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Episode 1: Interview with Dr Mel Barlow, Founder & Director of Reframing Conversations
10 Plays21 days ago
Reframing Conversations explores the everyday conversations that quietly shape trust, safety, teamwork, and outcomes.
Mel discusses how better conversations create safer systems, stronger teams, and more meaningful work and how currently what we are doing regarding communication training, is not enough.
www.reframingconversations.com
eLearning 10% discount code: LAUNCH10
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Transcript
Intro
Introduction to Dr. Mel and Her Background
00:00:20
Melanie Barlow
Reframing conversations Today we're joined by dr Mel who is a registered nurse who did her PhD at the University of Queensland Australia. You did your PhD in communication and social behaviour.
00:00:31
Melanie Barlow
Dr. Mel, thank you for being here. Thank you Dr. H
The Gap in Communication Training
00:00:35
Melanie Barlow
So why do you think so many communication strategies fail when they hit the real world?
00:00:41
Melanie Barlow
That's a big question. I think because a lot of communication training doesn't consider context so guess a bit of a story when i was close to 10 years ago now teaching communication training like speaking up and a lot of nurses would say to me oh but i can't do that i couldn't do that in front of the patient or i couldn't and i would say oh you've got permission from your leaders like going through this training you know what to say
00:01:17
Melanie Barlow
Like, of course you can. And then I went and did 10 years of research and discovered that absolutely right, the context is everything. And particularly also paired with social identity, like some professions, context really, really matters, such as nurses, whereas medical offices, not so much. And so I think Why they fail when they hit the real world is because we don't train for the real world.
00:01:50
Melanie Barlow
We don't train for context or social identity. We don't train to help people build resilience in their communication. Like how do you engage in a conversation beyond the script you've learned?
00:02:07
Melanie Barlow
Yeah. And then we also don't really teach people how to listen and respond in a way that's conducive to conversations.
00:02:19
Melanie Barlow
So what's one communication mistake you see happening again and again across workplaces? o Can I be a little provocative? I, you know, I'm an intensive care nurse, I was a resuscitation coordinator for a hospital, i taught advanced life support for many years,
00:02:41
Melanie Barlow
It's important it has a position, but organisations will take staff offline for four, eight, sometimes you know hours, sometimes two days to do advanced life support training.
00:02:57
Melanie Barlow
And super important because it does save lives, but how often do cardiac arrests actually occur in hospitals? It's not that common. Yet, how often do individuals and teams communicate like every day, all day.
00:03:17
Melanie Barlow
Yet we know from this so much data out there that medical error is way too high in our health organisations and a major contributing factor to patient harm is miscommunication and communication failure.
00:03:36
Melanie Barlow
You know, at some point medical error in the United States was the third highest cause of death. Like, it's significant, yet how much do organisations invest in communication training?
00:03:51
Melanie Barlow
A one-hour online module on how to speak up just doesn't cut it. It's a veneer of safety. It's not actually an investment in safety.
Technical vs. Communication Skills in Healthcare
00:04:03
Melanie Barlow
And so how has your perspective on communication evolved over your career? a Well, as I said before, context I've learned is super, super important, but also the words we use. So in healthcare, care we adopted crisis resource management principles from aviation that helped us advance in a lot of ways. So things such as understanding situational awareness, leadership, followership, all super important.
00:04:36
Melanie Barlow
It also brought the terms technical and non-technical skills with the non-technical describing communication, decision-making.
00:04:47
Melanie Barlow
And of course, we've got the term soft skills, which don't get me started. And I've seen those terminologies have detrimental impact to communication training.
00:05:04
Melanie Barlow
And what it has led to is the deprioritization of communication decision making, those skills over technical and psychomotor. So you look in higher education, you'll see learners learn technical skills. Those skills are broken down into the minutia, right? Like broken down step by step and then build back up again so they can repeat and learn the steps yet.
