Diagnosing Internal Audit Challenges: A Prescription for Tough Conversations

GUEST BLOG POST
When I was recently describing my work as an internal auditor to my older brother, a medical doctor, we stumbled upon a striking similarity: both our professions benefit significantly when focusing on Emotional Quotient (EQ) the ability to navigate emotions intelligently—over Intelligence Quotient (IQ), which focuses on traditional intelligence.

As our conversation unfolded, he introduced me to a framework he frequently uses called SPIKES, designed to help doctors deliver difficult news to patients with empathy, clarity, and professionalism.

The more he explained the SPIKES framework, the more parallels I saw between his work as a medical professional and mine as an internal auditor. Although the stakes are different, internal auditors also often find themselves in situations where they must deliver challenging or unwelcome information. These conversations often evoke defensiveness, frustration, or anxiety in stakeholders.  In his case, “stakeholders” are patients— in my case, internal audit clients. By adopting SPIKES, internal auditors can manage these discussions with the same care and professionalism clinicians provide to patients.

Here, I’ll explore how the SPIKES framework—originally developed in oncology—can be adapted and applied to internal auditing, providing a structured and empathetic approach to delivering difficult or unwelcome news to audit clients.

What Is the SPIKES Framework?

The SPIKES framework was first introduced in 2000 by oncologists Drs. Walter F. Baile, Robert Buckman, and colleagues in an article published in The Oncologist. It was developed to guide healthcare providers in delivering bad news, particularly in cancer care, where discussions about diagnoses, prognoses, and treatment plans are both frequent and emotionally charged.

The six steps of SPIKES provide a structure that balances clarity with compassion:

1. S – Set up the Interview
2. P – Assess the Patient’s Perception
3. I – Obtain the Patient’s Invitation
4. K – Give Knowledge and Information
5. E – Address Emotions with Empathy
6. S – Summarize and Strategize

The Impact of SPIKES in Healthcare

Since its introduction, the SPIKES protocol has gained widespread recognition across various medical specialties, with its effectiveness validated by multiple studies:

• Research in the Journal of Clinical Oncology demonstrated that SPIKES significantly enhances patient satisfaction and reduces emotional distress when conveying cancer diagnoses.
• A study featured in BMC Medical Education showed that training in SPIKES boosts clinicians’ confidence and equips them to handle challenging conversations more effectively.
• The National Library of Medicie highlighted the efficacy of SPIKES training in improving the delivery of bad news, emphasizing its practical applications in clinical practice.

Together, these findings underscore the universal value of SPIKES in fostering trust, empathy, and mutual respect during difficult discussions.

Applying SPIKES to Internal Audit

1. Set up the Conversation
Preparation is essential when delivering challenging news. Before discussing audit findings, gather all relevant data and ensure it is well-documented. Choose a private setting to respect confidentiality and minimize distractions. For instance, instead of addressing sensitive issues in a crowded meeting, arrange a one-on-one conversation. Setting the right environment establishes the foundation for a constructive dialogue.

2. Gauge Client Perception
Before presenting your findings, assess the client’s current understanding of the situation. Ask open-ended questions like, “How do you think controls in this area are working?” or “What challenges have you noticed with compliance in this process?” This step not only helps you understand their perspective but also enables you to tailor your message to align with their knowledge and expectations.

3. Invite Collaboration
In healthcare, doctors use SPIKES to gauge a patient’s readiness to receive difficult information. Similarly, internal auditors can create a collaborative tone by setting expectations and inviting dialogue. For example, begin with, “I’d like to share some findings and discuss how we can address these issues together. Does that work for you?” This approach fosters a sense of partnership rather than opposition.

4. Deliver the Message Clearly
When presenting findings, clarity is crucial. Avoid overwhelming clients with jargon or excessive detail. Focus on the main issues and provide actionable context. For example, instead of saying, “There’s a material weakness in financial reporting controls,” say, “We’ve identified gaps in the review process for financial reporting, which could lead to errors in the future.” Clear and actionable language ensures the message is understood without creating unnecessary confusion.

5. Address Emotions with Empathy
Clients often react emotionally to audit findings, expressing frustration, defensiveness, or even anxiety. Rather than dismissing these reactions, acknowledge and validate them. For instance, if someone seems upset, you could say, “I understand this finding might feel overwhelming, and I want to work with you to address it effectively.” Recognizing their feelings helps build trust and de-escalates tension, creating space for a productive discussion.

6. Summarize and Strategize Next Steps
Finally, outline a clear path forward. Summarize the key points discussed and collaborate on actionable next steps. For example, “To address this finding, we recommend implementing a quarterly review process for financial reporting. Let’s work together to identify the right resources and timeline to make this happen.” Providing a roadmap ensures clients leave the conversation feeling clear and empowered about the way forward.

Why SPIKES Matters in Internal Audit

The structured empathy of SPIKES can transform how internal auditors handle difficult conversations. By adopting this framework, auditors can:

• Deliver sensitive findings with clarity and professionalism.
• Strengthen relationships with clients through empathy and mutual respect.
• Foster a collaborative environment for addressing issues.

Just as SPIKES has been shown to build trust and reduce distress in healthcare, its principles align seamlessly with the goals of internal auditing, where effective communication is critical to success.

A Path to Constructive Communication

Delivering difficult news is one of the most challenging aspects of internal auditing, but it also offers an opportunity to build trust and collaboration. By using the SPIKES framework, auditors can navigate these conversations with empathy, professionalism, and clarity, ensuring their messages are received constructively.

Whether it’s in the doctor’s office or in internal auditing, the ability to balance honesty with compassion is essential to fostering trust and collaboration—one conversation at a time.  

Justin Silberlust is the Associate Director of Internal Audit at Oppenheimer & Co., with a career rooted in internal audit, risk management, and ethical practices. He is passionate about fostering collaboration and empowering teams, striving to create a positive workplace culture.