Things that get in the way of good conversations

As with all things we occasionally need to challenge ourselves and ensure we are self-aware and notice whether we behave in a way that can get in the way of a good conversation. We are all human so can behave in ways that are not ideal or perfect and we will get it wrong at times – the important aspect here is to notice it and say sorry, or acknowledge when you have got it wrong.

The following are a number of factors that we have noticed get in the way of conversations, which you need to be aware of when you are helping people talk to each other:

Hierarchy, status and power

All of these can inhibit people from speaking up.  They can do so in ways you don’t even realise.  If as a leader you feel strongly about something you can come across as authoritative and imposing – so much so that others don’t challenge or question you.  This can be particular risky if the action could be endangering a member of staff or patient, and people don’t speak up to stop it from happening.  Also, the prevailing culture is one of ‘telling’ and instructing others when in fact what most people want is to be guided and coached towards a decision or action.  Telling puts the other person down, it implies that the other person is ignorant; it assumes that the other person does not know.  We need to remove our bias towards telling, as we tell too often and even when we are asking questions, if we’re honest with ourselves we realise we are often still telling.


Women and men are often referred to as from two different tribes, each with a set of rules, beliefs and behavioural expectations.  Stereotypes exist for a reason, lots of women like to chat about their feelings and lots of men don’t but by saying that all men and all women are like that means we put people in a box and label them.  We then expect them to act accordingly.  Our gender impacts on how we communicate but so do a number of different variables.  People behave and communicate differently depending upon their mood, the circumstances, the stressors, their role, their race and their status. The tips and tools to communicating effectively apply no matter which gender you are.  It has everything to do with helping people speak out, helping people listen, respond and act.  The way different genders are treated can have a profound effect on safety. Across many cultures worldwide women find it hard to speak out, often only giving an opinion if asked. All of us, men and women, have a role to play to encourage and respect each other to help us all have a voice.


Grandstanding is when people think they are right about something and try to dominate or impress.  Some people find it very difficult to give up on their certainties, positions and beliefs.  In our experience, we have found that too often people speak as if they knew already the complex situation another person is describing; often without listening properly to the concern or problem being expressed.  Often people stick with their preferred solution and insist that it simply needs to be ‘downloaded’ to work.  Each of us need to try to unfreeze our fixed positions or move away from the entrenched views and assumptions we have long held; there is no room for high horses or grandstanding in safety.


Our words are powerful, they can hurt and they can encourage. The bullying culture is extremely inhibitory and sadly all too predominant in the health service. Staff can feel bullied by the way an organisation is run, by the pressures they are put under, the working conditions they are expected to work within.  They can also feel bullied by individuals.  Some of those individuals will not even recognise that what they are doing is bullying.  People feel frightened to speak up for fear of getting blamed or punished for doing so.  Bullies and bullying cultures can stifle conversations and shut down others. However, some people don’t even know they are acting in a way that could be perceived as bullying.  What we need is to encourage a culture where this is noticed and addressed quickly.

Habits and behaviours

We have somehow learnt a lot of habits and behaviours when we talk to each other which are not always great…for example we:

  • Talk too fast
  • Interrupt others
  • Monopolise the time
  • Turn it back on ourselves ‘I know exactly how you feel’ ‘the same thing happened to me’
  • Use confusing or ‘in house’ jargon, abbreviations, and acronyms that can silence others around us.

Labels and stereotypes

We are increasingly being defined by our labels; our job titles, our professions, our personality type.  We assume we know each other the moment we hear a label and put people in boxes.  These then become shorthand or generalisations for how we see each other and refer to each other, which can lead to stereotyping.

When we get rid of categorisations we start to see each other as, simply, other human beings.  This in turn can reduce the intimidation some people feel in relation to those perceived as more important than them.

So with this in mind, introductions need to be thought through. There is a need to rid ourselves of professional titles and other things that usually separate people.  A way you can do this is by using first names only when people introduce themselves and throughout the conversation.


We recently saw a talk (at the Learning from Excellence conference) from Chris Turner, an emergency medicine consultant, on the impact of incivility in healthcare and it really was eye opening!

The effects that incivility can have in the workplace is now beginning to be understood and it’s dramatic; it makes you less able to make decisions, your performance suffers, your team work less well together, and patient outcomes suffer – and it makes your patients lose confidence in all staff they encounter.

“Minor incivility has significant impact on performance with 61% reduction in cognitive capacity on recipients, 20% decrease in performance for ‘onlookers’ and 50% reduction in willingness to help others.” 

Chris Turner

It goes without saying that it hampers conversations. In the absence of kindness, it’s easy for civility to go by the wayside too, which is why Civility Saves Lives is a must-read website, full of evidence for the importance of how we speak to each other. It has influenced us greatly.