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Leadership conversations

Developing dialogue to drive change and collaboration is a key challenge confronting leaders. But, as Sharon Millar and Amanda Ridings report, help is now at hand.

Across sectors or within services, working with colleagues in the spirit of co-production and whole-system working is often easier said than done. Have you ever found yourself thinking: “Here we go again - yet another attempted takeover…” or “Why do we keep raking up old differences?”

Such thoughts are indicators that a mode of conversation is not fit for purpose. While few leaders in public services challenge the idea of greater integration, putting it into practice is proving challenging. A different kind of leadership conversation is required, one that engages with the complexity of wicked issues.

NHS Scotland is taking a range of early steps to change the shape and quality of leadership conversations. NHS Scotland’s National Leadership Unit works with partners to drive cultural change, and build leadership capacity and capability.

Together we explored ways to enhance capacity for conversations that would support effective collaboration within, and across, systems. Here we look at the results of pilot “dialogue practice development groups” for the leadership cohort in NHS Scotland.

The pilot dialogue practice development groups used a combination of inquiry, reflection, embodied practice, casework and short inputs to:

  • raise participants’ awareness of their contribution to, and impact on, leadership conversations;
  • develop their versatility in challenging conversations.

The programme also aimed to increase the personal resilience of participants, enabling them to make skilful choices, even when under pressure. In each group, seven leaders met for six sessions. Two distinct energies, which can be used to describe the shape of conversations, were outlined:

  • advocating energy - taking a position or stance;
  • inquiring energy - wondering about possibilities. 

American business theorist Chris Argyris defines dialogue as balancing of advocacy and inquiry, as each has value and purpose. Without advocacy there is no shaping or aligning energy in a conversation, no traction. A conversation may become circular, lacking focus and feeling repetitive, leading to disengagement.

Without inquiry, there is no supporting energy, no sense of space in which new possibilities can emerge. A conversation may become confrontational, as each party makes their point more energetically, perhaps excluding other voices and generating frustration or anxiety.

Using these descriptors, participants were able to describe two common patterns of “stuck” conversation, where progress stalled:

  • repeating, non-resolving conversations;
  • conflict.

In the “repeating” conversations, typical reactions before the pilot programme were: becoming frustrated; disengaging; enduring and moaning; or keeping silent. There was a tendency to expect someone else, typically the chair, to provide focus. In developing their practice, participants were much more likely to intervene and provide direction, even when not chairing.  

Where there was conflict, typical strategies before the programme were: steamrolling; digging heels in; using humour to deflect; “getting my defence in first”; playing the expert card; and “hitting back with barbed comments”.

Using dialogue practices, more options emerged, including:

  • being braver in sticking to my point of view - more calmly, less combative;
  • preparing - what is my intent, what do I want, how shall I enter, what is my tone?
  • asking more questions to understand the other person’s perspective;
  • diffusing tension between others by holding different ideas in balance.

Mindfulness in conversations

Throughout the programme, participants were encouraged to use dialogue practices to foster a forensic curiosity about:

  • what is happening in this conversation - is it fruitful or not?
  • what is my contribution - what options do I have?

These questions invite leaders to cultivate mindfulness, an impartial awareness of what is happening, as it is happening, both between people and within themselves. For example, leaders often edit what they are thinking and feeling about an issue, and only talk about their positions and conclusions (advocacy). This often suggests more certainty and alignment than is the case. We glimpse evidence of internal uncertainty when a leader says: “I’m in two minds about…” or “I agree with your rationale, but my gut instinct is…”

Such phrases indicate that perception reaches beyond the mind and includes feelings and intuition. Mindfulness of thinking is not sufficient to navigate the complexities of human experience: the body is also a “player” in conversations.

To explore the role of physiology in dialogue, participants were introduced to leadership embodiment practices. These practices, developed by Wendy Palmer, draw on principles from martial arts and mindfulness. They enable leaders to become aware of their individual survival pattern, and to develop capacity for “centring” or recovering a more aligned and resilient leadership presence. 

