Guide to Implementation

National Healthcare Communication Programme - Guide to Implementation |2

National Healthcare Communication Programme
Vision, Values and Goals

Vision

Healthcare workers take a skilled, sensitive and

person-centred approach in all conversations
with patients, their families and each other

Goals
The 6 goals of every
healthcare conversation

Values

The programme is underpinned by the core values of:

CARE COMPASSION TRUST LEARNING

 Build the relationship

...using a warm greeting, introductions, and positive

1 nonverbal behaviour. Recognise and respond to

emotional cues, demonstrate empathy using G.I.V.E.
Get that it's emotion
Identify the emotion
Validate by acknowledging feelings
Explore to better understand the emotion

Initiate the conversation

...using open questions and screening until all of

the person's concerns have been identified.
2
Then collaboratively set the agenda for the
conversation.

Gather information

...using active and reflective listening skills to

hear the person’s story and find out what matters most
3 to them. Explore the person’s perspective using I.C.E.
Summarise to check your understanding.
Ideas What can the patient tell you about their problem?
Concerns Sometimes the patient may have concerns that you
have not considered…
Expectations What does the patient think might happen next?

Provide information

...in a way that supports the person to understand

their issues. Frame your information in the
4 context of what matters most to the person.
Collaboratively develop a plan taking this
information into account.

Close the conversation

...by confirming next steps, safety-netting (giving

the patient clear and specific information about
5 what to do if things get worse) and collaboration
using a personal goodbye and positive nonverbal
behaviours.

Provide structure

...by agreeing a shared agenda and using

transitional statements to indicate that you are
6 moving from one part of the conversation to the
next, (e.g., an update, a decision to be made and
so on).
Contents
Part 1: Introduction 4
1.1. Overview 6
1.1.1. The National Care Experience Programme 6
1.1.2. The need for communication skills training 6
1.1.3. The National Healthcare Communication Programme 7
1.2. About communication skills in healthcare 8
1.2.1. Rationale for a Guide to Implementation 8
1.2.2. What is the evidence linking communication with quality, patient safety and care experience? 8
1.2.3. Communication skills training 8
1.3. About the Guide to Implementation 9
1.3.1. Purpose of the Guide to Implementation 9
1.4. National Healthcare Communication Programme 10
1.4.1. The Implementation Toolkit 10
1.4.2. The five steps to change 12

Part 2: Implementation toolkit 13

2.1. System change 14
2.1.1. Definitions and overview 14
2.1.2. Articulate a vision 14
2.1.3. Leadership buy-in 14
2.1.4. Resources for implementation 14
2.1.5. Tools for system change – tool descriptions 14
2.2. Training/Education 17
2.2.1. Definitions and overview 17
2.2.2. Programme design 17
2.2.3. Tools for Training/Education – tool descriptions 20
2.3. Evaluation and feedback 31
2.3.1. Definitions and overview 31
2.3.2. Tools for evaluation and feedback – tool descriptions 31
2.4. Reminders in the workplace 35
2.4.1. Definitions and overview 35
2.4.2. Tools for reminders in the workplace – tool descriptions 35
2.5. Creating a climate for excellence 53
2.5.1. Definitions and overview 53
2.5.2. Tools for creating a climate for excellence – tool descriptions 53

Part 3: The five steps to change 55

3.1. Preparing a quality improvement plan 56
3.2. Five steps to change 56
3.2.1. Step 1: Prepare 56
3.2.2. Step 2: Evaluate baseline 57
3.2.3. Step 3: Implement 58
3.2.4. Step 4: Evaluate impact 58
3.2.5. Step 5: Continuous improvement 58

References 59

National Healthcare Communication Programme - Guide to Implementation |3

 Part 1
Introduction
When you see a true master of verbal communication,
remember that these are learned behaviours, not something
innate which you are either born with or not. Which means
not only can we become more effective communicators
if we choose but that we should not let those who do not
employ them (the learned behaviours) off the hook when
there is a better alternative.
Nihal Arthanayake

4 | National Healthcare Communication Programme - Guide to Implementation

 Working together to make
conversations easier

EVIDENCE
Raising awareness or building knowledge is
not sufficient - they do not translate directly
into performance. To improve communication
attention must be given to developing
communication skills.

COMMUNICATION SOLUTION
Developing and improving Staff participation in communication
the communication skills of skills training. Role play with
healthcare staff was identified simulated patients to practice new
as a key priority. skills in a safe environment.

CARE EXPERIENCE IMPACT

The National Care Experience Using core communication
Programme has a suite of skills reduces distress and
surveys that capture the anxiety and facilitates the
experiences of people using delivery of person-centred,
our services. compassionate care.

They told me They listened to my

everything about my concerns and answered all
condition but didn’t listen of my questions, without
to me. I didn’t feel heard. ever dismissing me.

BEFORE AFTER

National Healthcare Communication Programme - Guide to Implementation |5

 1.1.2. The need for communication skills training
In the HSE the need for communication skills training has been
1.1. Overview stated in inquiries, internal reviews, guidelines and strategies.
1.1.1. The National Care Experience This importance of communication for the care experience is
Programme consistently evidenced in the views of the people who use our
services and those close to them submitted through thank you
The National Care Experience Programme (NCEP)
letters, compliments, complaints, surveys and audits and in
seeks to improve the quality of health and social
inquiries and review findings.
care services in Ireland by asking people about their
experiences of care and acting on their feedback.
Communication between patients, their caregivers, and
healthcare staff is a critical component of high-quality, safe
The NCEP has a suite of surveys that capture the
clinical care. Evidence shows that good communication
experiences of people using our services. The
leads to positive outcomes for patients, staff and the
Programme implements the annual National Inpatient
healthcare system and that poor communication often leads
Experience Survey, the National Maternity Experience
to complaints and adverse outcomes. Furthermore, staff who
Survey, the National Nursing Home Experience Survey,
communicate well report greater job satisfaction.
the National Maternity Bereavement Experience Survey
Communication skills are consequently core strands of
and the National End of Life Survey.
healthcare professional training, postgraduate assessment,
and on-going professional development.
Developing and improving the communication and
consultation skills of healthcare staff was identified
Of note, the HSE’s Better Together: The Health Services
as a key priority arising from the first National Patient
Patient Engagement Roadmap’ (HSE, 2023) recognises the
Experience Survey in May 2017 and similar key themes
importance of communication and its influence on the quality
have been identified in subsequent surveys. In the
of patient-healthcare worker interactions.
Survey feedback, patients and their families reported
that while there were many examples of care and
compassion in Irish healthcare services there were also
some problems with the communication between staff
and patients and their loved ones.
“
Effective communication skills are important for
both healthcare staff and patients to help build
confidence to participate in engagement activities.
The ability to establish meaningful interactions

“ between healthcare staff and patients depends on:

It made a huge difference. They knew my • the healthcare staff’s ability to communicate
story and I wasn’t repeating it over and effectively with the patient.
over again. • the patient’s ability to communicate their lived
experience and knowledge of their own health.

“
It meant a lot to me that everybody called
my baby by her name. “
The bereavement team was very
supportive and helpful. Listened to our
concerns and we felt heard. They were
there to answer any questions myself
“ and my partner had, and if I needed
I knew and was told exactly what was something they’d be straight in.
happening and going to happen...

