How to add value to consultations through structured conversations

Add value to consultations through structured conversations

‘Consultation’ has become a fashionable term in the workplace.

But while it’s been a trend for some time (and a requirement in some circumstances), not everyone who uses consultation in the context of managing a team of people fully understands its value and potential to improve the workplace.

Indeed, one risk is that consultation becomes just another box to be ticked. Unfortunately, when managers consult only because they have to, at the end of the day, they might as well not have bothered.

Conducting consultations effectively, on the other hand, where everyone involved understands why they’re doing it and gets benefits from the process, has the potential to transform a workplace.

Not only will both staff and managers be more aware of how things work in the organisation and why they work that way, but staff will also feel more included and engaged in the workplace.

What is consultation in the workplace?

Consultation is a two-way process between managers and their team members for the purposes of sharing views and information, raising and discussing issues and concerns, brainstorming problems, and obtaining input from team members to inform decision-making. Consultations can take place in both formal and informal contexts, may involve individual team members or groups of team members, and may be done on a regular or ad hoc basis. 

While consultations are most often conducted in the context of change management, according to the Fair Work Ombudsman (FWO), managers “should [also] consult with their employees on workplace issues that may impact on the welfare and productivity of employees.” 

“As a matter of best practice,” the FWO adds, “consideration should be given to the value that consultation could add to any business decision-making. Consultation can identify opportunities, assist decision-making, and help ensure any new ideas work effectively in practice.”

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In the context of healthcare, consultation is a term to describe the interaction between clinicians and their patients but is not often considered in terms of the relationship between management and frontline staff. Indeed, in our previous blog, we noted that in many healthcare institutions, there is a disconnect between management and frontline staff, where things that are clear to one group may be opaque to the other.

This results in a noticeable difference between work as imagined (i.e. how the managers imagine a task to be done) and work as done (i.e. how the task is actually done by frontline staff). Sometimes, this difference is caused by external factors that can’t be controlled, such as how patients are presenting; other times they’re environmental or circumstantial factors that can be controlled and avoided – but aren’t.

Regular consultations between managers and frontline staff can bridge that gap and address the factors that are within the organisation’s control.

The FWO also points out that collaborating and cooperating with employees and involving them in managers’ decision-making has a myriad of benefits such as:

  • Increased productivity
  • Better informed decision-making
  • Successful implementation of ideas
  • Attraction and retention of good staff
  • More adaptable workplaces
  • Fewer staff-management disputes

All of these both contribute to, and are the consequence of, high employee engagement.

“Genuinely engaging an employee means transforming someone from being a person who turns up every day, cranks the wheel and clocks off at the end of the day, into one who gets out of bed with a purpose,” says our director, Donna Cohen.

“Most importantly,” says Donna, “engaged employees want to do their job, take responsibility for their actions, and look for ways to improve. Because their work makes them feel valued and important, they develop the willingness to go the extra mile.”

It’s these positive traits that contribute to good workplace culture, and in an industry that takes care of the health and lives of people, this positive, proactive, and collaborative culture should be promoted.

These can all be achieved if effort is devoted to consulting with frontline staff in a way that’s effective and efficient.

Not all approaches to consultation are created equal

There’s no shortage of consultation approaches and tools available.

Surveys (online or hard copy), net promoter score tools and suggestion boxes (real or virtual) are widely used. These tools can be useful in some situations and have the advantage – particularly in the case of surveys – of providing structure and definition to the consultation. 

But when these are the only approaches used, they don’t always deliver good consultation outcomes.

A major reason is that these forms of consultation don’t really require any obvious commitment by the managers that use them. Once the survey or suggestion box has been set up, the manager doesn’t really need to engage with the process and can just sit back and wait for the responses from staff to flow in…or not. 

Another common issue is that feedback received through these approaches is often not acted on. Unfortunately, the knowledge amongst staff that feedback collected through surveys and suggestion boxes is unlikely to trigger any response from management makes staff cynical about participating. Reduced response rates in turn reduce the value of the information that is collected and further reduce the likelihood of it influencing decision-making by management.

On the other hand, consultations involving some kind of face-to-face interaction, such as team meetings and focus groups, require a commitment from all participants. Direct engagement between managers and staff helps team members feel that their voice matters and gives managers greater insight into the day-to-day experiences of their staff. It’s also much harder to ignore feedback that is provided in this context.

The potential downside of face-to-face consultations is the risk that the session becomes a talkfest without purpose, or that the loudest voices dominate the discussion.

The ideal consultation approach is one that combines the structure of a survey tool with the mutual commitment of a face-to-face session.

Structured conversations provide such an approach.

What are structured conversations? 

While conversations are usually thought of as an informal way of exchanging information, structured conversationshave additional elements that enable the participants to achieve a particular outcome, decision, agreement or shared understanding of the thing being discussed.

Structured conversations are typically collaborative, goal-oriented conversations. They provide opportunities for the participants to be heard – and to listen to others – on a defined list of topics. As such, they provide safe environments for collective learning and problem solving.

There are six key steps to using structured conversations as an effective consultation approach.

1. Decide what you want to achieve

As with any consultation technique, the first thing you must do is set objectives. What is the purpose of the structured conversation and what is the broader context? Is the consultation part of change management, program or project evaluation, quality improvement, or perhaps something else?

Everything you do with a structured conversation follows from this, so it’s important to take time to work out why you’re doing it and what you hope to achieve. If you’re not clear about your objectives, then other people will likely be confused or lost about the purpose too.

2. Identify who needs to be consulted, the most appropriate structured conversation approach and the tools you’ll use

  • Who needs to be consulted?

