Active Listening in Healthcare

Most of us think of ourselves as ‘good listeners’, and we might be, but we could aim much higher.

Active listening - listening attentively and responding empathically so a person feels heard (Levitt 2001) - should be the goal.

Active listening is a practised skill that requires intellectual and emotional focus.

Effective communication is, of course, necessary to all types of work. It could be argued, however, that in healthcare there is more to lose (such as a person’s life) in the event of poor communication.

A 2011 study by Dr Abraham Verghese, found on average when people sat down to talk to a doctor or nurse in the emergency department, they had roughly 15 seconds before they were interrupted (Verghese 2011 quoted by Ahern 2017).

This article will discuss the concept of active listening and provide you with steps to advance your listening and become a better communicator in and outside of your work.

What is Active Listening?

Active listening is paying complete attention to what another person is saying. It involves listening closely while showing interest and, importantly, refraining from interrupting.

Active listening is about hearing more than what is being said. It is listening not only for content, but also for the intent and feeling of the speaker (Jahromi et al. 2016).

According to Hunsaker and Alessandra, there are four main categories of listeners: non-listener; marginal listener; evaluative listener; and active listener (Hunsaker et al. 2008 quoted by Jahromi et al. 2016).

Active listening is the highest attainable listening category. At its core, active listening has three main criteria:

1. Demonstrating clear interest in a speaker’s message through non-verbal signals.
2. Refraining from judgment and reflecting the speaker’s message using verbal paraphrasing: ‘Correct me if I’m wrong, but what you’re saying is…’
3. Asking the speaker to elaborate on their beliefs, feelings, and experiences.

(Weger Jr. et al. 2014)

How to be an Active Listener

The role that active listening plays in effective communication is to signify to another person that what they’re saying is important. This is achieved through using verbal and non-verbal cues.

Verbal Cues

• Verbal encouragement (non-obtrusive words such as ‘I see’);
• Attentive silence;
• Reflecting a speaker’s feelings and content;
• Intelligently summarising the speaker’s words and purpose.

(Jahromi et al. 2016)

Non-Verbal Cues

Using body language to show involvement through:

• Attentive posture;
• Facial expression;
• Maintaining eye contact.

(Jahromi et al. 2016)

What is the Evidence for Active Listening?

A 2014 study on the effectiveness of active listening used 115 participants to test the impact of three types of responses used in conversation: active listening; advice; or simple acknowledgements.

Their results indicated that participants who received active listening responses felt more understood than participants who were provided with advice or acknowledgements. Additionally, rates of satisfaction in the conversation were considered higher in participants who received active listening or advice (Weger Jr. et al. 2014).

Furthermore, participants who scored highly on a measurement called the Active Empathetic Listening scale (AEL) positively aligned with other attributes including social expression, social sensitivity, emotional sensitivity, and social control. These measures are interlinked with a wide range of positive interaction and relationship outcomes (Weger Jr. et al. 2014).

Phrases to Embrace

‘Tell me more about that.’

‘Just to make sure that I understand, what you’re saying is...’

‘I’m happy to listen if you want to talk about it.’

‘How did you feel when that happened?’

Points to Consider

• It is estimated that although listening accounts for a significant amount of our communication, we retain less than 25% of the information we hear.
• You can’t fully focus all your attention on the speaker when you are multitasking.
• Try not to pontificate, instead go into a conversation with the mindset that you have something new to learn, which you do.
• Use open-ended questions rather than telling the speaker how they feel.
• Focus on the context of the speaker without thinking about your own feelings and experiences.
• It’s not that you shouldn’t give advice, it’s that if you’re waiting for a break in the conversation to give advice, you’re being a poor listener.
• In a clinical setting, it may be inappropriate to draw parallels from the speaker’s experience to your own, studies have found that patients do not find this helpful.

(Ahern 2017)

Conclusion

Listening attentively and responding empathically so a person feels heard is crucial in healthcare settings as patients are in a vulnerable position and therefore might have difficulty voicing their concerns.

Since you are in the position of power, you should a) create an environment that feels safe to talk in, b) encourage the other person to talk openly, and c) listen actively.

Additional Resources

• Watch the following Ted Talk, Celeste Headlee’s: ‘10 Ways to Have a Better Conversation’:
• Ausmed, Communication Skills Guide: https://www.ausmed.com.au/guides/communication-skills
• Ausmed Lecture, The Art of Active Listening: https://www.ausmed.com.au/cpd/lecture/active-listening

References

• Ahern, G 2017, ‘The Art of Active Listening’, Ausmed, viewed 12 November 2019, https://www.ausmed.com.au/cpd/lecture/active-listening
• Jahromi, VK, Tabatabaee, SS, Abdar, ZE & Rajabi, M 2016, ‘Active Listening: The Key of Successful Communication in Hospital Managers’, Electronic Physician, vol. 8(3), pp.2123–2128 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4844478/
• Levitt, DH 2001, ‘Active Listening and Counselor Self-efficacy: Emphasis on one Micro-skill in Beginning Counselor Training', The Clinical Supervisor, vol.20 pp.101–115 https://www.tandfonline.com/doi/abs/10.1300/J001v20n02_09
• Weger, HW, Bell, GC, Minei, EM and Robinson MC 2014, ‘The Relative Effectiveness of Active Listening in Initial Interactions’, The International Journal of Listening, vol. 28(1), pp.12-31 https://www.tandfonline.com/doi/full/10.1080/10904018.2013.813234