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 communication skills for Healthcare Leaders.
Click this link to download the Debrief in PDF format
Background
Professor Paddy Broe is the chief clinical director in a model four hospital. He has received a letter of complaint relating to an older person admitted to the hospital. This complaint describes an argument between consultants taking place on a ward within earshot of the patient, her relative, and other healthcare staff going about their work. He has arranged to meet with both consultants (Dr Maggie Hannon and Dr Mark Abiola) in his office.
Clips
There are four clips in this scenario.
FIRST CLIP
INITIATE THE CONVERSATION
00:21 – 01:59
Paddy uses good communication skills to initiate the conversation. He greets and welcomes Mark and Maggie in a friendly tone and very clearly sets out the structure and ground rules of the meeting.
SECOND CLIP
GATHER INFORMATION
02:00 – 07:06
Paddy uses good communication skills, in particular the skills for active and reflective listening to create an environment that allows Mark and Maggie to tell their version of events without premature comment or judgement. By summarising regularly he demonstrates that he is listening and shares his interpretation of what he has been told.
THIRD CLIP
SHARE INFORMATION
07:07 – 11:59
Paddy delivers the information in a step by step way and regularly checks that both Mark and Maggie are in agreement with his interpretation. He then begins to discuss what will happen next.
FOURTH CLIP
CLOSE THE CONVERSATION
12:00 – END
Paddy agrees next steps with Mark and Maggie and emphasises support.
Communication Skills
FIRST CLIP
INITIATE THE CONVERSATION
00:21 – 01:59
In this clip, Paddy gets the conversation off to a good start with Maggie and Mark.
- Paddy has organised for the meeting to take place in a quiet environment and invited Maggie and Mark to attend at an agreed time.
- Paddy starts the conversation with a warm greeting (“Hi Mark, come on in”).
- Paddy makes a connection with Mark by acknowledging his busyness and expressing appreciation for his coming to the meeting (“Thank you very much for coming from I know what is a busy clinic?”). Paddy continues to build rapport by attending to Mark’s comfort (“would you like a cup of tea or a glass of water?”).
- Conflict usually involves negative emotions, and as most of us are not comfortable with them, the discomfort can make people say things they don’t mean. When Mark says (“I’m just hoping this won’t take long...”), Paddy maintains a calm tone and moves on by showing that he has prepared for the meeting and clarifying the agenda for this conversation, (“...an incident was reported to me...between you and your teams...are you aware of the incident?”).
- Paddy uses positive nonverbals to build rapport with Mark and Maggie (eye contact, leaning, sitting at the same level, warm facial expression and calm tone of voice). His facial expression and body language imply a calm and compassionate approach.
- Paddy shares his thinking and uses signposting to set out how he expects the meeting to run (“The way these meetings usually go is that..”).
- Paddy uses the structure to emphasise their autonomy and psychological safety (“...each of you will get an opportunity, uninterrupted...”) and promotes collaboration by indicating that he is willing to approach the problem as a team rather than blame one or other of them (“...and move on to ways where we can prevent it...”). Using these words helps to set a safe psychological space for Mark and Maggie to work together and prevent this conflict from escalating.
- Note: Using phrases like... let’s see how we can prevent this from happening... can help to put conflicted parties at ease as it encourages them to work together against the problem and find a solution (rather than working against each other and finding each other’s faults).
- Paddy goes on to share his thinking regarding the ground rules (“The ground rules...each person will be allowed to speak uninterrupted...”).
- Paddy elicits the issues that Mark and Maggie may want to talk about (“Is there anything else you think needs to be in the mix here...?”), then signposts what they can do during the meeting if either of them is feeling uncomfortable or needs a break (“...just let me know”).
SECOND CLIP
GATHERING INFORMATION
02:00 – 07:06
In this clip, Paddy gathers information from Mark and Maggie. he listens to understand the words that are spoken and any underlying messages from them.
- Paddy structures this part of the conversation using signposting (“Perhaps Mark, you might begin”). This clarifies for Mark and Maggie how the conversation will proceed and focuses this part of the conversation on hearing their side of the story.
- Paddy uses active listening skills (eye contact, nodding, sitting at the same level, warm facial expression and use of silence) to listen to Mark. This helps to build rapport and trust and helps the rest of the conversation to flow more smoothly.