6 | National Healthcare Communication Programme - Guide to Implementation

1.1.3. The National Healthcare Communication NHCP Regional Coordinator
Programme
Profile A healthcare worker with an understanding
The National Healthcare Communication Programme
of communication skills and ideally a broader
(NHCP) has developed evidence-based communication
experience of quality and safety; he/she
skills training materials supporting staff to improve their
should be well-respected and able to access
communication skills and thus enhance trust, facilitate
high-level management staff at regional level.
shared decision making and improve healthcare outcomes.
Tasks • Ensure that there is a sufficient pool of
Programme Governance facilitators within the region (including
Establishing clear governance with senior leadership taking account of projected facilitator
support and responsibility is essential for the successful attrition)
implementation of the National Healthcare Communication • Put arrangements in place to enable
Programme. The governance structure to oversee the facilitators to co-facilitate workshops
implementation of this programme includes clear leadership outside of their local healthcare facility
from the HSE Board, Chief Executive Officer (CEO), Senior in a limited manner that does not burden
Leadership Team, and across the organisation. them or their organisation
• Support local healthcare facilities to
Success relies on communication skills training (CST) recognise the facilitation of CST as an
being planned in a regional context with clear and enacted essential element within facilitator roles
governance processes at regional and local level to monitor • Ensure there are a sufficient number of
and assess impact. This includes: courses within the region to meet demand
• Agreed and implemented corporate, regional and local • Ensure that local facilitators are supported
responsibilities for CST planning and delivery. to travel outside of their organisation to
• Clear reporting pathways to allow information to flow, access facilitator training
between local healthcare facilities and the regions/ • Ensure that regional processes are in
corporate level. place to use/act on local data at regional
level
• Create fora for the sharing of local
experience and ensure that local activities
are consolidated into a regional workplan.
Proposed NHCP Structure
Note:
Solid lines represent line management
reporting relationships.
HSE CEO National Director
(Culture/Patient engagement)
Dotted lines represent indirect
National Healthcare
reporting line relationships. Communication
Office of the REO
Regional Patient Service User Programme
Executive Officer Partnership Office
(Patient/Service User Lead)

Integrated
NHCP Coordinator
Health Area 1

CHN 1 Catchment Acute NHCP Lead

(population 50k) Hospital 1

Community Community Community Acute Acute Acute

NHCP Facilitators
Services 1 Services 2 Services 3 Services 1 Services 2 Services 3

This is one of a number of management structure options being considered. This is being used for illustration purposes to identify how the NHCP might sit in the National and Regional structure.

National Healthcare Communication Programme - Guide to Implementation |7

The HSE’s CEO and Senior Leadership Team will provide Patient outcomes: engaging patients and their caregivers
leadership and direction for the implementation of this plan. through effective communication has a positive effect on
They will also support the development of key performance patient outcomes, specifically, emotional health, symptom
metrics and incorporate them into management performance resolution, pain control, and physiological outcomes, such
reviews. Progress on this implementation will be included in as reduced blood pressure and blood sugar levels.
Capability and Culture progress updates to the HSE Board
and the Department of Health. Patient safety: The INAES Study (2018) of the frequency
and nature of adverse events in Irish hospitals found that
Transition to HSE Health Regions more than 70 percent of adverse events are caused by
The transition to the six HSE Health Regions is being breakdowns in communication among caregivers and
rolled out in 2024. This NHCP Implementation Plan is between caregivers and patients. Studies show that
cross divisional, and is the responsibility of all areas across patients who are informed and engaged can help improve
the HSE. It is to be implemented in alignment with the safety through informed choices, safe medication use,
transitioning arrangements and plans for HSE Health Regions. reporting complications, and practicing self-management.
The patient experience teams in the HSE Health Regions
will build on existing structures and resources, and, in Perceptions of quality: research demonstrates that
collaboration with national and local senior management patients’ and caregivers’ perceptions of the quality of
teams, will ensure the prioritisation of communication skills at care are largely determined by their perceptions of their
local level. An initial objective of this plan will be for interactions with staff. Staff who are perceived to be
Community Healthcare Organisations and Hospitals to responsive, empathic, and attuned to patients’ needs are
develop local implementation plans that align with the judged to be of higher quality than staff who are perceived
goals and objectives of this national plan. Each local to be less responsive and empathic, even if the clinical
implementation plan will need to include the current care provided is the same.
transitioning arrangements and move to HSE Health Regions
during 2024. Care experience: The available evidence indicates
that the care experience is strongly associated with
communication. Studies have outlined specific behaviors
1.2. About communication skills in associated with a positive experience, grouping them
healthcare into 2 categories: task-oriented behaviors (e.g. drawing
out patients with active listening responses and providing
1.2.1. Rationale for a Guide to Implementation detailed information), and affective behaviors, such as
This Guide to Implementation has been developed to responding empathically and addressing the patient’s
assist healthcare facilities to implement improvements in main concerns. Tallman et al (2007)
communication in accordance with the National Healthcare
Communication Programme. 1.2.3. Communication skills training
Therapeutic communication is a complex interaction
The Programme described in this Guide to Implementation
reliant on a willingness to engage and the skills to do so.
has been designed to be used by any healthcare facility,
A skill is a learned ability to do something well. Raising
irrespective of the level of resources or whether the facility
awareness or building knowledge is not sufficient. To improve
has already implemented any communication skills initiatives.
communication attention must be given to developing
The approach focuses primarily on improving communication
communication skills.
by healthcare workers who work with patients. Details of all
of the tools supplied to support successful implementation of
It is widely accepted that communicating in health and social
a communication skills training programme at any healthcare
care is different from how we communicate socially. This is
facility are provided in this guide.
not an innate talent, and effective skills and behaviours do
not develop simply by being a ‘caring’ person or by observing
1.2.2. What is the evidence linking communication
others in the course of their work (Maguire, 2000; Kurtz &
with quality, patient safety and care experience? Cooke, 2017). There is, however, an established and growing
Communication is the foundation of partnerships between the evidence base that communication skills can be taught and
patient, caregivers, and staff and affects the safety and quality that they result in measurable improvements in performance
of care received. Effective communication can improve: (Kurtz & Cooke, 2017).

8 | National Healthcare Communication Programme - Guide to Implementation

International medical graduates 1.3.1. Purpose of the Guide to Implementation
A particular challenge for the Irish Health Service is that many The Guide to Implementation:
clinicians have trained overseas and English may not be their • Is a manual to be used to facilitate implementation and
first language. This makes communication skills training even evaluation of a programme to improve healthcare staff
more important in the healthcare services. communication skills and thus improve care experience,
patient safety, healthcare outcomes and quality of care.
Improving professional communication competence relies on • Assists healthcare facilities in preparing a comprehensive
addressing 4 areas of communication skills training: quality improvement plan to improve communication skills
irrespective of their starting point.
1. Knowledge (what learners understand);
2. Competence (skills and behaviours); The Guide will inform staff how to:
3. Performance (what they choose to do in practice); and • prepare a quality improvement plan for communication
4. Outcomes (what happens to the patient as a result). skills improvement;
• evaluate the elements that exist in the healthcare facility
Given the skills orientation advocated here, the methods for ensuring effective communication skills;
selected for teaching and learning in communication • identify what system changes are needed at a healthcare
programs need to move learners beyond knowledge (do you facility level to support implementation of the National
know it?) to competence (can you do it?) and performance Healthcare Communication Programme
(do you choose to do it in practice?). • provide appropriate and effective education and
reminders to health and social care workers irrespective of
Improving professional communication competence
their starting point;
relies on addressing 4 components:
• undertake evaluation and feedback (e.g. observation/self-
awareness of communication skills competence); and
Knowledge Competence • maintain momentum and motivation for continued
(what learners (skills and communication skills improvement at facilities that have
understand) behaviour) already achieved excellent standards.

