International Hospital Federation (IHF): Four Relationship Skills for Hospital Leaders

One difficult shift can call for all four IHF relationship skills

A ward manager receives a complaint about a senior doctor who spoke sharply to a nurse. The doctor insists they were simply demanding accuracy. The nurse describes being interrupted and having her concerns dismissed in front of colleagues. Before drawing conclusions, the manager needs to establish what actually happened. The International Hospital Federation (IHF) identifies four competencies in its Relations domain: employee support and development (4.A), compassionate leadership (4.B), interpersonal relationships (4.C), and problem-solving and negotiation (4.D). All four come into play here. Kindness alone will not establish acceptable standards of behaviour. But issuing orders without listening may discourage people from speaking up the next time something goes wrong. The manager needs to hear both accounts, explain expectations clearly and follow up to see whether the agreed changes are happening.

4.A: Feedback works when people know what needs to change

Competency 4.A covers employee development, mentoring, coaching and constructive feedback. In a hospital, feedback can easily become a judgement of someone’s character, particularly when the person involved is a highly respected specialist. Saying “You’re difficult to work with” gives them nothing specific to act on. It is more useful to describe the incident: during the handover, the doctor interrupted a nurse twice as she raised a safety concern, preventing the team from hearing her reasoning. The manager can then describe the expected behaviour and agree on a time to review progress. That gives the employee an opportunity to discuss the facts instead of defending their identity. Kluger and DeNisi’s meta-analysis found that feedback does not invariably improve performance; sometimes it makes things worse. The question is not simply whether a manager gives feedback, but how they deliver it.

4.B: Compassionate leadership still involves difficult decisions

The IHF links compassionate leadership with recognising staff needs and making decisions transparently, involving the team where possible. Compassion is not a substitute for clear standards. A nurse may explain that several demanding shifts have left her exhausted. Her manager should take that seriously: ask what is most difficult, identify what can be influenced and be open about what cannot change. Promising extra staff when none are available would not help. The manager can still work with the nurse to agree on priorities and a time to revisit the issue. Reviews of compassionate leadership describe the importance of noticing distress, understanding people’s circumstances and taking meaningful action. In 2026, the IHF also highlighted Apollo Hospitals’ Kindness Charter, an initiative focused on how people treat one another in healthcare settings.

4.C: Hospital hierarchy can silence the people who most need to speak

A manager may say, “My door is always open,” but that promise rings hollow if they check their phone during briefings, interrupt speakers or embarrass staff in front of colleagues. Competency 4.C includes relationship-building, attentive listening and non-verbal communication. Professional hierarchy makes these skills especially important in hospitals: a resident may find it much harder to challenge a department head than a senior colleague does. In research involving 23 neonatal intensive care units, Nembhard and Edmondson examined links between inclusive leadership, psychological safety and participation in improvement efforts. Their findings support creating conditions in which employees can raise concerns without fear of humiliation. One practical change is to ask about obstacles before judging an idea. “What will be hardest about making this work on your shift?” often invites a more useful answer than “Any questions?”

4.D: Negotiation is not about pretending everyone is right

Disagreements over shift schedules or patient handovers can quickly become personal. One side calls the other inflexible; the other responds that nobody takes responsibility. Yet competency 4.D concerns solving problems, mediating and negotiating between competing interests. The manager needs to separate facts from accusations, understand what each side actually needs and identify the limits of any compromise. One person may need predictable shifts; another may need more help at peak times. Patient safety standards are not up for negotiation, but teams can agree on ways of working that respect them. Schmutz and colleagues’ meta-analysis found a positive association between teamwork and performance in healthcare teams. That does not mean every compromise is a good one. A better outcome than “we have made up” is an agreement about who will do what, by when, and how the team will know whether it works.

How can you tell whether better conversations survive the next shift?

Both sides may leave a difficult meeting feeling relieved, only to repeat the same argument a week later. A useful follow-up is to ask four questions: was the feedback about changeable behaviour, were the employee’s circumstances taken seriously, did everyone have a chance to speak, and did the discussion lead to a clear agreement? That is a practical way to apply the IHF’s relationship competencies. Reviews of nursing communication emphasise listening, clarity and checking that people leave with the same understanding. Research into interventions addressing unprofessional behaviour also suggests that one conversation or training session is not enough to establish lasting improvement. After several shifts, the manager should ask for concrete examples of what has changed. Good teamwork is reflected in what people do day to day, including when their manager is not in the room.

The IHF’s four relationship competencies are skills, not personality traits: helping employees grow, showing compassion, enabling open conversations and resolving disputes. Using them together is especially demanding during a busy shift. That is why managers need to follow up on agreements and look for changes in behaviour, rather than relying on the positive feeling after a single meeting.

How Empatyzer helps managers practise the IHF’s four relationship competencies

A ward manager hears about tension between a senior doctor and a junior nurse. Before meeting them, they describe the incidents and the different accounts to Em, leaving out any information that could identify patients. They ask for help separating observable facts from judgements and preparing questions that allow each person to explain their perspective. If colleagues’ profiles are available, the manager can also consider differences in how they communicate. Em helps them plan the conversation: hear both sides, name the behaviours that need to change, agree on ways of working and set a date to review progress. The manager can practise feedback that is direct without being humiliating. A few shifts later, they check whether the agreements are being followed and return to Em to reflect on any remaining problems. Micro-lessons help reinforce these conversation habits. This gives managers a practical way to work on the four relationship competencies described by the IHF in the situations they face every day.