Knowing your objectives will help you identify who needs to be included in the conversation. Some factors to consider when choosing the participants include: who has an interest in the conversation topic/s; who has relevant knowledge or experience; and whose perspective can add value to the conversation?

  • What is the most appropriate format?

Structured conversations can use one-to-one, small group or large group formats. Each format has advantages and disadvantages and the format you choose should reflect your overall objectives. For example, if you want your team to undertake some process review for the purposes of quality improvement, a small team format is going to provide more team reflection and learning opportunities than a one-to-one format. 

  • What tools should you use?

Tools can be anything from a detailed agenda or list of topics, to a table or proforma, through to a diagram such as a mind map.

Our preferred tool is a process/program logic map, which shows all the aspects of the system the conversation will focus on and the logical relationships between the various components.

The important thing is to have something that provides structure, otherwise the conversation can get side-tracked from the topics that will lead to the desired outcomes, or can be hijacked by the loudest voices.

3. Communicate

Make sure you inform your frontline staff about what they’ll be doing and what their participation in the process will involve.

Communication is always important, but in this context it helps the staff you’re consulting with to set and manage their expectations and also to prepare for their participation. Knowing the topics that will be discussed in the structured conversation can help them to identify issues, questions, or suggestions they want to discuss during the session.

4. Facilitate your structured conversation

The important thing to remember is that structured conversations don’t just happen, they need to be facilitated. This means creating a safe environment for everyone to share their thoughts and ideas and encouraging everyone to contribute to the conversation. It also means you – or whoever you have asked to facilitate the session – may need to “pepper the pot” to get the conversation started.

It’s worth noting that if the structured conversation approach is a new experience for your team, you might encounter some staff who will be reluctant – or even downright sceptical – when the exercise first gets underway. 

Don’t let that discourage you from sticking to the process. As your team members see the process working, their doubts that such a simple technique could actually be useful and beneficial will slip away. In our experience, some of the biggest fans of structured conversations were the same people who thought it would be a waste of time the first time they participated.

It’s also important to have a way of capturing the discussion points so that the structured conversation can serve as an evidence base for further action. On that point, be prepared to engage participants in identifying solutions for any issues that are raised during the conversation. This not only avoids the conversation becoming nothing more than a session for airing grievances and complaints, but encourages team members to become solutions-focussed and to take responsibility for implementing those solutions.

There are a number of tools available that can assist you to plan and conduct your structured conversations. The application we use is MEERQAT, which converts our process/program logic maps into interactive data collection tools. These tools allow us to capture the discussion points relevant to each component of the conversation and to capture both individual and group consensus ratings about each component. The other advantage of MEERQAT is that the tool that provides structure for the conversation links directly into an action planning tool, to allow ideas relating to issue diagnosis to be translated into ideas about issue resolution.

5. Follow up

This step is really an extension of the earlier Communication step and is about bringing the process full circle, so that participants see meaningful progress following the conversation. Here are three tips on how to effectively follow up with your team members.

  • Maintain the momentum.

The input you’ve gathered during the structured conversation very likely includes information about the problems team members experience in the workplace, proposed solutions to these issues, and ideas on how to further improve work practices. The structured conversation process will very likely energise your team and it’s important not to lose that momentum.

That’s why it’s a good idea to follow-up fairly quickly with a plan for how the consultation will be translated into actions and outcomes. This includes informing staff about timeframes for implementing the action plan and who is responsible for the various tasks. Seeing an action plan as a tangible output from the structured conversation will help your staff feel like their time and input were valued.

  • Keep the group engaged beyond the conversation and into the implementation phase.

While it’s not always possible for team members to be actively involved in every management decision or action plan task, keep them included where they can contribute – and informed where they can’t contribute – especially in projects or changes that were a product of their ideas.

  • Conversation is about dialogue, which means the feedback has to go in both directions.

Aside from giving the group your feedback, seek feedback too about their experiences around the structured conversation approach. This is how you can continually improve your structured conversations to meet the needs of all the participants.

6. Repeat

Don’t do it once then stop.

The structured conversation approach reflects a mindset and a philosophy about engaging others. It recognises the value that a range of knowledge, experience, expertise, and perspective can bring to decision-making. It’s about making consultation more than a token activity.

Not every consultation has to involve structured conversations, but for those consultations where this is the appropriate approach, it’s a good habit to get into. 

And from our experience, once you start, you won’t want to stop.

Structured conversations add real value in healthcare organisations

Although it was recognised some time ago that consultation in the workplace is a good idea, in the healthcare sector there has been little attention given to direct, face-to-face consultation between management and frontline staff. 

One major factor may be the nature of the workplace, since hospitals operate 24/7 with few downtime opportunities for managers and frontline staff to meet together. A second major factor may be the lack of suitable mechanisms to enable meaningful face-to-face consultations, compared to the relative ease and convenience of online survey platforms and virtual suggestion boxes as a means of consulting with staff.

This is why our recent 10-month research project at Epworth HealthCare’s Richmond hospital, where we trialled the MEERQAT structured conversation approach in two clinical units, represents a game-changing opportunity for the healthcare sector. The key results of the study were a 34% reduction in independently monitored adverse events in the two participating units compared to the rest of the hospital and greatly improved engagement of participating frontline staff in quality improvement.

The study demonstrated that regular structured conversations between managers and frontline staff are not only feasible, they are an effective mechanism for tapping into the knowledge, expertise and experience of frontline staff.

Watch our ACHSM/ACHS Congress 2017 presentation, Making quality everyone’s business: A new approach to engaging staff in quality improvement, to learn more about the MEERQAT methodology and read our paper in BMJ Open Quality for the results of our trial at Epworth.

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