The primary target audience for this Guide to

Implementation is:
• staff charged with making service-wide improvements in
staff communication skills and the care experience.
Outcomes Performance
(what happens (what they The Guide to Implementation may also be of value to the
to the patient choose to do following:
as a result) in practice) • Senior managers/leaders
• Learning and development
• Quality and patient safety
• Clinical leadership
• Clinical skills facilitators
1.3. About the guide to • Patient Advisory Liaison Services Staff
implementation
Implementation of the National Healthcare Communication
As part of their ongoing commitment to improve
Programme requires action in a number of areas. It is
communication skills in healthcare, the National Healthcare
important that staff with the ability to make key decisions that
Communication Programme has developed this revised
will result in improvement are actively involved in the process
Guide to Implementation and a series of tools to support
of implementation from the outset.
healthcare staff in establishing and sustaining excellence
in communication skills and improving the care experience
The National Healthcare Communication Programme makes
across the healthcare system. This Guide to Implementation
it clear that it should be relatively simple for healthcare
and the related Implementation Toolkit will assist in
providers in virtually every setting to immediately start and
the development of national, regional and local quality
continue to evaluate and improve their communication skills
improvement plans to address communication skills
in healthcare conversations.
improvement and sustainability, starting now.

National Healthcare Communication Programme - Guide to Implementation |9

1.4. National Healthcare Each of the 5 elements deserves equally important, specific
and integrated efforts to achieve effective implementation
Communication Programme and maintenance. However, healthcare facilities may have
progressed to different levels as far as communication skills
1.4.1. The Implementation Toolkit
training is concerned. Therefore, while some elements might
Successful and sustained communication skills improvement
be identified as the central features to start with in some
is achieved by implementing multiple actions to tackle
facilities, others may not be immediately relevant in others. At
different obstacles and behavioural barriers. The Guide
facilities with a very advanced level of communication skills
to Implementation has been proposed to translate into
training, some elements could nonetheless be considered for
practice the National Healthcare Communication Programme
improvement and action to ensure long-term sustainability.
and is accompanied by a wide range of practical tools
(implementation toolkit) ready to use for implementation.
It is important to note that implementation, evaluation and
feedback activities should be periodically rejuvenated and
The 5 key elements of the implementation toolkit are:
repeated and become part of the quality improvement
1. System change: ensuring that the necessary
actions that will ensure sustainability. Communication skills
infrastructure is in place to allow healthcare workers to
improvement is not a time-limited process: training, reminders
learn and practice communication skills.
and monitoring should continue once implemented.

2. Training/Education: providing regular training on the

The five elements, together with linked tools available for their
communication skills to all healthcare workers.
implementation, are described in separate sections of this
guide (Sections 2.1.–2.5., pages 14-54).
3. Evaluation and feedback: monitoring communication
skills practices and training, along with patient impact,
Acknowledging the different levels of awareness and the
while providing performance and results feedback to
barriers to implementing communication skills training within
national, regional and local managers and staff.
different healthcare facilities, an implementation toolkit has
been developed to support healthcare workers in improving
4. Reminders in the workplace: prompting and reminding
communication skills at their facilities, irrespective of their
healthcare workers about the importance of using good
starting point. The Guide to Implementation is central to
communication skills.
the toolkit and together they aim to facilitate the process of
translating the five elements of the implementation toolkit
5. Creating a climate for excellence: creating an
into action.
environment and the perceptions that facilitate
awareness-raising about communication in healthcare
The aim is that the improvement in communication will be
while guaranteeing consideration of communication skills
observed over time until at least 2029, when it is hoped
improvement as a high priority at all levels, including:
that a culture of communication skills excellence will
• active participation at both the healthcare facility and
be embedded in all healthcare facilities. Each individual
individual levels;
healthcare facility across the HSE must set its own realistic
• awareness of individual and healthcare facility capacity
targets and quality improvement plans for improvement in
to change and improve (self-efficacy); and
order to reach this aim.
• partnership with patients and patient organisations.

10 | National Healthcare Communication Programme - Guide to Implementation

IMPLEMENTATION TOOLKIT TOOLS FOR SYSTEM CHANGE

1. National Standards for Safer, Better Healthcare

2. National Care Experience Survey Programme
3. Better Together: The Health Services Patient Engagement Roadmap
4. NHCP Guide to Implementation
5. Quality Improvement Plans

TOOLS FOR TRAINING/EDUCATION

Facilitator training

NHCP Facilitator Training (4 Modules)

System change
Core modules
Training/Education

Evaluation and feedback Module 1: Making Connections (workshop)

Module 2: Core Consultation Skills (workshop)
Reminders in the workplace
Module 3: Challenging Consultations (workshop)
Creating a climate for excellence Module 4: Communicating with Colleagues (workshop)

Deep dives

Module 5: Demonstrating Empathy (workshop)

Module 6: Shared Decision Making (workshop)
Module 7: Motivational Interviewing (workshop)
Module 8: Emergency Situations (workshop)
Module 9: Responding to Feedback (workshop)
Module 10: End-of-Life Conversations (workshop)
Module 11: Communications Skills for Healthcare Leaders (workshop)

Elearning programmes

Making conversations easier

Telephone consultations
Video consultations
Clinical handover

Communication skills coaching

Communication skills coaching

Videos, animations, podcasts and publications

Communication skills demonstration videos on webpage

Communication skills module workshop training videos
Animated case studies
Podcasts
Key NHCP Publications

TOOLS FOR EVALUATION AND FEEDBACK

Levels 1 and 2:
- Pre and Post Training Evaluation
- Evaluation by facilitators
- Site visits
- Observation Tool (Communication Competencies)
Level 3: Follow-up Training Evaluation
Level 4: Patient Impact

TOOLS FOR REMINDERS IN THE WORKPLACE

• Posters/Illustrations
• Top tips
• Skills cards

TOOLS FOR CREATING A CLIMATE FOR EXCELLENCE

1. Template letter to advocate/communicate NHCP to Managers

2. NHCP promotional PowerPoint/Video

National Healthcare Communication Programme - Guide to Implementation | 11

1.4.2. The five steps to change The main objectives to be achieved in each step are the
In each section dedicated to the five elements of the following:
NHCP implementation toolkit, different approaches to Step 1: Prepare
implementation are suggested according to various potential
Ensuring the preparedness of the healthcare facility. This
situations of a healthcare facility. Overall, this guide proposes
includes obtaining the necessary resources (both human
a five step approach as a model to gradually implement
and financial), putting infrastructure in place, identifying key
a comprehensive communication skills programme at the
leadership to head the programme including an NHCP Lead
facility level. The approach represents a cycle that can be
and his/her deputy.
adapted locally and renewed periodically by any facility
aiming to sustain communication skills improvement.
Step 2: Evaluate baseline
Conducting/reviewing baseline evaluation of
The approach includes five steps to be undertaken
communication skills (review annual care experience survey
sequentially:
results, complaints, incidents and so on).
Step 1: Prepare readiness for action
Step 2: Evaluate establishing knowledge of the current Step 3: Implement
baseline situation Implementing the improvement programme. Ensuring an
Step 3: Implement introducing the improvement adequate number of trained facilitators is vitally important,
activities as is conducting staff education and training and displaying
Step 4: Evaluate evaluating the implementation impact reminders in the workplace. Well-publicised events
impact involving endorsement and/or signatures of commitment
from leaders and individual healthcare workers will generate
Step 5: Continuous developing a plan for the next 5 years
participation.
improvement (minimum)

Step 4: Evaluate impact

The overall aim is to embed excellence in communication
skills as an integral part of the culture in the healthcare facility. Conducting follow-up evaluation to assess the effectiveness
of the programme.

Step 5: Continuous improvement

THE FIVE STEPS TO CHANGE
Developing an ongoing quality improvement plan and
review cycle, while ensuring long-term sustainability.

5. Continuous These steps are described in detail in Part 3, after an

improvement
understanding of each of the five elements of the NHCP
implementation toolkit has been gained.

