning experiences.

Lag Measure

Lead Measure

For E-Portfolios the lag measure is developing a plan to give effective feedback by the end of each week.

 Is for clinical instructors to pair up at clinical sites for weekly WIG meetings 90% of the time.

To allow students thirty to forty-five minutes during a clinical day to work on the e-portfolio to blog or reflect on their clinical experience that day 90% of the time.

Discipline 2: Act on Lead Measures

Lead measures must be both predictive of achieving the WIG and influenced by the team. They must be counterintuitive, they are hard to keep track of, and often look too simple (McChesney, Covey, & Huling, 2012). Lead measures are harder to measure than the lag measures. They are the behind the scenes. If you think of the analogy in the book about dieting  in a whole most people are focused in on the weight in pounds lost. Actually that is you lag measure and technically you should be more focused in on the calories and inches, right? These are your lead measure. We need to be focused on the mustard the details to get the result.

To ensure we have a smooth roll out in the Fall of 2019 we will need to ensure that my team of clinical instructors are meeting in pairs once a week. They usually our on location at clinical sites at least once a week. Therefore, lead measure one is for clinical instructors to pair up at clinical sites for weekly WIG meetings 90% of the time.  This cannot be 100% due to the fact they are not all on the same schedule and they all work at different locations and I am not at the same place at the same time. I also, plan to pair up instructors to get the resistor with an instructor who is more of a influencer on the WIG.

My next lead measure is to allow students thirty to forty-five minutes during a clinical day to work on the e-portfolio to blog or reflect on their clinical experience that day 90% of the time. This cannot be 100% of the time due to unpredictable conditions in the hospital setting. Their day to day plans in the hospital setting is unplanned and unpredictable.  I am hoping these lead measure will ensure 100% on my implementation rollout for 2019 and the future of clinical instructors implementation e-portfolios.


Discipline 3: Keep a Compelling Scoreboard

People play differently when they are keeping score. There’s a remarkable difference between a game where the leader scores the team and a game where the players score each other. It means the team takes ownership of the results. It’s their game to play (McCHesney, Covey, & Huling, 2012). This rings so true, people are competitive in nature. Most of my students are always trying to out due the next. Therefore, if you keep score they are willing to work harder for it.

I will keep score by posting charts on the bulletin board in the hallway by my office and also on google documents for ease of access. Below, shows my lead measure where the student is receive access at the clinical site and the minutes they are receiving each week to work on their e-portfolios:

Next, I could measure my clinical instructor meetings with a chart that shows zero or 100% compliance. I could post it as well on google sheets or docs and along side my office.

Last we could look at the lag measure overall and how could we measure it as a score overall. Below you will find a chart showing the performance overall.

Discipline 4: Create a Cadence of Accountability

I already plan on sending the weekly spreadsheet and updates to the clinical instructors to keep them updated where we are at on our goals. When the weekly WIG meetings are held I hope that I will be apart of them. Due to the way our system works it is sometimes hard for me to be at every hospital and lecture on campus at the same time. Therefore, I am hoping maybe I can phone in or be there via through an email update. I want to get as much feedback, and information from the clinical instructors as they will see with my lead measure how the students are doing while they have 35 to 40 minutes posting on their eportfolios what their challenges are. They will be able to bring any information from that to our WIG sections.

I will have to send out a weekly agenda to keep us to date:

    1. How much time did the student’s get to spend on their portfolios?
    2. What were your struggles with giving feedback via the e-portfolio?
    3. What is our plan of action this week?

4DX vs. Influencer Strategy

I believe that the influencer strategy and the 4dx have the same idea but different concepts. The influencer strategy focuses more on social and emotional behaviors. How can you make a change by demonstrating and imitating others who have already done it correctly. While 4 Disciplines of Execution is stating accountability and focusing on the mustard. When I mean the mustard the grit the detail. Not the big picture. What is it that we need to do to really get down and dirty and make that change to get what we need done to make it work. They are saying if you follow these steps your big picture will come and you will be able to master that one goal.


Grenny, J., Patterson, K., Maxfield, D., McMillan, R., & Switzler, A. (2013).

             Influencer: The new science of leading change: 2nd ed.

             New York: McGraw-Hill Education

McChesney, C., Covey, S., & Huling, J. (2012). The 4 disciplines of execution:

           Achieving your wildly important goals. New York, NY: Free Press. 

Influencer Strategy

Influencer Strategy

Throughout the many assignments and coursework that has been assigned to us through the DLL program I have realized my one key goal is reflection. I believe that reflection is key to my student’s success and overall goal to becoming Registered Therapists. If they have a platform like e-portfolios it would give them access to reflect back on the daily activities and competencies that are to be met.

