A well-known fairy tale details the saga of a monarch in search of sartorial splendor. He hires two con-men couturiers who pretend to outfit him in apparel so fine as to only be visible to the most intelligent individuals. You know the rest-when he appears in public in his BVDs, his subjects swallow their amazement, compliment him on his taste, and bite their tongues.

When we suspect that saying something is going to give offense, we often choose to keep mum. We shouldn't. It is true that hurling injurious words at others typically causes at least as many problems as it solves. But it is not OK to be silent. Rather, we need to work to find ways to communicate without doing harm. And that brings me to my point.

In nearly every surgery facility in the country, there is at least one surgeon who needs a talking to. His start times are off or his costs per case are much higher than those of the other surgeons or he's simply really slow.

Usually, the surgeon and the facility would benefit by his knowing where he stands. Yet bringing up the issue with him is difficult at best. Any criticism, real or implied, threatens him. Feeling cornered, he may lash out, questioning your motives and your standing to even introduce the issue.

Because of these potential difficulties, too many surgery center managers feel it's easier and safer to let their concerns go unsaid. They shouldn't.

Unspoken resentment of the surgeon who just doesn't get it places a strain on the entire facility. Nearly everyone with the possible exception of the surgeon is aware of the problem. Allowing the poor performance gives rise to carping, and of course provides an excuse for others to slough off.

A much better response is to find a way to introduce the issue without provoking a violent reaction. This usually takes a lot more work, but produces a lot better results in the long run.

One solution is to introduce peer pressure, asking the surgeon's colleagues to speak to the surgeon about the matter. But I find more appealing another idea, gleaned from a recent visit to Philadelphia's Wills Surgery Center. That center frequently rates surgeons on items like on-time performance, cost per case and others. It then posts the results of its inquiries in the center. It masks the names of the surgeons, referring to them only as "Surgeon A," "Surgeon B," and so forth. The managers tell us that every surgeon in the facility inquires as to his or her own performance. If it's poor, the surgeon usually is inspired to take positive action.

To fulfill their responsibilities, managers must communicate their concerns to those with whom they work. Much unhappiness has come into the world, wrote Dostoevsky, because of things unsaid. But to make sure those concerns are heard, understood, believed and accepted, we must remember to spend as much time as we need to figure out not only what we say, but how we say it.