Multiple balances in workplace dialogue: experiences of an intervention in health care

Abstract

Purpose – This paper aims to illuminate and analyse the participants’ experiences of the influences of a dialogue intervention. Cooperation and coordination in health care require planning of dialogically oriented communication to prevent stress and ill health and to promote health, well-being, learning and efficiency in the organisation. Design/methodology/approach – An intervention method based on dialogue theory, with Socratic provocations and concrete workplace examples enhanced authenticity of conversations. A qualitative study, using qualitative content analysis, entailed interviews with 24 nurses, assistant nurses and paramedics, strategically selected from 156 intervention participants. Findings – Two themes emerged, dialogue-learning processes and dialogue-promoting communicative actions. The first includes risk-taking to overcome resistance and fear of dialogue, expressing openly thoughts and feelings on concrete issues and taboo subjects, listening to and reflecting on one’s own and others’ perspectives and problematising norms and values. The second comprises voicing opinions, and regarding one’s own limits; requesting support and room for manoeuvre; and restraining negative emotions and comments in the interest of well-being. Findings depict strengthened awareness and readiness regarding dialogue and multiple balancing of dialogue at work. Research limitations/implications – This study implies further observing and examining of communicative patterns during workplace dialogue. Practical implications – A useful approach to communication development for occupational health and personnel in health care and other workplace contexts. Originality/value – Previously, arenas have been created for dialogue, but close-process studies of dialogue in health-care work are scarce. This study provides insights into how workplace communication can develop towards dialogue.

Developing ethical competence in healthcare management

“…In addition, admitting flaws, asking for help and allocating time are not strong managerial characteristics (Schön, 2009). The healthcare managers therefore need competencies to deal with both their own and others' feelings and work-related taboo topics so that an adequate dialogue about the actual core-question can take place (Sandahl et al, 2010;Falkenström 2012Falkenström , 2014Grill et al, 2015).…”

“…Therefore, identification and ethical handling of contradictions and COI certainly concern strong emotional aspects of learning in the workplace (Argyris, 1990;Benozzo and Colley, 2012;Falkenström, 2014). Pedagogic interventions to facilitate workplace learning, or work-based learning, are strategically important with regard to competence development in organisations (Billett, 2010;Döös and Wilhelmson, 2011;Evans et al, 2011;Falkenström, 2014;Grill et al, 2015;Ohlsson, 2014).…”

Factors that may promote the learning of person-centred care: an ethnographic study of an implementation programme for healthcare professionals in a medical emergency ward in Sweden

“…The first author is a social anthropologist who has extensive experience of conducting ethnographic fieldwork in Senegal (Dellenborg 2004 , 2007 , 2009 ) as well as in various healthcare settings in Sweden (Dellenborg et al 2012 ; Wolf et al 2012 ; Skott et al 2013 ; Erichsen Andersson et al 2018 ; Dellenborg and Lepp 2018 ). The second author (EW) is a researcher who has extensive experience of organization studies and implementation research in the healthcare sector (Grill et al 2014 ; Arman et al 2014 ; Wigert and Wikström 2014 ; Grill et al 2015 ; Liff and Wikström 2015 ). The third author (AEA) is a researcher who has specialized in implementation research in hospital settings (Andersson et al 2012 , 2014 , 2015 ; Erichsen Andersson et al 2015 , 2018 ).…”

“…Typically, these earlier projects followed a cognitive, linear and instrumental planning rationality. Bååthe ( 2016 ) and Nilsen ( 2015 ) note that it is common for healthcare managers to mechanize and put what has been learned into manuals instead of internalizing it, and this may in fact work against genuine learning (Schein 1999 referred to in Grill et al 2015 : 449). Also, broader contextual factors tended to reinforce this task-oriented approach since healthcare policies generally reflect a heavy reliance on methods and tasks rather than offering guidance on ethics and how to handle the complexity and dilemmas involved in care (Schuster 2006 ).…”

How trainee hospital doctors lead work-based projects

“…Gordon et al, (2015) explored trainees' narratives of leadership through interviews and focus groups and reported that the narratives came predominantly from the position of follower within a hierarchy, suggesting a lack of perception in trainees that they are leaders. Grill et al, (2015) subsequently developed a dialogue training programme which was well evaluated, but unfortunately did not include doctors. Specialist trainees are both in very hierarchical relationships, within the medical team, and non-hierarchical relationships, at least formally, with other healthcare professionals, and so contexts of the specific conversations will vary.…”