4. Evaluate impact

3. Implement

2. Evaluate baseline

1. Prepare

12 | National Healthcare Communication Programme - Guide to Implementation

Part 2
Implementation toolkit

2.1. System Change

2.2. Training/Education

2.3. Evaluation and Feedback

2.4. Reminders in the Workplace

2.5. Creating a Climate for Excellence

National Healthcare Communication Programme - Guide to Implementation | 13

2.1. System Change 2.1.4. Resources for implementation
Resources needed for implementation will vary from service
2.1.1. Definitions and overview
to service depending on the size, with each healthcare facility
System change refers here to ensuring that the healthcare aiming to deliver the 4 core modules and any relevant deep
facility has the necessary infrastructure in place to support dive modules to their staff on an annual basis.
healthcare workers to improve their communication skills.
Staffing: Staff involved include an identified NHCP Lead, a
Support and commitment from senior key managers is multidisciplinary team to develop the NHCP implementation
crucial to communication skills improvement. It is essential plan, facilitators to prepare and carry out the training, staff
that a quality improvement plan to ensure system change champions for overall support and implementation and team
is prepared and implemented, involving key senior leaders members who will monitor the implementation plan.
and managers who will be depended upon to make system
change happen. Costs: Material costs include printing the NHCP posters,
skills cards, patient prompts, participant workbooks and
2.1.2. Articulate a vision communication checklists. Non-financial costs include time
Healthcare facilities need a clear vision and commitment to away from work to facilitate and attend the NHCP workshops.
improve the delivery of their services to patients. This vision
will be informed by the results of the care experience surveys System change is a particularly important priority for
(and other feedback mechanisms) and can be addressed by healthcare facilities starting on their journey of communication
implementation of the NHCP. skills improvement. However, it is also essential that
healthcare facilities regularly revisit the necessary
infrastructure to ensure that communication skills live up to a
2.1.3. Leadership buy-in high standard on an ongoing basis.
Obtaining the full commitment and support of clinical leaders
and managers is critical to putting the pieces into place for
2.1.5. Tools for system change – tool descriptions
the successful implementation of the National Healthcare
Communication Programme. This is the first step in changing The tools described in this section aim at directing and
the organisational culture to be more supportive of safe, supporting healthcare facilities in making prompt and
effective, person-centred care, including developing and appropriate system changes.
enhancing communication skills. The NHCP promotional
presentation (see 2.5.2., page 54) can assist in providing All of these tools can be used at the start of the
relevant information for management and leadership buy-in communication skills improvement journey but can also
to programme implementation in the facility. be utilised to improve communication skills where an
improvement programme is already in place or to undertake
In addition to leadership buy-in, it may also help to have routine or periodic monitoring.
champions on board—people who are widely respected
by other staff members, committed to the value of person- The range of tools available to support the implementation of
centred care, perhaps have experience of dealing with system change is represented in the following pages.
patient complaints, good communication skills, and willing
to engage others.

14 | National Healthcare Communication Programme - Guide to Implementation

 TOOLS FOR SYSTEM CHANGE

National Standards for Safer Better Healthcare

National Standards for

What
Safer Better Healthcare
June 2012
An underpinning framework for continuous improvement in the quality and safety of healthcare services (excluding
mental health services). The standards describe the principles of quality and safety for healthcare settings which can be
understood and shared by the public, service users and service providers.
Why The National Standards for Safer, Better Healthcare provide a basis for planning and managing services and measuring
improvements as well as identifying and addressing gaps and deterioration in the quality and safety of the services
provided
Where Services provided or funded by the Health Service Executive (HSE)
When Annual assessment programme
How Quality Assessment and Improvement resources are available to support healthcare facilities in assessing their services
against the National Standards. Healthcare facilities can use these resources to identify and prioritise areas that need
greater emphasis or a faster rate of progression towards full and sustainable compliance – particularly when identifying
areas of risk.
Who Users: The standards will be used by senior managers, clinicians and staff working in quality and patient safety at the
healthcare facility

National Care Experience Survey Programme

Findings of
the 2022
Inpatient
Survey

What The National Care Experience Programme, is a joint initiative between the Health Information and Quality Authority (HIQA),
the Health Service Executive (HSE) and the Department of Health
Why Care experience surveys are a useful way of identifying areas that need improvement in the delivery of health and social
care. By listening and learning from the experiences of patients we can bring about effective and sustainable changes
across the HSE.
Where • Nursing Homes
• Acute Hospitals (Inpatients)
• Maternity Services (care and bereavement experience)
• End of Life care services
When Annual survey programme
How Eligible participants periodically take part in the surveys. The findings are published and shared with service providers,
policy makers, and the public.
Who Users: HIQA/DoH/HSE
Targets: People using these services and senior managers, clinicians and staff working in quality and patient safety at the
healthcare facility

National Healthcare Communication Programme - Guide to Implementation | 15

 Better Together: The Health Services Patient Engagement Roadmap

Better Together:

What National guidance and tools for healthcare staff to create a strong culture of meaningful patient engagement
The Health Services Patient
Engagement Roadmap
Providing the essential guidance and tools for
healthcare staff to create a strong culture of
meaningful Patient Engagement, where Patient
Engagement is encouraged, expected and respected.

Why To achieve a consistent, cohesive, considered approach to patient engagement. Patient Engagement is recognised as a
fundamental cornerstone of healthcare and a critical component of a safe, people-centred service.
Where • Individual health and healthcare level
• Service design, delivery and evaluation level
• Policy making level
When • Every encounter every patient has with the healthcare service
• When updating existing healthcare services and designing new and integrated healthcare services
• When engaging with patients in updating and making policy, in writing governance and in writing strategy
How The roadmap is designed so that the reader can make it their own, choosing the sections that are relevant to the
healthcare level and the local context in which they wish to engage with patients
Who The roadmap is for all healthcare staff (clinical and non-clinical) working at all levels of healthcare services. It is also for
patients and their personal support network.

NHCP Guide to Implementation

What The NHCP Guide to Implementation gives an overview of and rationale for the National Healthcare Communication
Programme (NHCP). It provides step-by-step guidance to help healthcare facilities to implement the programme.
Why Implementation of the programme is essential to achieving an impact on patient safety, quality of care and the care
experience and therefore the guide aims actively to support the use of the NHCP materials
Where • Individual health and healthcare level
• Service design, delivery and evaluation level
• Policy making level
When The tool should be used by senior managers and clinicians and the NHCP coordinator at the healthcare facility
How The Guide is designed so that the reader can make it their own, choosing the sections that are relevant to their local
context
Who Users: The tool can be used by senior managers and staff charged with making service-wide improvements in staff
HSE ACUTE HOSPITAL SERVICES

2022
communication skills and the care experience and the NHCP Lead at the healthcare facility
Listening, Responding
and Improving
The HSE response to the findings of the
National Inpatient Experience Survey

Quality Improvement Plans

What A Quality Improvement is an healthcare facility’s framework for developing and improving areas for improvement identified
in the care experience survey results. It includes the direction, timeline, activities, and assessment measures of quality and
quality improvement within the healthcare facility.
Why The HSE responds to the Care Experience Survey results by developing quality improvement plans at national, regional
and local levels. The results also inform national policy and HIQA’s monitoring programme
Where • Nursing Homes
• Acute Hospitals (Inpatients)
• Maternity Services (care and bereavement experience)
• End of Life care services
When Annual quality improvement plans in response to the care experience surveys
How
• Healthcare teams, working across the HSE, use the findings of the National Care Experience Surveys to understand
what matters to the people who use our services and to inform priorities for improving care experience across
healthcare services
• Priority areas are identified for improvement and included in the healthcare facility’s QIP. Implementation of these QIP’s
is reported at National level in the HSE
Who Users: HIQA/DoH/HSE
Targets: Senior, accountable managers at healthcare facility, regional and national level
Staff charged with making service-wide improvements in staff communication skills and the care experience

