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The role of conversations

In your own practice, it is often useful to explore the capability, opportunity and motivation of behaviours you wish to change. You can do this by having conversations with your colleagues. This may be between you and one other colleague or may be more appropriate in a group setting.

Having a discussion with someone about how they think and feel about current healthcare practice will help you to have meaningful conversations about behaviour change. This may involve discussion about what you already do well but want to improve or something new and different you want to change.

The key is to be open-minded and actively listen to what people may think, believe or have tried in the past. It is important to go into any conversation about behaviour change with an enquiring and open mind.

How to have conversations about behaviour change

The image below shows four key ways to approach conversations with colleagues.

Click on the drop down sections below to learn more about each of these approaches and how to use them.

Building rapport

During conversations, this is when you attempt to put the person you are speaking to at ease so they feel more comfortable talking to you. This can be done in many ways including:

  • Making eye contact
  • Speaking face-to-face
  • Introducing them to yourself and your role
  • Matching their voice cues and body language
  • Pacing and tone
Active listening

Active listening is a skill that involves not only listening to what the other person is saying but also seeking to understand the meaning and intent behind what they are saying. This could be done by:

  • Being fully present in the conversation
  • Paraphrasing and reflecting back what has been said
  • Listening to understand rather than to respond

This in turn makes the speaker more likely to open up and be transparent in the conversation.

Open questions

Use open questions which encourage expansion and deeper conversation for example:

  • “How do you think we should approach this?”
  • “Why is the process like this?”

This elicits a more thoughtful response as opposed to closed questions that prompt yes or no answers such as; do you think we should try this? Or is this the right way to do this?

Reflective skills

Be able to paraphrase or summarise what someone is saying back to them. This allows you to:

  • Understand the topic more deeply
  • Show them you’ve understood them correctly
  • Offer space for correction or clarification.

It is important to show the other person that they have your full attention and understanding.

If you want to read more about this, The THET Tips for Communication toolkit provides a guide to good conversation in behaviour change and intervention design.

How to have conversations about behaviour change intervention

The conversational techniques above can be used throughout the whole behaviour change process, from defining the behaviour to designing an intervention. Using good conversational techniques when developing an intervention allows us to explore diverse influences and the many different ways to change a behaviour.

There is usually more than one way to tackle a behavioural problem and some may be easier than others. Again, open-mindedness and open enquiry leads to richer discussions and deeper understanding of the behavioural influences and appropriate techniques for change.

One example of how you would involve others and have conversations about behaviour change can be found in the CPA Quality Improvement workbook.

Developed by the CPA in collaboration with The Change Exchange© for use in antimicrobial stewardship (AMS), the CPA QI Workbook offers a practical guide to involving others in a project, defining a behaviour and its influences, prompts for open discussion and how to plan continuing behaviour change intervention projects. Although the guide has been developed for AMS projects, the same method can be applied to any behaviour change project in healthcare practice. 

We will now introduce the two case studies in this module, click on each of the the drop downs below labelled 'Case study I' and 'Case study II' to read through them.

Case study I

Read through the scenario below and as you progress through the rest of this module, think about the questions posed. We will revisit them at the end and discuss the best answer.

A pharmacy department consistently runs out of a particular brand of medication. Furthermore, the pharmacy waits for the branded medication to become available before issuing new prescriptions resulting in a gap in treatment. You would like to understand what might be influencing this behaviour.

Which of the questions below would be the best way to ask the pharmacy staff about their motivation?

  • Do you always order medicines using the same process, i.e., only specific brands of medication?
  • Are you aware that there are bioequivalent products that can be used for the same indication and patient group?
  • What is the rationale for the ordering and prescribing process?

 Lastly have a think about how you might approach this in your own work.

Case study II

Read through the scenario below and as you go through the rest of this module, think about the questions posed. We will revisit this at the end of the module.

A hospital has realised that there is limited communication between different healthcare professional disciplines (nurses, pharmacists, and doctors). In the past, this has made it difficult to ask clarifying questions, ask for advice or to challenge each other on potential mistakes. The group have decided that they want to change this behaviour and improve discussions. They have brought representatives together to form a behaviour change group and want to design an intervention. 

Why would the following questions be appropriate to stimulate a conversation about behaviour change intervention?

  • What do we want to achieve?
  • What is influencing this behaviour?
  • What might be a barrier to change?
  • Who might need to be involved?

As you move through the rest of this module, have a think about what questions you might ask in your own practice.