North London Partners in health and care

Active listening

Helen Shaw
Portfolio Manager for Social Care, Leadership in the Directorate of Education & Training at the Tavistock and Portman NHS Foundation Trust

This week there is a global initiative asking health care staff to ask the question: ‘What Matters to You’? of their patients and service users. It prompts us to think about the need for staff to feel that what matters to them is able to be expressed and being listened to. Can we ask our colleagues, our leaders, our team members the same question and can we really listen to their answers? How can we create and sustain workplaces that understand the importance of communication, praise and acknowledgment? We know that organisations that create cultures that encourage open communication, where the giving and receiving of feedback is valued, are organisations that thrive. They benefit from the diversity of experience and perspective from their staff members. They are organisations that are more able to navigate and respond to challenges successfully.

As we continue to respond to the pandemic with many people working in potentially traumatising and certainly challenging situations this is all the more important. So how do we really listen to our colleagues and develop our listening and questioning skills and through this broaden our awareness of what problems are, might be and how individual beliefs and assumptions frame and contribute to them.

In this time when we are all under considerable pressure it is even more important to check in with colleagues, ask them how they are and then give time and present attention to the answer – listen with you whole self, notice the emotions you feel, when your attention wanders or when it is piqued, whether you move to thinking about solutions instead of listening. Is it possible simply to listen and to be alongside people as a witness to their experience, to allow them the space to talk and to work through their dilemmas?

We are often asked to be experts, indeed many of us are experts in our roles in the disciplines in which we practice but this can also impede our ability to listen as we are hard wired to think about and come up with solutions. Can we also be facilitators and enablers and to sit in open curiosity with another and to really hear what they are saying and in so doing begin to know how they are doing. We can then begin to think about listening as an active process that is a skill that can be developed and honed.

Sometimes this active listening is just just about being emotionally present and able to sit through the uncomfortableness of just being and listening without rushing to those solutions. But questions that show openness and curiosity and a desire to understand as well as just hear can also be helpful – the so called what and how questions. So ask someone: How important is this to you? What’s at stake here? What is your greatest fear? How is this affecting you? What is the broadest range of options open to you? What could you start to do differently?

A helpful concept to support this stance of curiosity and presence is that of negative capability coined by the poet John Keats in 1817 who describes it as the state in which a person is `capable of being in uncertainties, mysteries, doubts, without any irritable reaching after fact and reason’. If we can tolerate ambiguity and paradox, and anxiety and stay in uncertainty, new thoughts and perceptions may emerge.

Breakthroughs in understanding often occur at the edge of ‘knowing’ and ‘not knowing’. Around every situation or ‘presenting problem’ lies an ‘empty space’ (full of issues about which we are not aware, tacit/unconscious assumptions, and unspoken imaginings and beliefs). The key is to resist the pressure to fill that space with our own assumptions and solutions.

All work provokes emotional responses in us all – is there space to reflect on and think about those issues and what they mean as a way of accessing some of the creativity within the organisation that sheds new light on the organisation’s challenges and dilemmas? I think there is.