16 | National Healthcare Communication Programme - Guide to Implementation

2.2. TRAINING/EDUCATION Facilitators will be briefed on the key messages to be spread
and supported to become familiar with the tools available for
2.2.1. Definitions and overview training; formal training of the facilitators is organised by the
Education is a critical success factor and represents one of NHCP regional coordinator in conjunction with the National
the cornerstones for improvement of communication skills Team.
practices.
The crucial role of facilitators should be clearly acknowledged
All healthcare workers require communication skills training. by the healthcare facility by allocating protected time to these
By disseminating clear messages about communication skills activities.
using a system-wide common language and approach (the
Calgary-Cambridge Guide), such Training/Education aims Plans for healthcare workers’ training should be made
to induce behavioural and cultural change and ensure that during the Prepare phase (Step 1, Section 3.2.1., page 56)
competence is deep-rooted and maintained among all staff in and should include decisions about how much time will be
relation to communication skills in healthcare. allocated to training as well as about the specific settings
where Training/Education will be provided in the first instance
Staff education is a key element of the implementation phase (e.g. priority according to...).
(Step 3, see Section 3.2.3, page 58) of a communication
skills improvement programme. As facilities move across the Facilities could consider implementing a system of observing/
communication skills improvement continuum, it is expected reviewing the competence of all healthcare workers who
that they will establish a robust programme of education on have received communication skills training. Utilising the
healthcare communication and provide regular training to all communication skills competence tool will also fulfil the
healthcare workers, including new starts as well as regular purpose of checks on competence.
updates and competence checks of existing and previously-
trained staff. At a minimum, basic training on the importance 2.2.2. Programme design
of good communication skills for building rapport and
Research suggests that while knowledge of communication
listening (NHCP Module 1: Making Connections) is essential
skills is important, it does not translate directly into
to ensure a better care experience for patients and their
performance therefore, considerable effort has been
family members.
dedicated to developing interactive communication skills
teaching modules and support materials. The modules are
In the context of a communication skills improvement
delivered in a facilitated, group-learning model. Module
programme, the targets for training at different levels are
design and instructional methods are based on adult-
facilitators and healthcare workers. A top-down approach to
learning theory and create an experience that attends to the
training is recommended whereby the NHCP Lead, together
psychological safety of the participants. Through viewing and
with other key players at the facility (senior managers and a
debriefing video scenarios, participants have the opportunity
committee if one exists), will identify the individuals capable
to increase self-awareness and develop their communication
of fulfilling the role of facilitators.
knowledge, skills and attitudes. Participants share individual
experiences, perspectives, challenges and strategies and
The NHCP facilitator will be in charge of delivering Training/
have the opportunity to engage in role-play simulations,
Education to healthcare workers. Ideally, they should be an
followed by a facilitator-guided debriefing.
influential and credible leader (e.g. clinical nurse manager/
clinical director/senior clinician/head of another key
department or discipline).

Note: Doctors are the primary profession leading the most

complex discussions relating to disease occurrence and
progression, individualised treatment plans which require
consideration of risk and benefit, decision making and quality
of life concerns. Personal experience of these communication
encounters is considered important when facilitating the
programme. Medical co-facilitation has also been strongly
positively evaluated by co-facilitators and their presence is
beneficial when responding to participants, most noticeably
doctors who may sometimes be resistant to training on
courses.

National Healthcare Communication Programme - Guide to Implementation | 17

 PROGRAMME DESIGN

Preparation
Each participant is encouraged to complete the online NHCP module prior to the commencement of the classroom based
modules.

Each participant is encouraged to complete the NHCP self-awareness tool (pre-training evaluation on the NHCP App),
prior to the commencement of each module of the programme.

Attendance and To build a stepwise skills based programme it is delivered in modular format, with
participation in each module focusing on core skills for different types of healthcare conversation. The
classroom-based programme contains four core modules each lasting between 120 and 240 minutes
modules depending on the module. The core modules are:
1. Making Connections
2. Core Consultation Skills
3. Challenging Consultations
4. Communicating with Colleagues and Promoting Teamwork

There are seven deep dive modules into specific areas like communicating in emergency
situations or end of life conversations.

Teaching model The National Healthcare Communication Programme is based on the Calgary-Cambridge
Guide. The Guide is widely used across the world to teach communication skills to
healthcare workers. It provides a clear structure for learning, practice, and reflection and
is used across the Programme for all types of healthcare conversation. The Calgary-
Cambridge Guide summarises the healthcare conversation as a sequential 5 step
process; initiating the conversation, gathering information, physical examination, providing
information and planning and closing the conversation. Providing structure and Building
the relationship are two steps that continue throughout the conversation. Within each step
are key communication skills that can be used to achieve the best outcomes from each
healthcare conversation.

The Module 1 workshop (Making Connections) focuses the Building the relationship
section of the Calgary-Cambridge Guide and the remaining sections of the Guide (Initiating
the conversation, Gathering information, Providing information and planning, Closing
the conversation and Providing structure) are covered in Module 2 (Core Consultation
Skills). Staff are encouraged to complete Modules 1 and 2 in advance of taking any of
the remaining workshops. All remaining programme modules use the Calgary-Cambridge
Guide, focusing especially on particular skills for particular conversations (e.g., delivering
bad news). Thus Programme modules provide consistent and cumulative learning.

18 | National Healthcare Communication Programme - Guide to Implementation

Core communication Small group learning
skills training Most of the teaching occurs in small groups; evidence shows that this promotes
components psychological safety and promotes skills acquisition.
Minimal didactic content
Each module begins with an introduction outlining some of the theory followed by
experiential learning. This approach draws on participant’s experience and prioritises high
levels of participant engagement to maximise potential for skills confidence and behavior
change.
Role play (preferably with simulated patients)
Each group of four to six participants works with a facilitator (using a peer-to-peer
approach), with the simulated patients taking the roles of patients during the sessions.
Trained simulated patients are able to take on more complex roles and can give
feedback from the patient’s perspective. This allows staff to practice new skills in a ‘safe’
environment.

Reflective practice and Participants will be asked to identify learning that they are taking from the module(s)
follow-up which they would like to put into practice. Each service will link with participants at regular
intervals to remind them of this commitment to on-going learning and development of
communication skills in healthcare.

Skills cards summarising key skills from each session will be distributed at the end of
the session as an easy reference for participants – these will also be made available
electronically.

Participants will be encouraged and supported to consider further learning. Communication

skills coaching will be offered to clinicians who require additional support.

Reading Participants will be issued with a reading list for the programme. Additional reading will be
recommended to participants throughout the programme.

Web-based resources There is an easy-to-access section on the HSE website which is used to store electronic
links, as well as PDF versions of articles and recommended readings for use as a resource
by staff to enable communication skills development. These links will be maintained to
provide a continually updated and improved resource.

Facilitators Skilled facilitation

The programme is designed to be facilitated by team leaders or clinical educators working
with small groups of staff in their department or service. This helps to maintain individual
and group psychological safety, creating an environment for optimal learning.

The National Healthcare Communication Programme (NHCP) is implemented using a

cascade (Train the Trainer) approach and is designed to be facilitated by team leaders or
facilitators working with small groups of staff in their department or service. It is preferable
to use two facilitators as a minimum for each workshop – one being a competent facilitator
with at least two years’ experience. If more facilitators are available they can take the role
of generally observing and supporting the lead facilitators and providing feedback at the
end of the session. Facilitators conducting each Module Workshop will have attended the
learning and development preparatory workshops (NHCP Module Part 1 and Part 2) for this
purpose.

