Note on using this video
Read the background information to gain an understanding of the scenario context. On watching the video, you might feel that while many of the skills are good, perhaps there are some that you might do differently.To support your thinking on this, the communication skills sheet overleaf includes some examples of different wording.
As in any acted version of a healthcare conversation, you will notice that the video does not capture the full nuance of real-life communication. Instead, it highlights in a simplified, sometimes repeated manner, skills that are known to make healthcare conversations easier and more effective. The intention is not to teach skills ‘by rote’ and to learn wording by heart, but rather to help engage viewers in reflecting on what they communicate and how they do so.
The video includes multiple phases and skills. If you are using it in a teaching session, It can be useful to think in advance about particular skills you want learners to look out for.
Supporting materials
Visit our webpage for supporting materials on good listening skills.
Click this link to download the Debrief in PDF format
Background
Maggie is a 30 year old mother of Fiachra and John is her husband. Maggie gave birth to Fiachra 2 months ago at her local maternity hospital. Following her discharge, she wrote a letter of complaint to the hospital manager. Niamh, the Patient Advisory Liaison Services (PALS) Manager has been in contact with Maggie (on the telephone) to discuss her complaint and has invited her and her husband John to a meeting in the hospital with Joe, the consultant obstetrician.
The video demonstrates the essential steps for dealing with a complaint of: a clear and unconditional apology; an explanation of what happened; an explanation of what actions the hospital is taking to prevent such episodes of poor care happening again; and continuing care and follow up. These steps are explained clearly and with empathy
Clips
There are six clips in this scenario.
FIRST CLIP
PREPARE
00:00 – 00:36
Joe and Niamh meet before Maggie and John arrive. The aim of this briefing is to ensure that they are both clear on respective roles and the meeting agenda.
SECOND CLIP
INITIATE THE CONVERSATION
00:37 – 02:21
Niamh and Joe use good communication skills to build rapport with Maggie and John and create an environment that is comfortable for them to talk about their complaint.
THIRD CLIP
GATHER INFORMATION
02:22 – 07:17
Joe and Niamh use open questions and appropriate nonverbal behaviour to continue to build a relationship with Maggie and John, and to find out more about their perspective.
FOURTH CLIP
PROVIDE INFORMATION
07:18 – 11:25
Joe shares his thinking on how the hospital will respond to Maggie’s feedback. Niamh summarises these steps, checks the couples understanding and their responses to this information.
FIFTH CLIP
CLOSE THE CONVERSATION
11:26 – 13:24
Joe and Niamh offer ongoing support (e.g. contact details and follow-up telephone calls) as Maggie and John may think of questions after the conversation. Niamh does a final summary and checks that the couple are happy with the plan.
SIXTH CLIP
DEBRIEF
13:25 TO END
Joe and Niamh have a debriefing after the meeting to check in with each other, summarise key points and a follow-up plan.
Communication Skills
FIRST CLIP
PREPARE
00:00 – 00:36
In this clip, Joe and Niamh meet before Maggie and John arrive. The aim of this pre-briefing is to ensure that they are both clear on respective roles and the meeting agenda.
- Joe clarifies relationships (“You’ve met Maggie and John already?”), roles (“Are you going to be the link person...?”) and checks that the environment has been prepared (“Are you happy with the room set-up?”).
- Joe then prepares himself for the meeting (“I had better switch my phone off...”). This type of preparation helps to establish a therapeutic environment for the conversation that is about take place.
SECOND CLIP
INITIATE THE CONVERSATION
00:37 – 02:21
In this clip, Niamh and Joe get the conversation off to a good start with Maggie and John.
- Niamh starts the conversation with a warm greeting (“Hi Maggie”), identifies herself by name, sits at the same level (rather than standing over them) and establishes her role in this particular consultation (“My name is Niamh Hogan, I am the patient advocacy liaison services manager at the hospital. My role here is to be the link...”)
- Niamh empathises with Maggie (“I can see that Maggie is very upset”)
- Joe starts the conversation with a formal hand shake and a warm greeting (“Hello”), identifies himself by name and establishes his role (“My name is Joe Quigley, I am a consultant obstetrician here in the hospital). He checks how they like to be called (“Is it alright if I call you Maggie and John?”)
- Joe expresses appreciation and involves the couple in the conversation (“Thank you both very much for coming along today, and for sending in the letter...”)
- Joe makes a connection with the couple by asking them an open question and shows that he has prepared for the conversation by using the baby’s name (“How’s life with the new baby? Fiachra... isn’t it?”)
- Joe again expresses appreciation and involves the couple (“Given your busyness, we appreciate the time that you have taken and the trouble that you have gone to..”.)
THIRD CLIP
GATHER INFORMATION
02:22 – 07:17
In this clip, Joe negotiates a shared agenda for the conversation. Joe and Niamh then listen to understand the words that are spoken and any underlying messages from Maggie and John.
- Joe sets the agenda for this part of the conversation (“If it’s alright, I would like to ask you to take us through what happened...”)
- Joe demonstrates that he has prepared for this meeting (“We have read the letter and we are taking it very seriously”), this helps to build rapport and re-build trust with the couple.
