Vulnerability, Healthcare and Courageous Conversations.

Author: Cristiana Theodoli


“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.”
— Theodore Roosevelt

I recently signed up for an online seminar organised by Healthcare Improvement Scotland on leadership in healthcare. As a newly qualified nurse, leadership is something I am only marginally involved in, mainly in terms of trying to be a good role model for others. Nevertheless, I joined in as the seminar was presented by someone I have been following on and off for a few years, American researcher Brené Brown.

Brené’s research, in the fields of social work and mental health, has covered topics such as vulnerability, shame, empathy, leadership and courage. Her TED talks are a must watch and she quotes the Theodore Roosevelt speech above, one of my all time favourite passages, in the audible version of her book ‘The Power of Vulnerability’.

In the seminar Brené discussed her research on leadership. She noted that though participants struggled to define good leadership, they were able to highlight what they saw as negative characteristics such as lack of courage, avoiding tough conversations, too much shame and blame, or not attending to colleagues’ fears and feelings. She summarised poor leadership as choosing comfort over courage.

The concept of improving leadership skills by daring greatly and choosing courage over comfort, along with Brené’s findings that high performance teams share trust and psychological safety, reminded me of a workshop on ‘courageous conversations’ I attended when I worked at NHS24 as a call handler. While most of us would call these conversations challenging, the workshop focused on how we should avoid the negative connotations of the word ‘challenging’.

In the workshop it was argued that courageous conversations are those in which two parties clarify the reality of an issue from both perspectives, allowing us to learn, progress and change by understanding how we all experience the same situation differently. This was reflected in Brené’s talk in which she noted one of the skills of courageous leadership is the ability to reality check our perceptions and reality check the stories we tell ourselves about the ways we experience situations in life.

When considering the day to day pressures of working in such an intense environment as an Emergency Department, it is easy to see how disagreements and misunderstandings can arise. As such I feel it is invaluable to have access to a framework that allows us to approach conversations we would traditionally identify as ‘challenging’ from a courageous outlook instead.

In her web seminar, Brené defined the importance of vulnerability in healthcare leadership as not an issue of disclosing our weaknesses to others but rather in terms of showing our humanity and recognising others’ humanity. This is reflected in the courageous conversations framework presented at NHS24, which defines a courageous conversation as one when broaching the issue is essential in maintaining the integrity of the relationship.

The ‘Courageous Conversations’ framework follows seven steps aiming to explaining the issue from the perception of the person initiating the conversation, exploring the gap between what the situation is at present and what they would like to achieve and eliminating this gap by coming to a resolution.

The seven steps as presented at the workshop, are:

1. Explain what the issue is from your point of view while keeping in mind it might not be an issue for the other person.

2. Give a specific example to help them understand your perspective.

3. Discuss your feelings about the situation, while remembering that the way you feel is your responsibility and not theirs.

4. Note what is at stake for you and the consequences of things not changing.

5. Take responsibility, acknowledge your part in this disagreement or misunderstanding.

6. Show that you want to resolve the issue and state that you would want a positive outcome.

7. Ask for the other person’s thoughts and feelings and show you are willing to listen to their point of view. Acknowledge that their views are true for them and their experience.

By using these steps to tackle conversations we may find difficult or uncomfortable we also reflect Brené’s suggestion that by normalising challenging conversations and recognising instances in which we are vulnerable we strengthen among our colleagues that trust and psychological safety characteristic of high-performance teams.

Having available an outline that helps us frame these conversations in a way that promotes a culture of trust and open discussions can only help strengthen our team in the face of the increasing pressure and intensity of our work.

Courageous Conversation Framework

1. The issue for me is…

2. A specific example is…

3. I feel about the situation…

4. What’s at stake for me is…

5. I’ve contributed to this by…

6. I want to resolve this with you.

7. I’d like to hear your thoughts and feelings about the situation.

Thanks to Healthcare Improvement Scotland for organising the WebEx with Brené Brown, Brené herself for the inspirational lecture, and to Lisa Walsh, Learning & Development advisor at NHS24 for sharing the courageous conversation framework with me and agree for it to be shared on.

Hannah BellComment