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Essential Mediation Skills for Healthcare Professionals

The Art of Handling Difficult Meetings: Essential Skills for Healthcare Professionals Working with Parents

Many healthcare professionals can feel nervous or stressed at the prospect of difficult meetings with parents, families and carers. Difficult meetings can bring out the vulnerability in us all. Using simple effective mediation strategies, healthcare professionals can feel more confident to handle difficult meetings, have those courageous conversations and proactively build positive relationships.

This article was first published by the Medical Mediation Foundation. Author Audrey Dorival is an Associate of MMF.

1. Start with the end in mind

Know the outcome you are seeking. If you are not clear about this in your own mind, the meeting could become derailed very quickly and go off track without achieving its intended aims. Ask yourself some key questions: “Why is this meeting being called? “By the end of the meeting what information do I need and what outcome do I want?” “What do I need to understand better?” “What information do I need to share with parents?” “What do the parents want/need from the meeting?” “Who else should be involved?”

By asking yourself these key questions, you will be able to do the necessary groundwork for the meeting. The result is that not only will you feel far better prepared but the prospects of the meeting being productive and constructive will increase dramatically.

2. Agree an agenda

We have all been to meetings where through lack of agenda there has been lack of direction and focus. If you have done the groundwork at Point 1 above, you will be able to pull together a simple agenda which covers the key points to be discussed and gives everyone at the meeting a road map. You don’t need to stick rigidly to the agenda. Always remain flexible.

Don’t make it overly complicated- keep it simple. Above all, ask the parents what they want to discuss and ensure this is covered in the agenda. This makes parents feel valued and demonstrates that their views, as experts on their child, really matter.

3. Think about the room layout

Whether it is a room or simply a space, do not underestimate the importance of the layout for getting difficult meetings off to a good start.

I have mediated in rooms slightly larger than broom cupboards. I have mediated whilst we all sat wedged into tiny primary school chairs designed for 5 year olds. I have mediated in places that had no access for disabled users or no facilities to get refreshments. None of these environments make people feel comfortable and can impact negatively on parental engagement.

Get your meeting off to a good start by ensuring you have a quiet space which is accessible for all parents, especially parents with disabilities. A jug of water with some clean glasses and a box of tissues are small touches that can make a big difference.

Think about where professionals and parents will sit. Seating arrangements can send a powerful non-verbal message and impact the power balance in the room. A row of professionals sitting opposite one or two parents can feel daunting and intimidating. So do whatever you can, within the limitations you are working with, to make the seating arrangements feel as comfortable and balanced as possible.

Imagine you are standing up in the balcony looking down at the meeting. What do the seating arrangements tell you? What non-verbal messages are they sending even before the meeting begins?

As a mediator, I find a round table works best for balancing the power dynamic in the room.

4. First impressions count

Research has shown that 90% of the lasting impression you make comes from the first 90 seconds of contact. Once a poor impression is made it is very difficult to change that view.

Greeting parents in a friendly way, with a smile, by their correct name instead of Mum or Dad can go a long way to making people feel acknowledged and respected.

Have ‘front of house’ staff, (reception/security) been trained to know the importance of first impressions for sowing the seeds of a positive relationship?

We all know how pressurised the working environment is for professionals. Staff are rushed off their feet with not enough hours in the day and certainly not enough resources. Yet, a few seconds invested in a positive welcome will definitely pay forward by igniting a sense of rapport. Embrace this simple opportunity to build relationship.

5. Open with a Mutual Benefit Statement

Often professionals struggle with how best to start the conversation. Their anxiety is heightened when the matters to be discussed are emotionally charged and disagreements have surfaced.

A technique I have shared with many professionals and which they tell me has helped them is the ‘Mutual Benefit Statement’. It is a quick four step process to help you get the conversation off to a good start:

State the parent’s reason for being there; e.g. “I appreciate that you have come to this meeting to discuss the medical treatment (child’s name) is receiving”

Link it to your reason for being there and if appropriate, acknowledge some common ground and differences; e.g. “My role as the paediatric consultant is to explain the treatment we have recommended for (child’s name) and work together with you to reach agreement on steps going forward. I feel sure that what we have in common is that we want to get this sorted as quickly as possible for (child’s name) and I am aware that there is a difference of opinion between us about the type of treatment they should be given”

Suggest aims and timescales; e.g. “So for this meeting my suggested aims are… “

Manage expectations around timescales so everyone knows in advance how much time has been set aside for the meeting.