- Niamh empathises with Maggie and John (“This may be difficult for you, so take your time. There is no rush at all”) and uses their names (Maggie and John) to build connection.
- Joe and Niamh support and encourage Maggie and John using positive nonverbals (eye contact, leaning, nodding, warm facial expression), and listening in silence, without interruption or attempts to dispute, giving Maggie time and space to tell her story. Their facial expressions imply a caring and compassionate approach.
- Joe empathises with Maggie (“I can see that it’s very, very upsetting for you”). He apologies for the distress caused, (“I would like to apologise to you and say that I’m sorry that happened to you... and acknowledges that the hospital had... fallen well below a very basic standard of care...”.
- Niamh empathises with Maggie and John (“I can see this has been really difficult for you Maggie”). She communicates respect for John’s role and status in this conversation, (“John, it must be hard to see Maggie so upset too”).
- Joe empathises with Maggie (“I couldn’t agree with you more. It should not have happened to you Maggie”), validating her emotions. He demonstrates this empathy nonverbally by silently passing her the tissues when she is crying. This skill helps him to convey that her emotional response is a universal experience, and to give Maggie permission to feel and to express her distress. He uses Maggie’s name to build connection and apologises for her experience, (“I’d like to apologise on my own behalf and on behalf of the unit”).
- Joe summarises his understanding of Maggie’s concerns, using the opportunity to demonstrate preparation for the meeting (“We have read your letter...”) and empathy for how Maggie is feeling, (“What’s coming across to me is our failure to protect your dignity… your story is reinforcing
that for me”). - Note that Maggie is clearly distressed during much of the conversation and we can see within this clip Joe and Niamh responding to her emotions in several ways – noticeably their posture and positioning, the softness of their voices and affirming her status, (“You are the most important person...”).
FOURTH CLIP
PROVIDE INFORMATION
07:18 – 11:25
In this clip, Joe shares information with Maggie and John.
- Joe structures the conversation for Maggie and John by sharing his thinking and using signposting (“I’d like to share with you what our thoughts are, what we have done so far and what we are planning to do”). This clarifies for the couple how the conversation will proceed and promotes collaboration with Maggie and John feeling partnership in the conversation with Joe and Niamh.
- Joe signposts and emphasises the couple’s autonomy (“Feel free to stop me at any stage…”). This helps to build affiliation and establishes Maggie and John as joint problem solvers in the response to their complaint.
- When sharing information, Joe uses clear, concise language (no jargon), appropriate pace and non-verbal behaviour. His tone of voice demonstrates that he is taking the matter seriously.
- Joe organises the information into four chunks (“Firstly we are going to... Secondly, I have...Thirdly, with your permission and... Finally, I would like to make”), he pauses after giving the chunks and waits to see if Maggie or John have any questions about the information before giving the next chunk. This helps him to ensure that key points are covered and helps Maggie and John to take in the information.
- He apologises again for the distress caused, (“I have spoken to the doctor... and she has asked me to apologise to you on her behalf...”)
- Niamh summarise and repeats what Joe has said, (“So Maggie and John, what we would do is that we would take your story...”)
- She elicits further information about what they thinking and emphasises their autonomy when she asks…(“Is this something that would, would this be something that you would consider ok?”)
- Joe reflects back to Maggie and John what he is hearing, in particular any statements that indicate their distress and again he apologises (“It should never have happened, I am really sorry that you had to go through that...”). This kind of repetition can be useful because it shows that Joe has heard exactly what Maggie has said. It also gives Maggie the opportunity to say more about the topic if she wishes to do so. By acknowledging and validating how they feel, he builds connection with Maggie and John and helps them to participate in the conversation by making their emotions feel less overwhelming.
- Joe finishes this part of the conversation by outlining the next steps. He builds affiliation by indicating that the summary would go to Maggie and John and emphasises their autonomy...(“I would like to make a summary of today’s meeting... if you agree that it is an accurate summary...”). He puts a safety net in place by signposting that Niamh will be their link person after this meeting and checking that they have her contact details, (“On an ongoing basis, Niamh is going to be...”).
FIFTH CLIP
CLOSE THE CONVERSATION
11:26 – 13:24
In this clip, Niamh checks that Maggie and John are happy with the plan by inviting questions, observing the couples nonverbals and agreeing on next steps.
- Niamh summarises next steps (“Just to clarify and summarise, what I would do is...”)
- Niamh empathises with the couple (“This can be a difficult conversation”) and uses silence and non-verbal encouragers (eye contact, nodding), giving Maggie and John time to ask questions or add any information before the meeting ends.
- Joe expresses appreciation and affirms the couples status, (“Your feedback has really been invaluable... thank you for taking the trouble... to write and especially to come in today...”).
- Niamh checks if there if there us anything else (“Is there anything else you would like to share?”), this question in conjunction with her tentative tone expresses her interest and empathy sensitively and cautiously. These skills help to demonstrate respect and continue to build rapport.
SIXTH CLIP
DEBRIEF
13:25 TO END
Joe and Niamh have a debriefing after the meeting to check in with each other, summarise key points and a follow-up plan.
- Niamh starts the debriefing with an open question (“How do you think the meeting went Joe?”)
- Joe outlines next steps (“I will try and have a summary...”).