00:05:35
Melanie Barlow
you know, often you'll see a tick box at the bottom of that competency say, oh yeah, and communicated with the patient. So those decision-making communication behavioral skills are not broken down to the same level. And then we wonder why learners struggle to apply in the real world and why they struggle to communicate and why communication failures occur.
00:06:03
Melanie Barlow
So I think we need to stop using the terms non-technical. I actually recently wrote a book chapter with two people from aviation.
00:06:15
Melanie Barlow
And I think healthcare has now surpassed communication. in aviation. So I think that book chapter was all about how now aviation has things to learn from healthcare.
00:06:28
Melanie Barlow
And starting with the terms we use that we need to reprioritise. And instead of like non-technical or soft, anyone in healthcare care who's had to deliver bad news to a patient, you know, knows that these are not soft skills. They're hard and they're really technical to get right.
00:06:52
Melanie Barlow
So I think words have power. So let's start calling them cognitive behavioral decision-making skills, not non-technical or soft.
00:07:03
Melanie Barlow
I wonder how does poor communication show up in the team dynamics? Is it before it becomes too obvious?
00:07:14
Melanie Barlow
I think where poor communication occurs, not all the time, but I think it's in environments where There's a lack of trust, where people are more comfortable choosing silence, overvoicing a concern or giving feedback.
00:07:31
Melanie Barlow
And where there's kind of maybe disruptive tribalism. So by tribalism, we talk about, well, in healthcare, care it might be different to disciplines or professions have different ways of approaching things and situations, different ways of communicating And what they do is prioritise their own group over that of others. And often this is unconscious. So we see that different departments in healthcare are quite competitive or have strong opinions about each other. And I think that leads to kind of, whether deliberately or unconsciously, think defensive and protective communication.
The Role of Psychological Safety in Communication
00:08:22
Melanie Barlow
This makes me think about the role of psychological safety. So what does the role of psychological safety play in good communication, especially in high-risk environments?
00:08:35
Melanie Barlow
A great deal. We know that people stay silent, experience higher rates of burnout, particularly because they tend to work in unsafe environments. So I think we also need to train and coach people on how to build reflexivity and resilience capabilities. So I'm not talking about when someone blatantly yells at you or shuts you down, that's unacceptable. But I'm talking about occasions where we speak up, for example, but we may not get the answer we wanted or expected, delivered in a way that we wanted
00:09:18
Melanie Barlow
or you know we didn't get that oh my gosh thank you mel you're amazing. Often we just get, okay, tough, you know, and that's often not what we're looking for. And sometimes people view that as being dismissed or not listened to.
00:09:34
Melanie Barlow
And so I think we need to build reflexivity in the moment to say, hang on, let me reword that maybe it didn't land the way that I wanted it or needed it to land.
00:09:48
Melanie Barlow
And also resilience, like, okay, I didn't get the response I wanted But this is still important. I still need to engage in a conversation. So how do I do that? And current training doesn't teach that.
00:10:01
Melanie Barlow
So I think we need to deliberately give people the capabilities of being able to understand their own behaviour within a conversation and build resilience to engage and stay engaged in a conversation because in high-risk industries, like people's lives depend on it.
00:10:23
Melanie Barlow
I mean, building trust and relationships really does build that psychological safety.
Dr. Mel's Personal Experience and Research Motivation
00:10:28
Melanie Barlow
You have started a business and a podcast called Reframing Conversations. What drew you into working with communication and business in the first place?
00:10:38
Melanie Barlow
Yeah, another big question. i guess I've got 30 years plus in nursing and, you know, 20 plus years in in education.
00:10:53
Melanie Barlow
both things. So I was involved as an intensive care nurse working in a trauma ICU. There were a lot of speaking up moments, but this particular moment, I had a critical patient.
00:11:08
Melanie Barlow
We were trying to wean them off all the support, worked in environment where it was highly competitive amongst the doctors. So when it was a new week for a new consultant, the consultants notoriously changed all treatment plans to stamp their authority on their week kind of thing.