Casework, using an approach called the left-hand column, also supported participants to develop mindfulness. By bringing to the surface internal dialogue, the process of writing a left-hand column stimulates reflection and learning.

One participant reflected: “I had often wondered why I couldn’t get what I wanted from certain interactions with others. Through the left-hand column exercise I realised that my entry into conversations could come across as aggressive, impatient and patronising, thus lessening my impact.”

The programme offered tools for diagnosing situations, and group practice supported participants to cultivate dispassion in that diagnosis, and compassion towards self and others in moving a predicament forward. Throughout the programme, there was anecdotal evidence that conversations were changing, to good effect. Afterwards, a formal evaluation process gathered narratives about the personal and organisational impact of the pilot.

Participants described their personal experiences as positive and valuable. They acquired new models and tools, cultivated resilience and presence through the embodiment practices, gained insight into the impact of their reactive habits, and increased their confidence in expressing potentially challenging points of view.

The evaluation showed the programme to be a good fit for developing the leadership qualities set out by NHS Scotland in its leadership strategy, Delivering Quality Through Leadership.

Organisational outcomes

Colleagues of those who participated noticed changes in behaviours such as:

  • more productive meetings, less time spent smoothing over ruffled feathers, more contribution and improved relationships;
  • improved reputation of participants, growing respect because they listen more to other perspectives;
  • more inclusive team-working, participants working through allies rather than independently, colleagues’ behaviour changing as a result of being understood;
  • enhanced leadership capacity, people letting go of things they would have previously fought “to the end”. 

The approach has potential for far-reaching change - leaders learn to look at conversations differently and, in particular, have a different take on conversations that “go wrong,” or are unsatisfactory.

Sharon Millar (sharon.millar@nes.scot.nhs.uk) is a leadership development consultant at NHS Scotland’s National Leadership Unit. Amanda Ridings (amanda@originate.org.uk) is an executive coach and author of Pause For Breath: Bringing the practices of mindfulness and dialogue to leadership conversations.

Readers' comments (5)

  • Great that this is happening in the NHS. Completely agree we need to focus on this important aspect if we are to build leadership capacity and capability. Have you been working with medical practitioners in particular, this would be helpful if built into their training but we need it for existing colleagues also. Helpful to all no matter how resistant or enlightened.

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  • Sue Heatherington

    This is an excellent overview of the pilot and a great encouragement that conversations can change. Well done. Is a full report available - particularly echoing the potential identified by Annon above.

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  • Yes a full report is avaiable. You can access it by emailing sharon.millar@nes.scot.nhs.uk.
    Both pilot dialogue groups included a mix of senior leaders, including clinial leaders (doctors, nurses, AHP and psychologist).
    Our next steps - well, we are planning an inquiry event for 22nd January 2013 to map out the different interventions on the continuum of dialogue practice needed to reshape care. Further dialogue practice groups based on the original format are also being provided.

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  • It is great to see support for this work - I am passionate about the benefits of it. However, it is 'slow work' as it is practice-based and so it takes time to change our conversational habits.

    As Sharon says, we had clinical leaders on the programme - and there are more in the current cohort. One described using these practices to influence colleagues on a long-running issue about drug treatment, and also to keep patients 'on point' when describing their condition. Another adopted approaches to influencing colleagues where there was no 'line' relationship. Another again found the confidence to stand their ground with challenging messages about clinical practice.

    I find these practices so powerful because they are 'systemic', looking at patterns in conversation. In changing your practice in one pattern, you change MANY conversations. It takes time, but the impact is far-reaching.

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  • I am one of the participants in one of the pilot groups and I am also a clinican. I found the course to be extemely powerful and useful in my roles as a doctor and as a manager.

    It has given me tools to have more productive conversations and build internal resilience that I did not possess before.

    The whole experience was extremely positive and I learnt alot personallly.

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