Mentoring for Facilitating communication skills requires particular skills that (like communication skills)
Facilitators need to be learned and practised. Following NHCP training, facilitators will be supported to
attend regular refresher sessions.

Individual coaching Tailored for individual clinicians, expert advice, guidance and coaching is available. The
coaching process can involve a series of scheduled sessions. These can be done in person,
over the phone, via video-conference or by using a combination of all three.

National Healthcare Communication Programme - Guide to Implementation | 19

2.2.3. Tools for Training/Education – tool descriptions

The range of tools available to support training/education is outlined in the following pages.

TOOLS FOR TRAINING/EDUCATION

FACILITATOR TRAINING

NHCP Facilitator Training

What The focus of these 4 workshops is to encourage facilitators to appreciate the perspective of the learner, the generic
structure and principles of a teaching session, the principles of adult learning and development, the skills based approach
used by the NHCP and to reflect on how they can apply all of these to their own facilitation style.
Why Module 1 (Part 2)
•Discuss the principles of adult learning and development
•Describe a skills based approach to communication skills teaching
•Describe the principles for each of the following sections of a teaching workshop (prepare/start/structure/close)
•Reflect on how they might adapt and apply this to their own facilitation style

Module 2 (Part 2)
• Discuss top tips for dealing with nerves, answering questions and dealing with challenging situations during their
workshops
• Discuss why learner safety is important, who might be at risk and the strategies that might help to establish learner
safety
• Consider facilitator tips for using videos for communication skills teaching
• Reflect on how they might adapt and apply this to their own facilitation style

Module 3 (Part 2)
• Discuss feedback and how it should be offered
• Practice giving feedback using a Module 3 scenario
• Reflect on how they might adapt and apply this to their own facilitation style

Module 4 (Part 2)
• Discuss their role as facilitator for Module 4 and the skills that they will need to facilitate this module
• Practice discussing and debriefing a Module 4 video under each of the elements of team-based working
• Reflect on how they might adapt and apply this to their own facilitation style
Where During Module Facilitator workshops organised by the NHCP for Programme Facilitators
When During training sessions for all potential NHCP Facilitators including training for new facilitators and regular updates for
previously trained facilitators
How These are virtual training workshops. The duration of each workshop is 3 hours. The workshop uses both theoretical and
practical/interactive approaches, including PowerPoint slides, small group and large group activities/discussion, media,
case studies and role-play.
Who Users: NHCP National Team
Targets: NHCP Facilitators
Note: Staff attending these Module part 2 workshops are required to complete the relevant Module Part 1 in advance of
taking these workshops

TRAIN THE TRAINER APPROACH

NHCP NHCP Coordinator NHCP NHCP Workshop

National Team (Regional) Lead Facilitators participants

20 | National Healthcare Communication Programme - Guide to Implementation

INTERACTIVE WORKSHOPS: CORE MODULES

Module 1: Making Connections

What The focus of this workshop is to enable healthcare workers to quickly establish supportive and caring relationships with
patients and their loved ones. The workshop content is based on the Building the Relationship stage of the Calgary-
Cambridge Guide.
Why • Understand that patient-centred communication requires a skills based approach
• Recognise the impact of non-verbal and verbal behaviour in building a relationship with the patient and on the patient
experience
• Describe and demonstrate skills in building rapport
• Recognise the consequences of active listening on the patient experience
• Describe and demonstrate skills in active listening
Where • During Module workshops organised by the healthcare facility for all healthcare workers
• During Module workshops organised by the NHCP for Programme Facilitators
When During regular training workshops for all healthcare workers, including training for new staff and regular updates for
previously trained healthcare workers
How • This is a face-to-face training workshop
• The duration of this workshop is 2 hours
• The workshop uses both theoretical and practical/interactive approaches, including PowerPoint slides, small group and
large group activities/discussion, media, case studies and role-play
Who Users: NHCP Facilitators
Targets: All health and social care staff

Module 2: Core Consultation Skills

What The focus of this workshop is to enable clinicians to deliver compassionate person-centred care in all consultations
and conversations with patients and their loved ones. The workshop content is based on the Initiating the conversation,
Gathering information, Providing information and planning, Closing the conversation and Providing structure stages of the
Calgary-Cambridge Guide.
Why • Describe a structure for the generic consultation and identify the preferred model
• Describe and demonstrate the skills required for getting the consultation off to a good start, gathering information from
and providing information to patients and their families
• Reflect on and identify key skills learners wish to practice to enhance their core consultation skills
Where • During Module workshops organised by the healthcare facility for all healthcare workers
• During Module workshops organised by the NHCP for Programme Facilitators
When During regular training sessions for all healthcare workers, including training for new staff and regular updates for
previously trained healthcare workers
How • This is a face-to-face training workshop
• The duration of this workshop is 4 hours
• The workshop uses both theoretical and practical/interactive approaches, including PowerPoint slides, small group and
large group activities/discussion, media, case studies and role-play
Who Users: NHCP Facilitators
Targets: All health and social care staff who consult with patients and their families
Staff attending this module are encouraged to complete Module 1 in advance of taking this workshop

National Healthcare Communication Programme - Guide to Implementation | 21

 Module 3: Challenging Consultations

What The focus of this workshop is to enable clinicians to deliver compassionate, person-centred care in more challenging
consultations, for example Delivering Bad News and Disclosing Errors. It builds on the skills learned in Modules 1 and 2
enabling the learner to use the same skills more deliberately when faced with strong emotions.
Why • Review core consultation skills using the Calgary-Cambridge Guide
• Consider how these skills need to be applied with greater depth and intensity in challenging consultations
• Describe and demonstrate key skills needed for challenging consultations in a safe setting
• Reflect on and identify key skills learners wish to practice to enhance their skills for challenging consultations
Where • During Module workshops organised by the healthcare facility for all healthcare workers
• During Module workshops organised by the NHCP for Programme Facilitators
When During regular training sessions for all healthcare workers, including training for new staff and regular updates for
previously trained healthcare workers
How • This is a face-to-face training workshop
• The duration of this workshop is 4 hours
• The workshop uses both theoretical and practical/interactive approaches, including PowerPoint slides, small group and
large group activities/discussion, media, case studies and role-play
Who Users: NHCP Facilitators
Targets: All health and social care staff who consult with patients and their families
Note: Staff attending this module are encouraged to complete Modules 1 and 2 in advance of taking this workshop

Module 4: Communicating with each other and promoting teamwork

What Team working in healthcare is taken for granted because teams of people and groups of teams must work
interdependently to provide high quality care for patients. The evidence, however shows that the quality of team and
inter-team working in healthcare is often poor. Such poor team working leads to errors that harm both staff and patients;
injuries to staff; poor staff well-being; lower levels of patient experience; poorer quality of care; and higher patient
mortality. This skill-building workshop is based on international good practice in the delivery of team-based healthcare.
It is designed to enhance the ability of learners to communicate effectively with other members of a multidisciplinary
healthcare team.
Why • Identify their preferred communication style and consider the styles of their colleagues
• Identify and discuss the core components of collaborative team-based healthcare
• Describe the key principles and skills of Handover
• Demonstrate these skills utilising the ISBAR3 tool
Where • During Module workshops organised by the healthcare facility for all healthcare workers
• During Module workshops organised by the NHCP for Programme Facilitators
When During regular training sessions for all healthcare workers, including training for new staff and regular updates for
previously trained healthcare workers
How • This is a face-to-face training workshop
• The duration of this workshop is 4 hours
• The workshop uses both theoretical and practical/interactive approaches, including PowerPoint slides, small group and
large group activities/discussion, media, case studies and role-play
Who Users: NHCP Facilitators
Targets: All health and social care staff
Note: Staff attending this module are encouraged to complete Modules 1 and 2 in advance of taking this workshop