One of the first steps to doing that is finding a few students to become a focus group and measure their outcomes. My goal is to have my incoming class in 2019 to begin their program with e-portfolios of their choosing. I will be at 100%  program wide by 2020. Also, would like at least 50% of my instructors, administrators, and cohorts to be involved in feedback of their learning or developing their own profiles to model the behavior by Fall 2019.

Below, you will find my results I would like to achieve, vital behaviors, how they will be measured, and who are my organizational influencers.


Below you will find my six sources of influencers it shows how we will model through personal, social, structural motivation and ability.

6-influencers_338004786 influencers


Grenny, J., Patterson, K., Maxfield, D., McMillan, R., & Switzler, A. (2013).
               Influencer: The new science of leading change. New York, NY: McGraw-Hill.



Why: We believe to empower students looking for their passion with the skills, knowledge, and develop them into great Respiratory Therapists.

How: We will create motivational and engaging learning environments in clinical and on campus classes.

What: To develop an e-portfolio that showcases a reflection of the skills that they have developed throughout the program to become Respiratory Therapists.

When I attended respiratory school I would go on from semester to semester forgetting little things that I would remember. Each semester, the things you learn builds on top of each other. Therefore, those key little things become very important. I would have to reflect back on my handwritten notes to remember and review the information. If respiratory students had the chance to use an ongoing system that could keep up with their presentations, notes, journals, blogs, and lectures I believe it would help with their learning. Our program would see better outcomes from the students and in turn better Respiratory Therapists.

I remember, starting my first job after graduating respiratory school and training with the other therapist I was amazed at all the skills I either forgot or the details that I missed.  I was really good at trying to jot everything down when my instructors brought up interesting details, new equipment, or easier ways of getting things done. Although, if I had an e-portfolio to take pictures, jot my ideas down, and blog about how my day in clinical went I could had reflected back once I began my career. I would have been able to use this information from semester to semester. Throughout, the years things change our memories fade, it is good to have a reflection piece to use.

Heart of Change:

How do we really affect someone, is it by their mind or heart? Why do we all feel that the mind controls everything? Commercials tend to use the mind for children by focusing on the best and newest toy, they affect the mind. But, how do we really affect someone, we have to affect them emotionally?

When, I think of my why I think of my patients first. First, because I want the best for my patients, my parents, my children, my sister, her kids, my friends, and the world. I want to develop, train, and mentor the best respiratory therapist that possibly can be. I want to make a change. That is my why.  Emotionally, you cannot be in the health field and not let it affect you at some point. Someone’s husband, wife, mom, dad, child, brother, sister, and friend you have either help save or could not help save.

Therefore, I have to to relate to my students not only mentally but emotionally. Being in health careers it is very important to emotionally to connect with our students. Without, the emotional connection they fail to understand why we are learning.  When, I bring up stories from personal reflection at the hospital or family they tend to emotionally connect with me. Therefore, the first question I ask them when they say I am interested in the respiratory care program is “Why do you want to become a Respiratory Therapist?” I need to know why, then I emotional connect with them. When you are more emotionally invested in something you will tend to work harder for it. Therefore, when a students why is because of a loved one they have seen suffer due to a bad respiratory disorder they seem connect faster.

Sense of Urgency:

What is change if you do not have a sense of urgency? Will anyone even care about your plan if you don’t feel like there really is a need for it? If you aren’t excited for feel like there is a need for it, is there really any point in making a plan for it?

No one, is going to make your plan a priority if you don’t make your plan the number one priority. I know this from experience. Starting last year our health careers school implemented an annual interdisciplinary disaster mass causality simulation. This year no one has made it a priority or made it feel like it was of high priority. Everyone is walking around campus like if we get it done we get it done. I am not the one that is leading the organization of this simulation. I only have 23 students involved versus some who have 200. The simulation is less than three weeks away and the sense of urgency does not feel like it is there for the disaster to be performed.

I need to establish a sense of urgency when it comes to my innovation plan. I realized that after reviewing the material and talking with Dr. Thibodeaux this week. When creating my plan to implement E-portfolios I knew their was a need and I know their is a need for urgency. Therefore, the longer I wait to implement something the less effect our plan has. It tends to fizzle out and eventually goes away. The time is now!


Kotter, J. (2011, March, 23). The heart of change. . Retrieved from

Kotter, J. (2013, August, 15). Leading change: Establish a sense of urgency. . Retrieved from

Sinek, Simon. (2013, September 29). Start with why. Retrieved from