Check for agreement on the above: “How does this sound to you?” “Is there anything you would like to add or remove from this?”

This simple 4 step technique is almost guaranteed to get most meetings off to a positive start and demonstrates a collaborative approach, acknowledging parents as partners.

6. Use open questions and listening to build relationship

By asking parents open questions (e.g. “Tell me some more about that…” or “What do you see as your child’s greatest strengths?”) and really listening to answers (without interrupting), parents feel that their expertise and unique knowledge of their child is valued and matters. Why is this important? In my experience, parents who feel seen, valued, and heard are less likely to become engaged in destructive conflict with professionals. Of course, differences of opinion will arise over highly emotionally charged issues such as end of life treatment or education provision for a child with disabilities. However, where the parent/ professional relationship is underpinned by respect, communication and trust, these differences can be navigated far more constructively.

Ask more, tell less.

Words themselves can be powerful and need to be chosen carefully. I recall sitting in a meeting where the Hospital’s Complex Discharge Manager explained to me and my elderly Mother that nursing homes would ‘bid’ for my Father as part of the process for finding a suitable placement for him (sadly due to his severe dementia). The unfortunate choice of word still stings two years on. Words can make or break a parent/professional relationship.

Language should be non-complicated and jargon free. Everyone has their own ‘language’ and when professionals listen to what parents say and summarise back using some of the parents’ language’ this can be powerful.

“If you talk to a man in a language he understands, that goes to his head. If you talk to him in his language, that goes to his heart” – Nelson Mandela

7. Strike the right tone

Vocal tone matters. It is one of the most valuable tools in my mediator tool box for conveying empathy, building rapport and diffusing hostility. Often, it’s not what you say but how you say it. By being conscious of your pitch, volume and pace, you can control and change the meaning of your words. Research tells us that when it comes to assessing the meaning of communication in relationships, only 7% of that meaning comes from the spoken word while 38 % comes from the tone of voice.

Why is this important? Tone can be particularly critical when professionals have to deliver bad news to parents. How professionals deliver a life changing diagnosis or prognosis to parents can have devastating consequences that endure for years. The grief and trauma cannot be underestimated. Whilst professionals should be upfront about the diagnosis or prognosis, most parents value professionals who provide candid, uncomplicated information using a compassionate, sensitive tone. Some parents prefer or need more details than others. Each family is unique.

8. Be Curious. Don’t be defensive

If parents push back at what you are saying or challenge you, don’t get defensive or make assumptions. Instead get curious.

I don’t know who coined the phrase “Never ASSUME…it makes an ASS out of U and ME” but it is certainly a great reminder about the pitfalls of making assumptions.

A technique I train professionals on is to gently and empathetically encourage parents to say more about whatever they are objecting to. A simple phrase such as “Can you say some more about that…?” signals that you are listening and acknowledging. This can disarm hostility and help you get to the need at the heart of the issue. By listening carefully and then summarising back to the parents what they have said, professionals feel better equipped to respond and parents feel heard.

“You can’t move the conversation in a more positive direction until the other person feels heard and understood… And they won’t feel heard and understood until you’ve listened. Whenever you feel overwhelmed or unsure how to proceed, remember that it is always a good time to listen.” – Douglas Stone

9. Close well

In my experience, too often meetings end rather hurriedly with professionals having to rush off into their next meeting.

It is vital that a few moments are spent at the end of a meeting to summarise actions, check for agreement, and confirm timescales. Next steps should be clear with no ambiguity. Parents need to know who is doing what and when. Professionals who follow through on what has been agreed or communicate with parents to let them know why timescales have slipped, build trusting, respectful relationships with parents.

Finally, thank parents for their time and input, even if the aims of the meeting have not been fully achieved or agreements have not been reached.

Your willingness to enter into a difficult meeting and have a collaborative courageous conversation will shape the path of the parent/professional journey to come.

“The quality of our lives depends not on whether or not we have conflicts, but on how we respond to them” – Thomas Crum


Audrey Dorival is an Associate Trainer and Mediator with the Medical Mediation Foundation. She is a CEDR and Special Education Needs/ Disability (SEND) accredited mediator with over twenty years’ experience in the field of disagreement resolution involving families, local authorities, and health providers. She managed the award-winning KIDS SEND Mediation Service for twenty years until 2023, overseeing several hundred mediations per year. Audrey is a non-practising solicitor and former litigator with global law firm Eversheds Sutherland.

For further information on the Medical Mediation Foundation and upcoming training courses visit their website at Medical Mediation Foundation.

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