00:11:28
Melanie Barlow
And the medical rounds were large, lots of allied health, nursing, medical students, etc. And they came round to my bed bay and i the doctor, the senior consultant, ordered the patient to be weaned off the ventilator.
00:11:47
Melanie Barlow
So what we call extubated. And I spoke up and said, I've assessed the patient I don't think they're ready and I gave my reasons and I was in front of everybody and the whole unit just shouted at put in my place yeah it was a bit traumatic at the time and so when they moved to the next bed I pulled the registrar aside and said you know hey this is what I've assessed and he was like Mel I agree with your assessment but that consultant
00:12:21
Melanie Barlow
has a deciding decision whether I get on the ICU training program or not. I can't speak up. I can't, you know, say anything.
00:12:32
Melanie Barlow
like What we'll do is we'll give X, Y, this Z drugs. We'll do this. and And just to say, come back from wanting to, we'll pull the tube. So I was expecting badness. So I had all the emergency equipment there and everything.
00:12:45
Melanie Barlow
And so we pulled the tube and lo and behold, the patient rapidly deteriorated. and went into full cardiac arrest. And as we were resuscitating, the consultant walked in and went and like screamed across the unit, know what the hell are you doing? And it was just like it was just the biggest aha moment for me, particularly years later when I started.
00:13:07
Melanie Barlow
I developed a culture change program for a large organization. We were putting 6,000 staff through it. And we were teaching people how to speak up. And we were doing you know barriers and enablers, writing them up.
00:13:22
Melanie Barlow
And time and time again, it was like the receiver, the receiver, the receiver. And I was like, oh my goodness, we have to teach this person based on also my experience. I don't want anyone going through that. And by the way, the patient did survive, so that was good.
00:13:39
Melanie Barlow
And so I did research to how to teach it. And at the time there was not a single article in the healthcare literature around how to teach someone how to receive speaking up.
00:13:54
Melanie Barlow
There was no speaking up literature from the point of the receiver. So my mentor at the time said, Mel, you've officially run out of excuses to do your PhD.
00:14:05
Melanie Barlow
So my PhD was in the role of the receiver and it was all about how do we enhance how people receive and respond. And it's not straightforward. It deals with all the things we've talked about so far, psychological safety, as well as context and social identity, professional identity. So I wanted to fundamentally make a difference and get this out there and to help people have better conversations because you get more work satisfactions.
00:14:40
Melanie Barlow
Yeah, and I guess the question really is how can leaders themselves create that environment where people feel safe to speak
Leadership and Effective Communication
00:14:46
Melanie Barlow
up? and Yes, that can do a lot. So i was fortunate I spent some time in Boston and while I was living there, I got to see Amy Edmerson talk in person at Harvard Business School.
00:15:02
Melanie Barlow
And she said something that really resonated with me and it was around The invitation of voice is much more powerful than the expectation of voice.
00:15:17
Melanie Barlow
So when we teach speaking up, organisations then have an expectation of voice. We've trained you, speak up. It's not that simple.
00:15:27
Melanie Barlow
So we need leaders to invite voice and the researchers in Amy Edmondson, and Ingrid Nemba, I can never pronounce that, sorry Ingrid, have done the research and leader inclusiveness is a super important part.
00:15:44
Melanie Barlow
And it doesn't have to be the most senior leader, could be in a meeting, could be any level of leadership, the invitation of voice is super important. And the other thing for leaders is to walk the talk. I've been in an environment where leadership espoused great things And then behind the scenes did the exact opposite and it immediately you lose trust, it becomes psychologically unsafe and people absolutely choose silence.
00:16:20
Melanie Barlow
So I wonder why do people avoid these difficult conversations even though they know that they're important?
Emotional Management and Communication Challenges
00:16:28
Melanie Barlow
Well, I think emotions. So we don't teach people how to manage emotions in the moment and the role emotions play in conversations and in learning.
00:16:40
Melanie Barlow
Fear and fear is really real. And feelings of futility. So I've spoken up before, I've tried, Alita didn't do anything or didn't circle back to tell me they had done anything.
