How do we have difficult conversations with each other?

 In Blog

By Cat Harrison

This excellent question was posed recently by Navina Evans (the Chief Executive of East London Foundation Trust) recently in her blog, Respect and Dignity, Everyday. It’s a question that has been on our minds at Sign up to Safety for some time now and in some of my earlier blogs, I‘ve touched on what has helped us as a team have awkward or difficult conversations well (see ‘looking in the mirror’ and ‘when conflict creates connections’).

Our work since 2014 has shown me one thing loud and clear, that all roads lead back to kindness. It is the essential component of relationships, and relationships are the fabric of health and social care. Without the myriad of interactions and dependencies that are a central part of a complex system like the NHS, it wouldn’t be possible to get what we need to get done. We all rely on each other and making space to support each other and to connect around what we need to do our jobs well, to work safely, and what we want for patients, is key. The quality of relationships between people matters, and it is kindness that can create the right environment where understanding, curiosity and humility are nurtured. And it is kindness that can also create the right environment where difficult conversations can be tackled more easily.

But I am aware that kindness is tremendously under-rated. That is, in my opinion, because it is so fundamental that when we have it in our lives, it may give us strength whilst its power goes unnoticed.

But woah do you miss it when it’s not there.

We’ve understood from our thousands of conversations with people working in NHS organisations over the last few years that this absence is where we have gotten to in some areas of health and social care today.

So, taking from what all these people have shared with us, what do I think kindness looks like in difficult conversations?

Lay the ground work;

Trust and relationships are built over time, and trust is something that really helps in difficult circumstances. It helps people feel safe. I know personally that I feel a lot less defensive if a difficult subject or issue is brought up within a trusting relationship, as I know that the ‘issue’ isn’t everything – I am not that issue, I am all the other facets of that relationship to this person. So, it provides perspective. Having a difficult conversation well starts a long time before the conversation is needed, in nurturing real and authentic relationships with those you work with.

Show gratitude;

Since an interaction between individuals is not an isolated incident, showing gratitude for what has been done well can help people cope better with being told what isn’t. This more thoughtful and considerate approach also takes into account one of the biases we all suffer from; that we take far greater notice of negative feedback than positive – the negativity bias. Studies have shown that our brains are more sensitive to negative news. Blame evolution. It’s also been found that the ratio for a sense of balance in positivity and negativity in relationships is 5:1. We must take it into consideration in our relationships with others. Be careful with people and remind them of what they do well, because they need to be told, and this too can help to create an environment of trust where a greater level of openness is possible.

Be respectful;

This goes for yourself as much as others in my mind and in practice is centred around reinforcing the values and behaviours that you expect to role model and see in others. When done with kindness, it is perfectly possible to point out when someone is transgressing these, and it often requires you to be human, vulnerable and honest with that person, which, in itself, can build bridges. In fact, once again, the groundwork for this is laid in advance, before a difficult conversation is even faced, by allowing people the time and opportunity to talk about the values and behaviours that help them, and by providing them with food for thought (our newsletter archive is full of this). This helps to set the tone before you even approach a difficult conversation.

It doesn’t look like…

Avoiding tricky or uncomfortable subjects;

Most of us, and leaders especially, need to make difficult calls and raise issues with people. Having difficult conversations well is not about avoiding the difficult part of it, rather the difference between a kind and unkind conversation is not in substance but the tone, approach and motivation for it. Sometimes kindness is helping people choose a path in life that better suits them, or it is pointing out that they are acting out of character and asking what is wrong, or helping someone be aware of how their chosen behaviour is influencing their reputation or handicapping their best efforts. It’s how you do it that matters, including the time chosen, the place, and who is party to it. Again, having an existing relationship build on kindness and trust can create a backdrop against which difficult conversations are not seen in isolation or taken out of perspective, but seen as part of a much wider discourse.

Exerting your personal power;

Having a difficult conversation can be fraught with power play when done badly, but when you start from a place of humanity and kindness, this energy can fly out of the window. Meet on a level, as human beings first and foremost, even if they are getting off on the wrong foot or seeking to unsettle you. What can shift the tone is simply asking how they are, what their day has been like. Perhaps there is more going on for them than you realise.


All this aside, we also have to remember to ask ourselves, why is it so hard to have these conversations? What is this telling us about the environment we’re working in? What do others feel about this? What can we do to have this discussion openly which might help?

In a high-risk industry like healthcare, some conversations will always feel difficult, but for those that you know in your bones are difficult for the wrong reasons, the best step you can take is to start a conversation around it where you are.

And for those on the receiving end of a difficult conversation? I’ll leave you with a quote from the American organisational psychologist Adam Grant;

“Insecure leaders ridicule others. Secure leaders laugh at themselves. Great leaders take their work seriously, but don’t take themselves too seriously. The ability to make fun of yourself is a mark of humility and a catalyst for learning from mistakes.”

Resources to help you;

Civility Saves Lives – a treasure trove of evidence to highlight the importance of civility in healthcare

Creating a workplace where staff can flourish – The King’s Fund

Looking in the mirror

Being Human

When conflict builds connections

About negativity bias

About the author;

Cat Harrison is the communications and engagement lead for the Sign up to Safety team, and has advised numerous FTSE100 companies as well as national charities and health-related organisations. Her expertise lies in the development of impactful campaigns, the importance of language and tone in connecting with people, and engagement approaches that motivate and excite people to take action to make care safer. You can tweet her @catharrison4

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