Enabling difficult conversations in the Australian health sector

Abstract

Background: Research on difficult conversations is mainly about the impacts of avoiding difficult conversations, with little research on enabling difficult conversations except for improving communication. Objective: This study aimed to identify the ideal environment for enabling difficult conversations to take place in healthcare settings. Methods: Convergent Interviewing was used with 20 clinical supervisors to explore the following question: “What enables healthcare professionals in the workplace to have difficult conversations?” Of these 20 clinical supervisors, 10 were nurses, eight were in allied health (five speech pathologists, two physiotherapists, one community support worker) and two were in medicine. Results: Enabling difficult conversations is complex and requires change at the individual, team, profession, and organisational levels. Enabling these conversations is not as simple as improving communication skills, although effective communication skills are necessary. Discussion: Other requirements include the desire for someone to want to have a difficult conversation. This relationship exists between the people needing to have the conversation, the physical environment and time required to have the conversation, and also having management, disciplinary and organisational support to engage in difficult conversations. Conclusion: Enabling difficult conversations between healthcare professionals is a complicated endeavour involving individual, team, profession, and organisational changes. This implies making a significant effort in presenting training and educational opportunities for all health professionals. What is already known about the topic? Poor communication is a key contributor to medical errors. While clinical supervisors need to have difficult conversations with peers, patients and managers, many supervisors lack the skills to adequately perform these on a regular basis. What this paper adds: Having difficult conversations between healthcare professionals is complex. That focussing on ‘enabling’ is a more proactive and positive approach than focusing on ‘avoiding’.