International Journal of Healthcare Simulation

Background and aim:

Whether clinical or non-clinical, patient facing or not, staff working in a healthcare environment will need to initiate or manage challenging conversations in the workplace, with colleagues, patients or relatives/carers. How well and how compassionately these more difficult interactions are handled is critical to whether the conversation is effective, and leaves all parties feel respected and heard, even if the issue itself cannot be resolved. If there is negative escalation of the situation, trust is undermined, leading to further complications, distress and potential error. This can have a significant impact on team working, and ultimately on the patient or their relative’s experience [1].

Activity:

Evidence was gathered from a large NHS Trust during the two-month long design of the workshop. The aim was to enable participants to learn communication strategies and techniques helping them to effectively manage challenging conversations with kindness and compassion. In 2020, five standalone sessions were delivered online (a result of the geographical size of the Trust rather than a result of the pandemic); there has been a further six online deliveries per year to date, with constant review and revision. Content includes: Active listening, empathy, communication strategies, appreciative enquiry, an exploration of values, and opportunities for reflection. The scenarios cover colleague to colleague interactions (Teams meeting), frustrated relatives (phone call), isolated patient (video consultation) and unsafe colleague (face to face). All are effective in an online environment, and are authentic and relatable.

Findings:

Over 300 NHS staff have participated over three years. Evaluation shows they agree or strongly agree that their skills and knowledge has improved, the scenarios were relevant and authentic, and the mode of participation provided a valuable opportunity to practice new skills in a safe environment. All felt more confident to hold challenging conversations that would be more mutually positive and avoid escalation. Consistently, participants have commented on the positivity of receiving feedback from each other and the involvement of actors was found to be highly beneficial, with feedback from them, from their perspective, uniquely insightful.

Conclusion:

For the last three years, staff from a large NHS Trust have been able to learn and practice challenging conversations, through online, live simulation, with ‘real’ patients, relatives/carers and colleagues. They have explored why conflict occurs and practised strategies, stopping and restarting, rehearsing and debriefing. Participants have requested further sessions and stated they would highly recommend all colleagues to undertake this training.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.