Holding crucial conversations - emotional and risky discussions - is key to improving patient safety, reducing errors, improving morale and reducing staff turnover, explains Richard Pound

Poor communication remains a dominating factor in many preventable incidents.

A recent study of 1,700 healthcare professionals showed that less than 10 per cent speak up effectively when they see (or simply think) something is wrong - something as seemingly innocent as a nurse feeling it is not her place to remind a consultant to use alcohol handwash before attending to a patient.

Ten per cent of respondents admitted that they had seen harm come to patients as a result, while those who said they do speak up said they had seen dramatic improvements in patient care.

Some simple steps, used in Crucial Conversations seminars, can help people speak openly and honestly to others about sensitive and difficult issues.

1. Reverse your thinking

Most of us decide whether or not to speak up by considering the risks of doing so. For example: "I can either raise this issue with my manager and make them doubt my loyalty, or I can say nothing and keep the relationship intact."

Those best at crucial conversations think first about the risks of not speaking up. They realise that if they do not share their differing views with the team, they will have to live with the poor decisions that will be made as a result of holding back.

2. Stay focused on what you really want

Frequently, we get distracted by new motives and start to go after things that are less important than our primary goals (for example, providing excellent patient care). These motives, such as winning an argument, saving face, or punishing the other person, suddenly seem more important.

So as you see yourself moving to these new motives, ask yourself "what do I really want?" Do you really want to feel like you got your revenge? Or would you rather feel happy that the issue was handled in a way that was respectful and mutually beneficial?

3. Make it safe for others to speak up

If you can create enough safety in a conversation, people will let you say almost anything to them. People do not become defensive because of the content of messages, but the perceived intent. It is not what you say, it is how you say it.

Start your next crucial conversation by assuring the other person of your positive intentions and respect for them. When you do this, they let their guard down and begin to listen, even if the topic is unpleasant.

4. Separate fact from fiction

The main reason we do so badly in crucial conversations is that by the time we open our mouths we are irritated, angry or disgusted with the other person. No matter how much we try to fake it, our negative thoughts take over.

So, before opening your mouth, focus on the facts, not your conclusions or stories. You may not agree with the other person's opinions or actions, but hold a good thought for them and you will come across entirely differently.

5. Invite dialogue

After you have created a safe environment, confidently yet tentatively share your views, starting with the facts (not your story or conclusions). Then invite different opinions. Encourage the other person to disagree with you. People who are best at crucial conversations are not just out to make their point; they want to learn from others' views and make the best decisions. If you are open to hearing other points of view, people will be more open to yours.

As you start asking the right questions and holding crucial conversations in your own organisation, the culture of silence will be replaced by a culture of safety where employees feel motivated, engaged and empowered to speak up and share their best thinking.

For more information, visit www.gra.uk.com or www.gra.uk.com/silencekills