- Paddy demonstrates that he is listening by reflecting back to Mark what he is hearing, (“So you are doing your normal post call... and checks that his understanding is correct (“Is that right..?.”) This also gives Mark the opportunity to correct Paddy or add further information.
- Paddy uses silence, verbal (mm-mm) and nonverbal (nodding) encouragers to give Mark space to continue to tell his story.
- Paddy again reflects back to Mark his understanding of what Mark has said (“So the first two were pretty straightforward... the third patient was not so straightforward...”) Paddy continues to explore Mark’s story by inviting him to talk about the third patient (“So tell me about her..”)
- Paddy provides ongoing cues throughout the interaction that he is listening, (“Alright” and “Mm-mm”, maintaining eye-contact, nodding and leaning), his body language imply an interested and caring attitude. These skills enable him to encourage Mark to tell his story and share his concerns.
- Paddy summarises his understanding of Mark’s story, (“So you have an 89 year old...you wanted the geriatric service to take over that patient sooner rather than later”). He checks his understanding (“Is that correct?”), this question in conjunction with his tone express his understanding and empathy. These skills help to demonstrate respect and further build rapport.
- Paddy stays neutral and does not say anything that could be heard as ‘taking sides’ with Mark or Maggie, and this avoids escalating the conversation into an argument or dispute. By not threatening either participant it increases the likelihood they will participate in working on solutions to the problem.
- Paddy then asks a more focused question so as to gather more information about the chronology of events (“So what happened next?”) and encourages Mark to talk about his interaction with Maggie (“And how did that go?”). Paddy then summarises his understanding of what Mark has said and checks if there is anything else that Mark wants to say (“Have you anything else to add?”). Note: An alternative way of wording this would be to say... “is there something else that you would like to add?”.
- Paddy continues the gathering information part of the conversation by inviting Maggie to tell her side of the story (“So Maggie, you’ve heard Mark’s version... what do you want to say?”).
- Paddy uses silence, verbal (mm-mm) and nonverbal (nodding) encouragers to give Maggie space to tell her story.
- Paddy uses reflective listening (“So your registrar normally reviews...”?) and clarification (“Is that applied to all colleagues?”) to show Maggie that he is listening and to check that his understanding is correct. By asking for clarification, Paddy gains further insight into their thinking and rationale.
- Paddy continues to explore Maggie’s story by inviting her to continue (“What happened next?”)
- Mark responds to Maggie’s story with negative verbals (“Ok, this is ridiculous...”) and we can see within this clip Paddy responding to these negative emotions in several ways – noticeably his open body posture and positioning, eye contact and demonstrating empathy, (“I know you don’t like hearing things... none of us like hearing things that are said about us...”). He validates their emotions by acknowledging that this is a difficult conversation... (“A reaction is normal...”) and reminds them of their agreement on how this conversation would go and requests that they (“...remain respectful of each other”).
- Paddy then checks if there is anything else that Mark wants to say (“So Mark, is there anything else you have to add?”) and continues to use Mark’s name to build connection.
THIRD CLIP
SHARE INFORMATION
07:07 – 11:59
In this clip, Paddy signposts that he is moving to the next part of the conversation: sharing information.
- Having listened to their stories, Paddy then moves the conversation forward, using signposting (“So I have additional information... from nursing colleagues”).
- He elicits further information by inviting Mark to add more (“Any comment?”). This helps to build affiliation and establishes Mark and Maggie as partners in the conversation and acknowledges their roles as senior colleagues.
- Paddy delivers the information in sizeable chunks, pausing between each chunk of information (this helps allow Mark and Maggie to digest what they have heard) and watches nonverbal responses (when they need some time to take in information given so far).
- Paddy continues to share further information (“... the lady’s son, who happens to be a GP?”), this information in conjunction with his calm tone expresses his concern and compassion.
- Paddy then pauses after sharing this information, giving Mark time to respond. He then says (“Maggie”) using a questioning tone to encourage Maggie also to comment.
- Paddy then uses a collecting summary, (“So let’s recap here...we have two teams, one finishing up a busy night on take...”), followed by a key checking question (“So does that summarise it for you both?”).
- When sharing information, Paddy uses appropriate pace and non-verbal behaviour. His tone of voice demonstrates that he is taking the matter seriously.