22 | National Healthcare Communication Programme - Guide to Implementation

INTERACTIVE WORKSHOPS: DEEP DIVES

Module 5: Demonstrating Empathy

What The focus of this workshop is to enable staff to provide compassionate care during all conversations and consultations
with patients and their families. Participants review core communication skills using the Calgary-Cambridge Guide,
focusing especially on the skills for demonstrating empathy.
Why • Define empathy
• Consider and identify the communication skills for demonstrating empathy
• Describe and demonstrate the skills required for demonstrating empathy
• Reflect on and identify key skills learners wish to practice to enhance their communication skills for demonstrating
empathy
Where • During Module workshops organised by the healthcare facility for all healthcare workers
• During Module workshops organised by the NHCP for Programme Facilitators
When During regular training sessions for all healthcare workers, including training for new staff and regular updates for
previously trained healthcare workers
How • This is a face-to-face training workshop
• The duration of this workshop is 2 hours
• The workshop uses both theoretical and practical/interactive approaches, including PowerPoint slides, small group and
large group activities/discussion, media, case studies and role-play
Who Users: NHCP Facilitators
Targets: All healthcare staff
Note: Staff attending this module are encouraged to complete Modules 1 and 2 in advance of taking this workshop

Module 6: Shared Decision Making

What The focus of this workshop is to teach the skills for shared decision making thus enabling clinicians and patients to reach
important healthcare decisions together. Core communication skills from the Calgary Cambridge guide are reviewed with
particular emphasis on those needed for shared decision making.
Why • Define shared decision making
• Understand why shared decision making is important
• Consider and identify the communication skills for shared decision making
• Demonstrate the skills required for shared decision making
• Reflect on and identify key skills learners wish to practice to enhance their communication skills for shared decision
making
Where • During Module workshops organised by the healthcare facility for all healthcare workers
• During Module workshops organised by the NHCP for Programme Facilitators
When During regular training sessions for all healthcare workers, including training for new staff and regular updates for
previously trained healthcare workers
How • This is a face-to-face training workshop
• The duration of this workshop is 2 hours
• The workshop uses both theoretical and practical/interactive approaches, including PowerPoint slides, small group and
large group activities/discussion, media, case studies and role-play
Who Users: NHCP Facilitators
Targets: All health and social care staff who consult with patients and their families
Note: Staff attending this module are encouraged to complete Modules 1 and 2 in advance of taking this workshop

National Healthcare Communication Programme - Guide to Implementation | 23

 Module 7: Motivational Interviewing

What The focus of this workshop is to teach the core skills for Motivational Interviewing and Behaviour Change thus enabling
clinicians to support patients in changing behaviours (for example smoking, exercise) which are affecting their health.
Core communication skills from the Calgary-Cambridge Guide are reviewed with particular emphasis on those needed for
Behaviour Change.
Why • Understand what motivational interviewing is
• Understand the principles of motivational interviewing
• Consider, identify and demonstrate the communication skills for motivational interviewing
• Reflect on and identify key skills learners wish to practice to enhance their communication skills for motivational
interviewing
Where • During Module workshops organised by the healthcare facility for all healthcare workers
• During Module workshops organised by the NHCP for Programme Facilitators
When During regular training sessions for all healthcare workers, including training for new staff and regular updates for
previously trained healthcare workers
How • This is a face-to-face training workshop
• The duration of this workshop is 3 hours
• The workshop uses both theoretical and practical/interactive approaches, including PowerPoint slides, small group and
large group activities/discussion, media, case studies and role-play
Who Users: NHCP Facilitators
Targets: All health and social care staff who have healthcare conversations about changing healthcare behaviours
Note: Staff attending this module are encouraged to complete Modules 1 and 2 in advance of taking this workshop

Module 8: Emergency Situations

What Healthcare emergencies require healthcare workers to communicate clearly and concisely with patients and colleagues.
This workshop builds upon the skills learned from the Calgary Cambridge Guide in Modules 1 to 4 and introduces the
learner to additional skills from Hostage and Crisis Negotiation.
Why • Describe the law of approach and avoid
• Understand the importance of emotion
• Identify the impact of emotion on communication
• Name the five core emotional concerns
• Consider the skills and tactics required to communicate in emergency situations
• Reflect on and identify key skills and tactics learners wish to practice to enhance their ability to communicate in
emergency situations
Where • During Module workshops organised by the healthcare facility for all healthcare workers
• During Module workshops organised by the NHCP for Programme Facilitators
When During regular training sessions for all healthcare workers, including training for new staff and regular updates for
previously trained healthcare workers
How • This is a face-to-face training workshop
• The duration of this workshop is 3 hours
• The workshop uses both theoretical and practical/interactive approaches, including PowerPoint slides, small group and
large group activities/discussion, media, case studies and role-play
Who Users: NHCP Facilitators
Targets: All healthcare staff working in emergency situations
Note: Staff attending this module are encouraged to complete Modules 1 and 2 in advance of taking this workshop

24 | National Healthcare Communication Programme - Guide to Implementation

 Module 9: Responding to Patient Feedback

What Patient feedback is increasingly being sought to help improve the delivery of healthcare services. Healthcare workers
need support to attend and respond to patient feedback in a person-centered, empathic way. This workshop reviews
core communication skills using the Calgary-Cambridge Guide, focusing especially on skills for responding to patient
feedback. Learners are encouraged to consider how these skills can be used and adapted for conversations with people
who may have varying degrees of distress relating to their complaint. The conversations may take place over the phone or
face to face with the person making the complaint.
Why • Consider and identify the communication skills for responding to patient feedback
• Name the five core emotional concerns
• Demonstrate the skills required for responding to patient feedback
• Reflect on and identify key skills learners wish to practice to enhance their communication skills for responding to
patient feedback
Where • During Module workshops organised by the healthcare facility for all healthcare workers
• During Module workshops organised by the NHCP for Programme Facilitators
When During regular training sessions for all healthcare workers, including training for new staff and regular updates for
previously trained healthcare workers
How • This is a face-to-face training workshop
• The duration of this workshop is 4 hours
• The workshop uses both theoretical and practical/interactive approaches, including PowerPoint slides, small group and
large group activities/discussion, media, case studies and role-play
Who Users: NHCP Facilitators
Targets: All health and social care staff with responsibility for having conversations with patients and their families
regarding their feedback on their experience of care
Note: Staff attending this module are encouraged to complete Modules 1 and 2 in advance of taking this workshop

Module 10: End-of-Life Conversations

What End of life care requires staff to have caring and sensitive conversations with patients and their loved ones. This workshop
reviews core communication skills using the Calgary-Cambridge Guide, focusing especially on skills for sensitive and
difficult conversations. Learners are encouraged to consider how these skills can be used and adapted for conversations
with patients/family members where a patient is likely in their last weeks, days, or hours of their life, and also where family
members have been recently bereaved.
Why • Review core communication skills using the Calgary-Cambridge Guide, focusing especially on skills for sensitive and
difficult conversations
• Learn how these skills can be used and adapted for conversations with patients/family members where a patient is
likely in their last weeks, days, or hours of their life, and also where family members have been recently bereaved
• Practice key skills for these conversations so learners gain a better understanding of their own communication, through
reflection and facilitated feedback
• Learners set themselves up to three realistic goals for using their learning in their own work
Where • During Module workshops organised by the healthcare facility for all healthcare workers
• During Module workshops organised by the NHCP for Programme Facilitators
When During regular training sessions for all healthcare workers, including training for new staff and regular updates for
previously trained healthcare workers
How • This is a face-to-face training workshop
• The duration of this workshop is 4 hours
• The workshop uses both theoretical and practical/interactive approaches, including PowerPoint slides, small group and
large group activities/discussion, media, case studies and role-play
Who Users: NHCP Facilitators
Targets: All health and social care staff who has personal contact with people who are dying (whether suddenly or over
a long period) and who has personal contact with dying people’s close ones (partners, relatives). The large majority of
people who work in health (and social care) services will have contact with patients and family members who are in this
situation.
Note: Staff attending this module are encouraged to complete Modules 1 and 2 in advance of taking this workshop.

