Talking leadership: breakthrough conversations

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We talk to Patricia Boyle, a senior consultant here at The King’s Fund, about why important conversations sometimes become stuck and what helps and about our new programme on this topic, Leading breakthrough conversations. 

What is a breakthrough conversation?

We’ve all got experience of conversations that go around in circles, of times when issues are debated but no way forward is agreed, or worse – of when crucial conversations are avoided. A breakthrough conversation takes you beyond these experiences to really collaborate with others where it matters. 

Increasingly, people in the health and care system are being asked to collaborate across very challenging, complex geographies to deliver transformational change of services for whole populations. Although they may have a common interest, it’s likely people will have different priorities – and often people are being paid to pay attention to opposing priorities. People don’t think the same way, they come at issues from different perspectives and they don’t even use the same language to describe the same situation. By learning to observe a conversation at a structural level while still being involved in it, and using a wider toolkit of dialogue techniques, you can help yourself and others to break through and reach effective agreements. 

What are the kinds of things that get in the way or prevent us from having those conversations more often or at the right time?

There are so many things that can get in the way, connected to us as individuals and also to the context we are working in. 

Individually, before attempting a conversation, we automatically judge context, timing and whether we have the authority to get things under way. This makes sense and is generally helpful; however, it is also easy to feel overwhelmed and believe you can’t have influence when you are working in a big system like health and care.  This leads us to doubt ourselves: do I have the courage; do I want to persist with chronic issues where there are many answers or no answers; will I destroy relationships by tackling this; do I believe I have the skills to lead this? 

Organisationally, we might be working in contexts where we to have to deal with hidden conflicts, or we might be working in a general culture of avoidance. More subtly, we might have to deal with others who deliberately stonewall, make sure we are not in the conversation, don’t turn up to meetings or who just won’t be prepared to think differently. 

What does the evidence tell us about what works in encouraging the right conversations?

The King’s Fund has clear evidence on the skills required for systems leadership: building trusting relationships, getting to a mutual understanding, building rapport, open and inclusive communications, regular personal contact, surfacing and resolving conflict. Dialogue capability underpins much of this. In wider system work, you need great conversations to make progress towards wider collective agreement.

While there’s a place for hierarchy and role-based decision-making, sometimes ‘telling’ people doesn’t get the results you want. Better dialogue can get people on board.

To help this happen you can learn to become more aware of the ‘invisible structure’ of conversations which is’ hidden in plain sight’. You can become aware of how you tend to contribute and change it where it will help you and others. Knowing if you are more of an advocator or an enquirer is a first step. Beyond that, you can be more helpful if you can detect and distinguish between those roles in more detail.

Once you get good at noticing what your habits are and watching yourself in conversations, you are better placed to pay attention to the structure of a conversation and can then get less caught up in making moral judgements on the people in the conversation! You can pay attention to what you are contributing – or not – and be more constructive and productive. When practising initially, it helps to use the insights to plan before you enter a conversation and also to reflect after when things go badly or if you want to plan for the next. 

The hardest part of this discipline is being able to catch yourself right in the middle of a high-stakes situation, notice what is going on in you and the conversation and bring what’s missing structurally to help shift the conversation. 

How will the Breakthrough conversations programme help? 

The programme will provide you with the time to really dig into the detail of this, get supported practice time and gain confidence and skill. As a leader, it can be difficult when you are responsible but not in control, so anxiety can cause you to close down dialogue. By staying open, involving others, framing issues from the perspective of others and purposefully structuring conversations to find out better ways of doing things, you can get the best out of everybody’s thinking.

As a leader, you will have more awareness of what raises the stakes for you and affects your flexibility in conversations. You will have a new way of looking at the structure of conversations so that you can notice your own habits – so you can do something different. You will be more able to lead the type of conversation that creates buy-in sooner and deals with objections constructively and creatively.

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