Safety conversations 

Getting beneath the surface

Tuesday 27 October 2015 was a fairly momentous day for me.
The Sign up to Safety campaign has a small but very select team of specialists; in campaigning, in patient safety, in large scale change and importantly in learning. Everyone in the team makes a unique individual contribution to the whole.  One of our team (guest blogger) David Naylor – has significantly contributed to our approach to learning. He is helping us think about how we can enhance people’s capacity to talk and think more deeply together about the critical issues facing patient safety and what lies beneath the surface of things to get to what really matters and what is really going on.

Together we designed an approach which we tested on 27 October. We developed a day for 33 people to have a conversation about safety – we chose the problem of the implementation gap, but we quickly learned that we could have chosen any aspect of safety.  The day was a carefully structured and facilitated process – which started with recruiting a diverse group of staff from the NHS across England; diverse in profession and status, equal in terms of gender.  Nothing was not thought through.  The pre-event communications, the event handbook, the facilitation, recording and venue.  The welcome was warm and embracing.  Our enthusiasm to see everyone very genuine.  Individuals were connected to their ‘trio-mate’ and introduced by name only; again trying to move away from the usual associations of role, organisation and status.

The method uses a process of trios – three people who have three consecutive rounds of dialogue; a conversation with three very particular roles; a speaker, an active listener and an observer.  We had eleven trios.  Some readers may have experienced this type of approach in other guises (such as coaching, co-consultancy and appreciative enquiry). Each member of the trio takes it in turn to experience each of the three roles.  A structured conversation.

A novel aspect of the conversations was the use of metaphors to help build and connect from one story to another.  This seemed to be a stroke of genius – the use of metaphors seems to transcend or at least help with the language barrier and the potential for things being ‘lost in translation’ between the individual participants.

The individual people in the trios met together in small groups; again another neat trick – with all the original speakers, original active listeners and observers meeting together.  This was to spread their insights and then meet and feedback into a larger group to continue to carry the conversations into collective knowledge.  To be honest we need to get better at the feedback stage but that didn’t stop us seeing the potential.

Conversation is a core human skill but we still need help to speak, and given time to speak, we need help to listen actively and ask the right clarifying and open questions and we need skills to observe in such a way that we start to see meaning that wasn’t there before.  The culture of conversation is a different culture.  These are the skills we wanted to enhance.

The reason why it was momentous was that we found that for most of the 33 participants we seemed to provide them with something very special. The method seemed to create what some describe as ‘psychological safety’ and lessen inappropriate grandstanding and peoples attachment to their own points of view.  Words like ‘novel, different, enhancing’ – were often used during the day. They told us that we had provided a safe, comforting and comfortable space, the time to talk, time to listen, and time to observe.  They felt valued, respected, cared for.  One person said we had provided them with ‘the ability to feel human again‘.

It felt that this was at the very heart of what a safety culture should be

The potential for immediate and practical implications for patient safety seemed to shine very bright for us.  Why attend a conference and passively be spoken to when you could have a meaningful conversation about safety. I am probably getting ahead of myself – we have yet to properly evaluate the day but structured conversations using this method could help with learning from error and harm, a collective approach to creating new knowledge, creating  shared understanding of contributory and causal factors associated with patient safety investigations, addressing the implementation gap and helping with large scale change.

Change is a natural result of constructing meaning and knowledge together.  If we pose the right questions and convene the conversations, one good conversation that matters could shift the direction of change forever. If we combine conversations that really matter with the reach of the campaign and the desire of the frontline we have a powerful force for change from the ground up.  We believe that we have the potential for something great.

There is the possibility for a transformation of the nature of the conversation about safety, both individually and collectively and that is what we are exploring.

So what next.

  • We will continue to test and evolve the methodology
  • We will continue to share what we are learning
  • Importantly David will provide his own unique view in his guest blogs over the coming months.
  • and finally…. instead of just telling people about this method and our insights we will probably need to work out how we get some more people to experience it in a way that demonstrates its power and possibility.


  1. Hi,

    I was forwarded your blog by Bryan Healey from BCH. I am coordinating the Human Factors Training Program at BCH. We are still in our relative infancy; 11 faculty, 11 one day courses ran in 2014, the same planned for 2015. We are having a faculty away day on the 19th January (In Birmingham) and I wondered whether you would like to come and tell us more about Safety Conversations. You talk in your blog about it’s relevance to other areas of safety, I would be interested in hearing more about this. Being a relatively new group we are very open to ideas about how we can improve. We are in a unique position of having the potential to significantly influence the safety culture in our Trust if we get things right.

    Many thanks,

    Dr Amy Walker
    Consultant Anaesthetist
    Birmingham Children’s Hospital

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