Advanced Communication Skills Refresher Transferring skills back into

Advanced Communication Skills Refresher Transferring skills back into your workplace Welcome to the study day!

Housekeeping & Introductions

What is your definition of an effective communicator?

Do any of these possible definitions match with how you think patients, carers or colleagues experience their communication with you ? • Someone who listens using a mixed range of communication skills and behaviours, checks what the person has understood and positive feedback from the patient about their experience? • Someone who recognises the difference between relational and transactional care avoiding the ‘interactive bear traps’? (Sweeney 2009) • Someone who constructively questions widely held beliefs enshrined in communication training manuals? (Stokoe 2018) • Someone with a strong understanding of EBM (the objective), has clinical expertise (the experience) plus understanding of the patients unique set of values & experiences (the subjective)? (Stewart et al 2007)

Or these…? • Someone who can navigate through a structured consultation starting with the patients agenda – facts, perceptions, feelings (Atul Gawande 2014), coping & past experiences – before giving information? (ICE framework; Cambridge Calgary Model Silverman et al 2005) • Someone able to navigate the conversational race track? (Stokoe, 2015) …………………

…Or is there still something else? Lim R. & Dunn S. – Journeys to the Centre of Empathy

REVISE What was covered previously? • How patient feedback has influenced how we communicate – NHS Cancer Plan & Darzi • The impacts when communication goes wrong – see references from previous handbooks up to 2012 • Recommendations from national reports • The evidence base for ACST training – focussed on the Maguire, Fallowfield & Wilkinson RCTs and evaluations • An agenda set by participants – brainstorming difficult communication issues • Barriers to communication for patients & HCPs (ECST includes a focus on ‘HCP survival skills’)

Blocking behaviours that inhibit any consultation NB Disclosure Behaviours that facilitate those encounters including cues & empathy Non-verbal communication NB Cues Structuring a consultation – establish rapport, signpost what is to be discussed, gather before you give, chunk & check, summarise, way forward • Practising challenging scenarios using key skills, behaviours & strategies & receiving feedback • • • Transferring skills back into practice

REFRESH Core components of refresher day AIM – Refresh and reflect on previous learning (ACST/ECST) and its impact when you transferred skills back into practice OBJECTIVES – Revisit & reflect on what is effective communication – Critique your communication behaviours/techniques – Practise & analyse AC/EC skills – Decide what to transfer & evaluate back at base

Working agreement

REFLECT Confidence versus competence

What’s new out there?

What has ‘communicated’ to you?

COFFEE BREAK

What are patients saying? Kieran Sweeney https: //youtu-be/-u. MNY 55 nw 4

Fast forward from NHS Cancer Plan & Darzi… • Communication is at the heart of care (Mid Staffs NHS Public Enquiry 2013; 6 Cs 2012; CQC Caring services criteria ongoing; www. telegraph. co. uk/health-fitness/body 28 Jan 2018; Awdish 2018; Kissane et al 2018) • Good communication can improve physiological functioning (Stewart et al 1995; Harari et al 2000) • Poor communication can lead to psychological morbidities in patients & carers (Maguire 1996; Thylen et al 2013; Mitchell et al 2013) • Unsatisfactory communication can lead to patients and carers feeling anxious, unsafe and dissatisfied & can affect adherence to care (Shilling et al 2003; www. pointofcarefoundation. org. uk ; National Patient Survey Reports 2010 onwards; Doyle et al 2014; Duty of Candour 2015; You. Gov survey 2017; Achieving World Class Outcomes for Cancer 2015 -20)

What are colleagues facing? Atul Gawande https: //youtu. be/45 b 2 QZx. Dd_o

What more do we know…? • Lack of skills and job purpose affects staff leading to stress, poor job satisfaction and emotional burnout (Giving Sad & Bad News Fallowfield 1993; Zohar & Marshall 2004; Gurgis et al 2006; Assisted Dying debate 2019 & ongoing) • Many patients state that they do not receive the information that they need • Honest and regular conversations with patients and carers are needed to achieve shared decision-making (Ambitions for Palliative & EOLC 2015 -20; www. respectprocess. org. uk; Royal (Montgomery Ruling 2015; www. each. eu ) College of Physicians 2018; Zwakman et al) • A single word or para verbals can all change a conversation (Parry et al 2014; Stokoe 2018; • Communication skills do not improve through experience alone (Thorne et al 2013) Real Talk Project – Pine & Parry 2018)

Hot Topics What causes communication difficulties for you?

“However brilliant we might believe we are at communication, we never see ourselves as others do and we always need to learn, both from the experience and evidence from what went before and from what the next generation have learnt from us, improved upon, and developed. ” Baroness Ilora Finlay, 2018

Forum theatre A live scenario in real time

LUNCH BREAK Back in 45 minutes please

REFLECT

Revisiting the transfer session Aim • Reflect on skills, behaviours & strategies practised to improve the likelihood of their transfer and sustainability back in your workplace In order to do this you were asked to: • Set yourself a goal – identify a key skill/behaviour/strategy to transfer • Anticipate the consequences of transfer – both benefits and potential negatives • Identify support mechanisms you could draw on to ‘stay on course’

Headline feedback Since my last communication skills training… • Name that skill! • What effect has this had on my communications with patients/ relatives/ colleagues? On me? • What challenges did I face? How did I overcome these?