Power talking – using ‘conversational intelligence’ within occupational health

The Royal London Hospital, part of Barts Health NHS Trust. The trust's occupational health team has benefited from developing "conversational intelligence". Shutterstock

Investing in ‘conversational intelligence’ (CI) training has transformed how the occupational health team at Barts in London communicates, collaborates, reports and delivers its services. Sue Kennard explains what CI is and how and why it has made such a difference

At Barts Health NHS Trust in London our team of 12 occupational health advisers deals with an average of around 260 referrals a week.

But volume isn’t so much the challenge. Barts has 17,000 staff working across four – very different – hospital sites, all with their own structures and cultures. And the OH function also serves external customers in the public sector locally: employees from GP surgeries, schools, maintenance staff from contractor Serco and so on.

It’s the kind of diversity of organisation and challenges to wellbeing that demands a consistency of approach. The traditional “cup of tea and sympathy” leads to a general level of box-ticking, keeping up the flow of referrals through the system, a sympathetic ear for an hour. But it doesn’t necessarily ensure there is a clear grasp of the real issues being presented; how the employee can best be helped, how to get valued staff back to work.

About the author

Sue Kennard is head of the employee wellbeing service at Barts Health NHS Trust

When I joined the trust in 2017, there were inconsistencies that needed to be addressed. The information from the manager about the referral could be poor. It was likely to just give the reason as “stress” and nothing more. It wouldn’t be clear whether the employee was still actually in work or not, how long that might have been for or whether the cause was thought to be a work-related issue or something happening at home. Without more guidance on the OH role and processes, line managers had got into a routine of jotting out a cursory note.

Routine, tick-boxing reports

That was one end of the problem. The other end was how the one-hour sessions were being run. Staff would, as a rule, hear about needs and then produce a report. It was a routine, an inflexibility, one that could lead to issues being discussed at just a surface level.

An employee, for example, might summarise a situation as how they were just not getting on with their manager or maybe they felt the pressure of the job had recently escalated and they were not coping.

But there could well be underlying issues behind these feelings that needed to be understood in order to reach more effective and longer-term solutions. OH needed to know about all the issues that could be influenced in order to have any chance of having an impact on events and circumstances that could not in themselves be changed.

It was clear therefore that we needed to step back and look again at the whole process and how it could be improved for both clients and customers.

That was the beginning of implementing a case management process in order to provide that necessary level of consistency. We set about building new attitudes and understanding of OH through information campaigns.

This included resources for individual audiences about what information was needed from a referral, including: what to consider, what to expect, and ensuring all the different needs from the service were being met.

At the heart of the change was an emphasis on improving the quality of the conversations or what’s known as “conversational intelligence” (CI).

We made use of the expertise of CMP, a workplace relationships specialist, to deliver training across the team. It wasn’t a case of questioning the team’s level of clinical knowledge or their counselling skills but going back to essentials, to core soft skills and ways to widen discussions without being overly assertive.

This included looking at how to have better quality conversations that would work better for both sides, reach better outcomes. That meant being able to dig deeper and understand the bigger picture, not just listening, accepting and moving on.

Understanding conversational intelligence

CI is about being equipped to have conversations in which we don’t make assumptions. We are curious about different views, experiences and approaches. It’s when we listen in a reflective way and are conscious of the need to empathise with views that might be different from our own. Critically, having CI means being able to create a sense of safety, so that the staff member feels able to be entirely open rather than giving expected answers, following the path of least resistance.

The one-day training programme has focused on building an awareness of the role of conversations in relationships, how the quality of conversations changes dynamics, the huge influence they have on the outcome of situations, particularly those most difficult of conversations where we’re most likely to want to rush to the easiest conclusions.

Core skills for CI include “situational awareness”, the essential practice of “curiosity”, “reflective listening”, “empathy”, and “self-awareness” – so not just listening outwardly but inwardly, how your own “inner state” is impacting on the flow of the conversation.

One very experienced member of the team needed some persuasion to take part. They didn’t make it explicit they thought they knew it all already but the implication was there.

I wanted the whole team to be part of the experience, to learn together and share their experiences, so it wouldn’t work without them. I guaranteed they’d learn something new, even if it was just about the rest of the team.

A day after the training that senior leader was raving about the training to everyone. They’d learnt a great deal about themselves and were going to re-think their entire approach! They’d seen just how much our personal thoughts, feelings and prejudices were entering in to conversations and acting as a blocker to better outcomes.

All the staff who took part in the CI training have reported benefits to them as individuals. In terms of the overall service, the package of changes involved in moving to a case management approach has transformed the nature of the services. CI was important for that: the quality of reports has improved, with more insights and clearer, more purposeful ways forward.

Importantly, the employee wellbeing service has been able to deliver higher quality information back to HR, so upping the level of relationship. The team itself has become more engaged in the regular team meetings, looking at processes, being more self-reflective, contributing more and focusing on fairness and consistency across the diverse range of customers.

To conclude, Barts Health has plans to keep CI skills at the centre of “how we do things around here”. This means not necessarily repeating training, but looking to continually develop levels.

We also plan to look at harder evaluation of the impact of changes, monitoring for absence, and getting more feedback from HR.

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