When No One Volunteers: What a Tibetan Dance Taught Me About Speaking Up in Healthcare
The moment no one moved
I was on a trip recently. The music paused, and the dancer looked out at the audience and asked for a volunteer to join her.
Nobody moved. I had not come to dance. But the silence stretched on, I could see her waiting. I could sense how uncomfortable the quiet was for her, standing alone in front of a room full of people who all hoped someone else would answer. I wanted to support her so I stood up.
I did not know a single step. What I learned in the minutes that followed is something I have been thinking about ever since: life is like a dance, and so is leadership. Someone has to take the first step. And most people wait.
What happens once you step in
The last time I had danced on a stage was at university, in a modern dance performance, many years ago. This was a different form entirely, and I was thoroughly out of practice. I followed her lead, copied her movements as best I could, and felt awkward and exposed. Then something shifted. I stopped worrying about how I looked and started paying attention to my partner. We were moving together.
After a while, I felt giddy, perhaps from all the spinning at that altitude in the mountains. The room tilted a little. I did not stop. I slowed down during the spin and kept going.
Afterwards I kept returning to the silence before I stood up. It was not indifference. Everyone in that room was weighing a risk: What if I look foolish? What if I get it wrong? Most decided that staying seated was safer.
Healthcare conversations carry the same calculation, in rooms where the stakes are far higher than looking clumsy at a dance.
Lesson one: silence is not agreement
Consider a family whose loved one has died suddenly with no warning. They sit down with the care team and are asked, “Do you have any questions?” They say nothing. It would be easy to hear a green light. In reality, they may be overwhelmed, afraid of sounding accusatory, or unsure what they are even allowed to ask. The questions do not vanish. They return weeks later as a formal complaint or a letter from a lawyer.
A patient, relative, or colleague who says “that is fine” while looking away, folding their arms, or going unusually still may be telling you something different. When words and body language do not match, treat it as a cue to ask, not as proof of anything.
The data point the same way. In Candello’s 2025 analysis of malpractice cases in the United States from 2014 to 2024, about 40 percent involved a communication failure, up from roughly 30 percent a decade earlier. Failures between providers and patients or families appeared in 63 percent of those cases, up from 58 percent (Candello, 2025). Separate research found that claims involving communication errors were also less likely to be dropped, denied, or dismissed (Humphrey et al., 2022). What are the costs to your organisation?
Lesson two: someone has to go first
Why did I stand up? Not because I was braver than anyone else in the room. I stood up because the dancer had made it safe. She was warm, clear about what she was asking, and visibly comfortable with waiting.
Leaders set that tone. When something has gone wrong, people look to the person with the most authority to learn what is safe to say. A leader who goes first, by naming what is known, admitting what is not yet known, and saying what happens next, lowers the cost of speaking for everyone else. Delivering difficult news is the clearest example.
A few practical shifts help:
• Invite feedback early, before frustration hardens into a formal high stakes complaint.
• Thank the first person who speaks up, whether a patient, a relative, or a colleague, and do it without a “but.” How you respond to the first voice decides whether there is a second.
Lesson three: follow the rhythm of the other person
A good dance partner listens with the whole body. The dancer who invited me up did not drag me through the steps. She adjusted to my pace and let me find my footing.
Distressed patients and families need the same. When someone arrives frustrated, frightened, or angry, the instinct is often to explain: the policy, the timeline, the clinical reasoning. People need to feel heard before they can take in information.
Match the other person’s pace and tone first. Slow down when emotions are high. Reflect back what you are hearing. Acknowledge the impact before you address the facts. In high stakes disputes, this is often the difference between a conversation that de-escalates and one that hardens into opposing positions.
One technique I teach is the strategic silence/purposeful pause. When someone is upset, the instinct is to fill the silence with explanation. Silence is the space for the family to process their emotions and thoughts. Silence can be uncomfortable for the medical team as there is a tendency to fill the space and over explain. It is important to also observe the family body language and check for congruence with what they say . Pausing, listen fully, and acknowledge what you have heard before you respond. A pause is not withholding information or going quiet when answers are needed. It is how you make sure your answer lands.
Lesson four: you do not have to be ready
I was no longer a dancer. I had not rehearsed, I was out of practice, and I had no idea what the next step would be. And yet, with a good partner and a willingness to begin, I managed.
When the room started to spin, I did not quit. I slowed down and stayed engaged. Clinicians and leaders can do the same when a conversation becomes disorienting: slow the pace, find your footing, and stay in the conversation.
Teams do not need perfect scripts. They need practised, shared ways of speaking up under pressure, and permission to be imperfect. Readiness is rarely a feeling. More often it is a habit built in advance, when the stakes are low.
From metaphor to practice
Every healthcare organisation has moments where communication carries real risk: distressed patients and families,high stakes feedback, difficult news, and tension. When these conversations go wrong, the costs reach patient trust, staff confidence, and the organisation’s reputation.
These skills can be rehearsed. High-Stakes Communication: A Risk Mitigation Programme for Healthcare Professionals is built for healthcare professionals, supervisors, and team leaders. It is delivered as mobile-first micro-learning on Gnowbe, with realistic healthcare scenarios, structured communication frameworks, and three group coaching sessions. I bring a background as a seasoned mediator and former high-stakes dispute resolution specialist. Rehearsal is far cheaper than recovery.
Your turn to step forward
When I think back to that room, I do not remember the steps. I remember the silence, and the moment it broke. One person stood, and the performance became something we did together rather than something watched from a distance.
If you would like your teams to practise these conversations before they count, book a 30-minute consultation with us.
Stepping forward isn’t only for the stage. On the journey home, I invited myself to a language game with 2 new friends. There was laughter and fun, and a reminder that connection often begins with a willingness to join in and make the conversation 2 way.
References
Candello. (2025, November 17)https://www.mplassociation.org/Web/Publications/Inside_Medical_Liability/Issues/2026/Winter/Financial_Impact_of_Medical_Miscommunication.aspx
Humphrey, K. E., Sundberg, M., Milliren, C. E., Graham, D. A., & Landrigan, C. P. (2022). Frequency and nature of communication and handoff failures in medical malpractice claims. Journal of Patient Safety, 18(2), 130–137. https://doi.org/10.1097/PTS.0000000000000937
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