Reflective practice: Improving self awareness to reduce risk

Reflective practice is common – but do your insights go deep enough to ensure real change? Senior risk adviser Liz Price offers practical advice

  • Date: 16 August 2021

Dentist thoughtful KNOWING yourself is the beginning of all wisdom. So said the Greek philosopher Aristotle.

In dental practice it has become commonplace to “look inwards” when things go wrong by engaging in reflective practice, both personally and in collaboration with the wider team.

Exploring the impact of human factors – such as leadership style, safety culture and workplace policies/procedures – can enhance safety and improve quality.

But in too many cases, the insights are fairly superficial and not deep enough to bring about change that will effect risk reduction in practice outside the scope of the original incident.

Deeper reflection

What if we took the opportunity now, to proactively reflect at a deeper level to understand, assess and improve our own insight into personal pitfalls in order to proactively enhance quality and safety? Wouldn’t it be great if, having done that, we were able to dynamically reflect in the moments right before we ‘get it wrong’, allowing an adverse incident or difficult encounter with a patient or colleague to be avoided?

And wouldn’t it be even better if these reflections could increase your own, and the team’s, wellbeing?

Do any of the following statements resonate with you?

  • I would like to change the way I approach situations which I find frustrating, anxiety-provoking or challenging, as afterwards I feel drained, ruminate on the situation for ages, and/or worry that team relationships or patient care could be compromised.
  • I feel empathy easily but some colleagues or patients seem to trigger me, resulting in stress due to my inability to demonstrate empathy for them or their situation.
  • I would like to help a colleague develop insight into how their behaviour or communication can be problematic for others in the team, leading to them not being approached when appropriate which results in more work for others, and potentially risks patient care.

If so, then further exploration of self-reflection and assessment strategies to develop insight which can lead to positive change might help. They can enhance our performance by helping us understand and remove blocks, and assist in developing resilience when dealing with challenging people and situations.

Three key skills

In my experience, reviewing both cognitive and emotional aspects of individual experience in challenging situations can help provide a more rounded reflection. Three skills are required:


This involves the ability to view situations as what they really are. It is necessary to become aware of our biases (about others, the situation and ourselves) and challenge these in order to overcome barriers they create. For example, do you expect a certain colleague to respond in a negative way, or as a meeting approaches do you start to engage in destructive self-talk based on previous negative experiences which then impacts on your ability to engage honestly and directly in the meeting? How you respond when you make a mistake impacts on the outcome, your ability to resolve the matter, share lessons or move forward. Being open to this helps us choose an alternative response.


This is the ability to notice (and observe) your own thinking and emotional responses with perspective and distance. We usually find it easy to do this for others but much harder for ourselves. When we are able to master this, we can start to overcome habitual behaviours.

For example, my compulsion to take control of situations or meeting agendas can lead to lack of personal development for others and less effective discussions and outcomes respectively. So observing when I start to want to “close discussion down” or “go into active charge mode” allows me to pause and be able to allow others to take responsibility and participate more freely.

If you are able to observe yourself in real time – engaging in destructive self-talk, or becoming anxious before a meeting or encounter – you can then analyse the validity of these thoughts/emotions and choose to tolerate them or modify them to be more realistic or accurate. This can help you to feel more positive/empowered.


This is the ability to separate out your thoughts, emotions and responses from your own sense of identity. Negative thoughts, emotions and experiences can often determine our view of ourselves, leading to generalised feelings of inadequacy, disempowerment or failure. They can also lead to defensive or avoidant behaviours/actions which can impact on safety.

When this skill is practised, we are able to recognise that thoughts, emotions and actions are in the moment and do not define us. Taking this perspective allows for acceptance and positive change planning, which is essential if we wish to improve how we approach similar incidents or challenges in the future. In cases where our members are undergoing scrutiny by their regulator this can be key to demonstrating insight and remediation.

Putting the skills into practice

Taking the time to practise these three skills after situations or encounters that you have found (or find) challenging, or have previously led to unhelpful or unsafe behaviours, allows you to:

  • increase awareness
  • slow down
  • gain a sense of control
  • think rationally.

And over time, all of this helps place us in a more powerful position where we are able to “reflect” rather than “react” – even “in the moment”. This allows us to break destructive cycles of thinking, emotions and behaviours and achieve better outcomes, which in turn can have a positive impact on emotions and future resilience.

Next steps

If this article was of interest to you and you would like help to get started developing further insight yourself or help others in your team, please feel free to book on our brand new course below, being held via Zoom on September 28, 2021 from 9.30am to 12pm.

Self-reflection: Developing personal insight in self and others, making changes and improving wellbeing

  • Do you want to understand why you or your colleagues fall into destructive or unhelpful patterns of behaviour with some individuals and not others?
  • Would you like to change the way you approach situations or individuals that you find frustrating, anxiety-provoking or challenging?
  • Have you experienced a situation or encounter with a patient or colleague which has led you to behave out of character, feel a lack of empathy or become upset?
  • Would you like to help a colleague develop insight into behaviour or communication that is problematic for others in the team?

If you answered yes to any of the above, then this interactive, reflective and challenging course might be useful for you.

This course is suitable for any healthcare professional and will be run as a small group-based, interactive workshop led by Liz Price, Head of Training, CPD and Risk Advisory Services at MDDUS.


This page was correct at the time of publication. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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