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Open dialogue: a model for conversation

How can the principles of the Open Dialogue approach help managers and leaders to hold conversations about health and wellbeing with their staff?

In this step we are going to look at what makes a helpful health and wellbeing conversation between a manager or leader, and a member of staff you may be concerned about.

It is tempting to imagine that the best way to hold conversations about health and wellbeing with colleagues, particularly if they are distressed or you are concerned for them, is to prepare carefully what you are going to say so that you have a plan for what will happen. While understandable, this desire for control of the conversation can be unhelpful because your plans and needs can get in the way of truly relating to the other person. In the end it is the quality of this relating that will really determine what happens next.

Clearly it is important to pay attention to when and where you have conversations that invite a level of intimacy and emotional honesty not usually present in working life. But when it comes to the conversation itself, it’s more helpful to consider how you will show up in it, rather than planning what you will say or do.

What is open dialogue?

The Open Dialogue  principles below can help you think in broad terms about your approach to a health and wellbeing conversation with a colleague. In the video above, Nicola Blythe, a former mental health social worker trained in open dialogue, explains the spirit and practice of the approach in more detail. Consider the principles in the table below and then watch her video before reading on.

Principle of open dialogue Application
A social network perspective Be curious about the sources of distress and solutions that might exist for someone in the collective (the team and wider system) as well as the individual.
Immediate help Find out what the person needs right now – both in the immediate aftermath of the conversation and in the coming days and weeks – and try to meet those needs wherever possible.
Responsibility Take responsibility for the welfare of your colleague and don’t hand the issue off to anyone. Take responsibility for learning any lessons and for applying any changes that will ensure others don’t experience the same distress.
Consistency Stay involved and provide continuity. This includes taking an interest in people’s wellbeing long after any episode of distress or burnout.
Flexibility Try to be as flexible as you can in your response and stay open to a range of possible solutions.

A dialogue is a very specific and special kind of conversation where each participant feels heard and responded to, and a shared understanding of the issue can emerge. It’s important to remember that feeling heard is the basis for any change. 

What skills do you need?

To be in a genuine dialogue with another person (or group of people) requires your presence; an attention to the here-and-now without any preconceived hypotheses or specific agenda. As the manager or leader in a conversation of this kind, your role is to be (intellectually and emotionally) present so you can generate and promote the flow of dialogue and, in turn, help mobilise the resources of the other person(s). Your ability to facilitate an open, participatory, transparent and emotionally honest conversation is what will generate this outcome. Good facilitation of a dialogue therefore requires four key skills.

  • Attending skills
    Notice your body language, use of eye contact and state of relaxation. You cannot give the other person the attention they deserve if you are mentally distracted, so make sure you really are present for the conversation and able to truly listen. Also pay attention to actions like note taking that divide your attention and can give the impression the conversation is procedural or part of a formal process.
  • Listening skills
    Listen to understand and not to respond. Pay attention to the words used, the language chosen, the tone, body language and any patterns in what is being said. Try to listen also for what is not being said and don’t be in a hurry to fill silences with your voice.
  • Reflecting skills
    These include re-stating, para-phrasing and summarising what you hear and checking you have understood it. Reflecting also validates what the other person is saying and demonstrates they have been heard.
  • Inquiring skills
    This is all about respectful curiosity. Examples include open questions, hypothetical questions, and even challenge. Asking questions with kindness and compassion from a desire to understand better the other person’s perspective and what is going on for them will open up possibilities for action based on a shared understanding of the problems. As tempting as it can be, try to resist giving advice.

Finally, in an earlier step we explored emotional self-awareness, and this is one of those occasions where it becomes a real asset. Empathy, compassion and relatedness to the other person are only really possible if you have this capacity. Emotional self-awareness is also vital to your ability to self-differentiate. That is, to empathise and connect with the other person without absorbing their distress as your own, an outcome that is critical for your own health and wellbeing.

Conversations about health and wellbeing require patience and presence and can be emotionally intense. The quality of them, done well, is usually at odds with our prevailing culture of work and the many and varied pressures that shape it. Good managers and leaders are able to hold this tension and create an emotional ‘container’ for a conversation that is compassionate and restorative for the other person.

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Leading Well for Staff Health and Wellbeing in the NHS

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