- After sharing this information, Paddy pauses and waits for Mark or Maggie to re-initiate the conversation. Leaders often find it uncomfortable pausing like this in silence, but it is important to give the conflict partners space to react.
- Maggie then uses this opportunity to share her thoughts in relation to how she may have contributed to the problem, (“I suppose what I am saying is it’s not all on you Mark”). Recognising and sharing this information, Maggie shows Mark that she is willing to acknowledge her contribution. This willingness can help to dispel Mark’s negative emotions and he responds with (“Thank you, Maggie”).
- Paddy continues to signpost (“As I said at the outset, you’ve given your reports...) and builds affiliation (“...and now we need to have a discussion about how we move forward and make sure these incidents don’t occur again...”). Using ‘we’ implies he is willing to approach the problem as a team rather than blame one individual and asking for their input shows that he values their opinions and inputs. Encouraging them to find a solution shows a willingness to deal with the issue, find a solution and then move forward.
- Paddy moves the conversation on by reminding Mark and Maggie of his expectations of them (“We want your services and the other services of the hospital... I expect you to behave professionally... with each other”). In using ‘we’ and sharing his perspective as clinical director, Paddy reminds Mark and Maggie of their responsibilities as senior clinicians to each other, to their teams, to him as clinical director and to their patients.
- Paddy then pauses and this pause allows Mark time to articulate out loud what he is thinking... (“I know, I agree that in hindsight, I could perhaps have handled the situation differently...”).
- Paddy sits in silence, without interrupting and builds connection with Mark using positive nonverbals to encourage him to continue talking.
- Paddy then refers back to a difficult part of the conversation, (“So Mark... what about the son’s reference to that term ‘grot’ he thinks he heard”), he listens in silence to Mark’s response and invites Maggie to contribute, (“Okay, Maggie?”)
- Using good communication skills Paddy demonstrates his understanding that no single person was at fault and that he wants to work with Mark and Maggie to find a solution. This opens a safe space for Maggie to acknowledge that perhaps her policy with regard to handovers may have contributed to the problem, (“And I think that my policy on seeing the patient first contributed to this argument”). Maggie then suggests a solution (“...perhaps we should have a bit more clarity and consistency in how handovers and hand backs work”).
- Paddy builds on this acknowledgment by suggesting that Maggie might (“...present...a protocol for all teams on how you expect to have elderly patients transferred to your service”). His tone and words help to create a safe psychological space for Maggie to work from and also indicate his belief that Maggie can develop a solution while asking for her input (“Would you be prepared to put together a protocol like that?”)
- Paddy moves to discussing the letter from the patient’s son (“And now I have this letter from her son to respond to”). He invites input from Mark in coming up with a solution to this issue (“Have you any thoughts on how I might go about that Mark”)
- Paddy listens in silence to Mark’s response, encouraging him to continue speaking using positive nonverbals (eye contact and nodding). Mark then invites Maggie to contribute (“What do you think Maggie?”), thus demonstrating that they are now working together. Maggie responds positively (“I think that’s a very good idea and I’d be happy to work with you both”).
FOURTH CLIP
CLOSING THE CONVERSATION
12:00 – END
In this clip, Paddy signposts and checks that Mark and Maggie are clear on and comfortable with the next steps and that he can move to close the conversation.
- Paddy begins this part of the conversation by outlining the next steps... (“Positive actions we have coming out of this meeting then... ”).
- Mark takes the opportunity to apologise to Maggie (“I am also sorry for not being very patient with you... it’s not usually my way”). This sincere apology from Mark helps to mend his relationship with Maggie. Maggie responds with positive nonverbals and acknowledges... (“I’m sure I have snapped at people from time to time... and it would be great if you could help me with the protocol.”)
- Paddy ends the meeting by expressing his appreciation for their time, (“Listen, thank you very much for...”), their input (“I think the meeting has been very productive”), their honesty (“You’ve both been very honest”), their solutions (“We’ve had... some solutions to prevent this happening again”).
- He reminds them that they have next steps arising from the meeting (“We have a few actions to follow up with...”).
- Paddy puts a safety net in place (“If either of you have any concerns or continuing issues...)
- Paddy moves towards the end of the conversation a warm closing... (“Please get in touch.”).
- In closing, having clearly explained what will happen next, Paddy reaches a shared understanding and agreement with Mark and Maggie that they can leave the conversation and pick it up again together at another time.