Communication Series

Here at St Emlyn’s, we understand the significance interpersonal interactions and communication can have on the care and safety of our patients, our colleagues and ourselves. Over the next several months we aim to run a series of communication blogs and podcasts that we hope will encourage you to reflect, be curious, learn and improve your own communication across all facets of your life. The great challenge for all of us (me included!), is to understand how our communication style and habits impact those around us. Insights into your own communication can only come from the insights of others, those who get to experience you. This is not always a comfortable experience (trust me).

Listening

The first in this series looks at one of the most important, and the most challenging skills in communication LISTENING. Listening is the first communication skill we develop as babies. There is compelling evidence that suggests that contemporary life is making quality listening more challenging than any other time in history!

Quality listening requires us to have sustained attention without competing stimulus, a rarity in almost all environments. If you think about your work in a hospital we are surrounded by noise, competing conversations, the haptics of our phone/watch notifying us of text messages and emails. In addition, healthcare professionals are frequently hungry, tired, or juggling competing demands. This results in our attention frequently being interrupted or fragmented and reduces our ability to listen. Quality listening is cognitively expensive, and constant distraction is cognitively cheap and dramatically reduces our ability to listen, connect and pay attention.

There is no evidence that over the centuries humans have reduced biological capacity to listen. We simply live in a world that rewards us for not listening. Modern communication and medicine frequently reward those who appear to function and thrive despite constant interruption, uncertainty and less than ideal environments. Yet, the consequences of poor listening in our personal and professional lives can be devastating. Conflict, misunderstanding, error, patient harm, distrust, relationship breakdown, lack of safety, reduced psychological safety and poor staff wellbeing are directly attributed to poor listening and subsequent communication breakdown (Kwan et al., 2024; Auberbach et al., 2023; Alingh et al., 2019).

Listening is a clinical skill and intervention

Listening is a skill that can be improved through self-awareness, discipline and intention. To improve our listening, we must understand what listening is, how it works and our own relationship with listening.

Listening and our brain. The brain is hard-wired to listen, evaluate information, judge and predict outcomes and respond quickly. This method for listening was highly effective for most of history, however, our frenetic and complex world has compromised our listening abilities. The brain’s first chore in listening is to listen to itself, evaluating what has been said and relating the stimulus to our own experiences, biases and knowledge (Singh, 2024). This is important to understand – listening is not only what you hear. Listening is shaped by gender, history, experiences and current and past physiological and emotional states (Singh, 2024). This can result in 3 people hearing the same words though interpreting the conversation in three different ways.

To improve your listening it is critical to first understand how you do (or don’t) normally listen and to understand your listening habits. While it is older, I still prefer Stephen Covey’s Five Levels of Listening as a clear framework for understanding your listening habits.

The Five Levels of Listening:

Ignoring – you don’t listen, you choose to completely ignore a person or background noise and sounds.

It is critical to ask yourself who, what and where do you continually ignore someone or something and why.

Pretend Listening – you nod and murmur, but you do not listen.

Where in your life are you pretend listening? Children and older people are two groups who regularly experience pretend listening.

Selective listening – you pick up and respond to selective pieces of the conversation often while engaged in another task.

There are times clinically where selective listening may be useful. However, selective listen with caution. There is strong evidence to suggest our biases and beliefs strongly influence what we decide is important enough to listen to.

Attentive Listening – you attempt to pay attention and focus on the words you hear.

At this level you are making a conscious effort to at least try to respectfully listen to people with a level of intention.

Empathic Listening– you use self-awareness and try not to project your own intentions, biases and frame of reference on to others. You are listening with an intention to empathise with the person and understand their paradigm. You seek to understand before you seek to be understood.

(Covey, 2004).

I encourage you to pause here for a moment and really consider – when and why you listen and how this may be impacting your life, relationships and clinical outcomes. To reflect on how often you engage with others without them having to compete with screens and other distractions. How often important people in your life – patients, colleagues, partners and children must amplify their behaviour or voices to have any chance to capture your undivided attention.

I have moved away from promoting ‘active listening’ as a concept because what I observe and hear is not a lot of people actually actively listening, instead I hear people actively’ parroting’ or echoing what someone has said and then returning to their own viewpoint or speaking.

Most people do not listen with the intent to understand, they listen with the intent to reply
Stephen Covey

Today what many people call listening is often more turn taking. For example, I say something, then you say something. Or while you say something I plan my response as to why my story or experience was better, more impressive, harder, funnier etc. In the book Radical Listening (van Nieuwerburgh and Biswas-Diener, 2025) this is referred to as the ‘fight for airtime’. This approach to communication of essentially waiting to talk is a significant barrier to effective listening.

Listening does not equate to more time

In health we spend most of our time in level 3 selective listening and level 4 attentive listening. This may be a survival technique, however, are you INTENTIONAL in your selective and attentive listening or do you just zone in when you think you should? Remember that your selective and attentive listening is driven by bias, pre-conceived ideas and previous experiences and while some of these may have relevance others may create blind spots and risks. When we are with our patients, we need to be engaging as much as possible in empathic listening. Empathic listening may ironically reduce time with patients as it quickly builds rapport and trust and improves the flow of information.

Listening should involve connection as well as comprehension.

The key to listening in our personal lives is silence and presence.

Silence in health is a never event, presence however is something we can achieve. Even when it is busy and your mind is racing. In this context we may have to give verbal cues that we are still listening to patients and colleagues.

“Sorry to have my back to you, I am listening however I need to type at the same time”

“I am going to look up your medications while you are telling me your current symptoms”

These verbal cues of an intention to listen despite multitasking can remind you to listen and signal to whoever you are talking to that you are at least attempting to be present and listen.

A final reflection is to ask those you work with and those you love outside of work some simple awareness questions:

What sort of listener am I?
How can you tell when I am listening?
How can you tell when I am not listening?
What does it do for our relationship or for this team when I am really present and listening?
Under which circumstances do I listen best?
When is a time or occasion you know there is no point talking to me because you know I won’t listen.

I can promise you, your team and your family and friends know the answers to these questions. While their responses may not be comfortable, they will assist you in learning more about your listening skills and deficits.

Finally, start paying attention to what you do when someone else is talking. Are you listening? Are you on your phone? Are you giving non-verbal cues of your listening? Are you preparing to respond? Or are you trying to simply absorb their words without jumping to solutions or formulating your response story.

Here are a few sentences that may change your relationship with listening at work and home…

“Tell me more”

“What am I missing?”

“Does anyone have any suggestions?”

“Have I answered all your questions?”

Liz Crowe.