00:16:56
Melanie Barlow
I think it's around helping people become more self-aware how they communicate. So that reflexivity, because if you know how you communicate and you're reflexive, then you can adapt your communication.
00:17:12
Melanie Barlow
So it lands and yeah, build reflexivity. So i teach a lot around, i guess, micro habits. to start building so it's small and achievable and you can start changing.
00:17:28
Melanie Barlow
I'm really interested to hear you talk about those micro habits. So what kind of change do you ultimately want to see in workplaces then?
Investment in Communication Skills for Workplace Success
00:17:37
Melanie Barlow
I mean ultimately big picture, it's investment in that is social, behavioural and cognitive skills equal to teaching the psychomotor technical skills.
00:17:48
Melanie Barlow
If we're truly interested in safety, it's both. When you look at the rates of medical error and adverse patient outcomes, it's both. So let's start paying equal attention to both.
00:18:01
Melanie Barlow
So I've got some rapid fire questions for you. Okay. So best communication advice you've ever received? I think it's my worldview is unique to me. It doesn't mean other people share it.
00:18:16
Melanie Barlow
So approaching a situation where I have a perspective, not the perspective. And I think if you have that in mind, it allows you to get curious and allows you to actually listen to what the other perspective is.
00:18:33
Melanie Barlow
Excellent. What's one communication skill everyone should master? Don't make assumptions. I think we make assumptions about people's intent based on how it landed on us and often that's the mismatch. It might have landed her hard on us but very rarely do people intentionally want to hurt us or put us down. So don't jump to assumptions about intention.
00:19:00
Melanie Barlow
That's where you get curious. That's where you engage in a conversation. I like that perspective around curiosity. So what's one simple habit that can dramatically improve workplace communication?
00:19:13
Melanie Barlow
I think pause before responding, take a breath and then get curious. Say, tell me more or help me understand why it is your concern because I'm currently not seeing it that way.
00:19:28
Melanie Barlow
Because regardless of how much experience you have, you've always got something to learn. Otherwise, what's That's the point, right?
00:19:38
Melanie Barlow
So I think having that perspective that there's an opportunity that I could learn something here super important. So if we want to take away one actionable strategy from this conversation about communication in business, what should it be?
00:19:57
Melanie Barlow
I think people need to think effective communication is not an innate skill that we all just miraculously get as we get older or we graduate from university and lo and behold you know we're effective communicators. It's a skill like any technical skill, requires training, requires deliberate practice, requires feedback and coaching.
00:20:22
Melanie Barlow
No one, even the most elite sportsman does not get better without feedback, coaching and deliberate practice. I think when we look at the cost, so the NHS just released a like a report from 24-25 and they said the annual cost of harm from clinical negligence, so medical error, alone in England is £4.6 billion.
00:20:52
Melanie Barlow
Like if we invested that amount of money into teaching people to be more effective communicators, listening, speaking up, like imagine the difference we could create. so if you truly want to invest in your people and the success of your business, give them the gift of effective communication.
00:21:13
Melanie Barlow
It'll make a world of difference to efficiency, clarity, safety, staff satisfaction, and well-being. Well, Dr. Amell, I've really enjoyed this conversation. It's been a really fascinating discussion.
00:21:29
Melanie Barlow
So I look forward to speaking with you again soon for the next one. Excellent. Thank
Special Offer for Listeners
00:21:34
Melanie Barlow
you. And can I just do a plug? Absolutely. If you don't know where to start, Reframing Conversations has some e-learning modules that you can just do in your own pace, in your own time and in your own environment and context.
00:21:51
Melanie Barlow
And we are offering listeners as a launch to this podcast, a discount. So if you go into reframingconversations.com and go to your e-learning and put in the discount code LAUNCH10 and we'll put it in the show notes, you'll get 10% discount.
00:22:10
Melanie Barlow
Great. Reframingconversations.com, discount code LAUNCH10. Thank you so much, Dr. H great. Dr. Mel.