Empty speech bubblesThere are times when we need to hear what we need to hear. We need to hear what we are not doing well enough, what we have missed, the problems we have caused others. We need to hear what we need to do more or do less, what to change, what to start and what to stop. We need to hear how we can improve.Though some of us may have well developed levels of self-awareness, none of us can be fully aware of all our short-comings or the impact that we have on other people without help. We all need these things brought to our attention. We need other people to let us know. In many ways, for us to hear what we need to hear, we depend on those who we work with to say what needs to be said.

When should we be saying what needs to be said?

The topic of saying what needs to be said come up in many of our courses. In our Teach the Teacher Courses we explore the need to bring things to the attention of those who are learning from us. In our Essentials of Medical Leadership and Management Courses we discuss initiating/embedding change and dealing with under-performance. During our Advanced Team Communication Skills Course we address the need to bring things to the attention of our leaders and our colleagues. Even on our Medical Interview Skills Courses we work with delegates to make sure they are able to raise controversial subjects and inform a prospective employer of the improvements they need to make to their department or organisation.

Shortcomings in giving feedback or critique, raising challenge or simply bringing things to the attention of others in these contexts can have major consequences. People and teams fail to reach their true potential. Safety issues increase, errors multiply and mistakes are not addressed.  Standards slip, inefficiency is accepted and initiatives fail. It has direct relevance to honesty and integrity. It can even be argued that the Duty of Candour starts with the communication between healthcare professionals. If we don’t speak up then we become part of the problems which surround us. These are just a few examples to illustrate why doctors must skilled in saying what needs to be said. Yet there is a problem.

Trouble saying what needs to be said.

Our published research, based self-assessment by over 200 doctors, has identified a shortfall in sharing feedback and challenge.  Significant percentages say they don’t do this enough or even at all. (Please note that the emphasis here is on face to face discussion, rather than annual anonymous feedback via a digital portal). There are likely to be numerous reasons for this.

We all know it can feel awkward and uncomfortable when we receive criticism or when someone disagrees with us or challenges us. So this may inhibit our willingness to speak up. The medical professions also have a long established culture of hierarchy. So this may make people feel it’s not their place to say something. Bullying is all too often allowed to persist through lack of challenge.  The perception of bullying and team friction can be the result of clumsy critique or challenge. In addition, many doctors have not learned how to speak up and challenge their leaders, peers or learners. They don’t know how to say what needs to be said in a way that it will be heard in a constructive manner.

So what needs to change?

Examples of poor quality critique are abundant in our entertainment media. Alan Sugar and Gordon Ramsey have prospered through barking insults and put-downs. On the X-Factor and other talent shows the judges are often heard telling someone, “You need to take it to the next level,” or “You’re not very likeable.” What can the contestants do with feedback like that? There are parallels here with the reviews which some doctors place for our services on the independent TrustPilot website. We genuinely want to know what we are doing well and what we should improve. Yet a comment along the lines of “Great course full of useful resources and information. I would not hesitate to recommend to a colleague” being followed by an award of 4 stars out of 5 can only ever leave us wondering if we somehow fell short and how we could ever get that 5th star.

The receiver needs to clearly hear what it is that they needs to address so we must communicate this clearly and constructively.

How clearly are you saying what needs to be said? Are you and your colleagues hearing what needs to be heard?

Stephen McGuire – Head of Development