National Healthcare Communication Programme - Guide to Implementation | 25

 Module 11: Communications Skills for Healthcare Leaders

What Emotional Intelligence is the capacity for recognising our own feelings and those of others, for motivating ourselves and
for managing emotions well in ourselves and in our relationships. This Module supports participants to learn and develop
MODULE: FACILITATOR GUIDE
their communication competence for the four domains of emotional intelligence: self-awareness, self-management,
Communication Skills
for Healthcare Leaders
social awareness, and relationship management. As with all competencies, people can learn ways to improve, change,
and develop their competence with deliberate practice and training. The results include improved quality of working
relationships, creative solutions, and lasting agreements for addressing challenges and opportunities in the future.
Why • Review the four domains of emotional intelligence (EI) and it’s competencies;
• Review the Calgary-Cambridge Guide, focusing especially on the communication skills for each EI competency;
• Learn how these skills can be used and adapted to expand your own leadership style repertoire;
• Practice key skills for conversations for healthcare leaders and gain a better understanding of your own
communication, through reflection and facilitated feedback;
• Set yourself up to three realistic goals for using your learning in your own work.
Where • During Module workshops organised by the healthcare facility for all healthcare workers
• During Module workshops organised by the NHCP for Programme Facilitators
When During regular training sessions for all healthcare workers, including training for new staff and regular updates for
previously trained healthcare workers
How • This is a face-to-face training workshop
• The duration of this workshop is 6 hours
• The workshop uses both theoretical and practical/interactive approaches, including PowerPoint slides, small group and
large group activities/discussion, media, case studies and role-play
Who Users: NHCP Facilitators
Targets: All health and social care staff in leadership positions regarding their feedback on their experience of care

E-LEARNING PROGRAMMES

Making conversations easier (online module - introduction to the programme)

What This video-based module introduces learners to the communication skills they can use to improve their conversations
with people who use our services, with carers and with colleagues. It contains a series of video scenarios following
one patient’s journey through the hospital system and back to primary healthcare, all the while showcasing good
communication skills in practice.
Why • Patients and their caregivers report that while there are many examples of care and compassion in our Healthcare
Services, there are also many problems with the communication between staff and patients and their loved ones
• Good communication has a positive impact on the therapeutic relationship between patients and staff and has also
been shown to positively affect healthcare outcomes
Where Online module available at [Link]
When For new staff and regular updates for previously trained healthcare workers
How Online module demonstrates, via video, how to:
1. Build a relationship
2. Communicate with colleagues at handover
3. Listen to people and enable them to feel understood
4. Communicate with family members and carers
5. Provide information and plan with people
6. Have challenging conversations
7. Communicate with colleagues at discharge
Who Targets: All health and social care staff

26 | National Healthcare Communication Programme - Guide to Implementation

 Telephone consultations (online module)

What This module introduces learners to the communication skills they can use to improve their telephone conversations with
people who use our services. It contains a poor and good version of a telephone conversation between a patient and their
clinician. Applying the Calgary-Cambridge Guide to video calls provides a structured and safe approach to this virtual
format.
Why Many healthcare staff are now carrying out consultations on the telephone. This is often a type of consultation that staff
have not encountered prior to COVID19 and needs the use of particular communication skills to ensure safe and efficient
calls that address the needs of patients and their relatives.
Where Online module available at [Link] and on webpage
When For new staff and regular updates for previously trained healthcare workers
How Online module demonstrates, via videos and accompanying debrief, how to apply the core skills of the Calgary-
Cambridge Guide to telephone conversations in healthcare
Who Targets: All health and social care staff having healthcare conversations on the telephone

Video consultations (online module)

What This module introduces learners to the communication skills they can use to improve their video conversations with
people who use our services. It contains a poor and good version of a video conversation between a patient and their
clinician. Applying the Calgary-Cambridge Guide to video calls provides a structured and safe approach to this virtual
format.
Why Video consultations in healthcare are not new, but the COVID19 pandemic forced many clinicians to rapidly take up video
consultations as a feasible alternative to face to face consultations. This is often a type of consultation that staff have not
encountered before.
Where Online module available at [Link] and on webpage
When For new staff and regular updates for previously trained healthcare workers
How Online module demonstrates, via videos and accompanying debrief, how to apply the core skills of the Calgary-
Cambridge Guide to video conversations in healthcare
Who Targets: All health and social care staff having healthcare conversations using a virtual video platform

Clinical handover (online module)

What This module introduces learners to ISBAR3 and the communication skills they can use to improve clinical handover with
their colleagues. It contains a poor and good version of a clinical handover conversation between two clinicians.
Why Ineffective communication between team members is a well-recognised contributor to patient harm. Research indicates
that clinical handover is one of the most important contributing factors in serious adverse events and is a major
preventable cause of patient harm.
Where Online module available on webpage
When For new staff and regular updates for previously trained healthcare workers
How Online module demonstrates, via videos and accompanying debrief, how to apply ISBAR3 and the core skills of the
Calgary-Cambridge Guide to clinical handover conversations
Who Targets: All health and social care staff involved in handover conversations

National Healthcare Communication Programme - Guide to Implementation | 27

 COMMUNICATION SKILLS COACHING

Communication skills coaching

What The core modules of this programme give an overview of core consultation skills. However some clinicians may need
more focused learning to improve their skills. Communication skills coaching is a practical, structured process in which a
trained coach helps staff on a one to one basis to develop or enhance their skills to communicate more effectively with
patients, families and colleagues in the workplace.
Why • To help staff examine their communication skills and identify which skills they would like to improve on
• To assist staff to gain more insight into how their communication skills impact on them and on others
• To encourage and support staff develop and enhance their communication skills
Where At a mutually agreed venue
When Following self-referral to the communication skills coaching service or if a staff member is referred by a line manager
How A communication skills coach will meet with the individual over a number of sessions, usually four to six, one and a half
hour sessions and will go through the Calgary‐Cambridge Model of communication skills with the individual, allowing
them to work through their communication skills in a structured way
Who Users: Specialist trained facilitators
Targets: All health and social care staff

COMMUNICATION SKILLS VIDEOS AND ANIMATIONS

Communication skills demonstration videos (available on App and webpage):

• 29 demonstration videos spread across 11 Modules

• Accompanying skills debriefs to explain the content and communication skills for the different scenarios
What A series of videos to demonstrate the key communication skills for healthcare conversations. Aims to show staff how to
apply a common framework (the Calgary-Cambridge Guide) for different types of conversation, by different healthcare
workers in a variety of settings (acute/maternity/community and so on).
Why To provide additional opportunities for staff/NHCP facilitators to review and consider communication skills discussed
during relevant workshops
Where Available on webpage and in NHCP App
When At any time, both proactively to support facilitators in their task and to provide staff with additional opportunities to review
and consider skills discussed during NHCP workshops
How • By discussing the relevant videos during training workshops
• By referring all healthcare workers with access to the internet to the website/NHCP App where the videos are featured.
This can be done by giving the web address/asking staff to download the App during training/workshops
Who Users: NHCP Facilitators
Targets: All health and social care staff

28 | National Healthcare Communication Programme - Guide to Implementation

 Staff piece to camera videos (available in App and webpage):

37 piece to camera videos spread across 11 Modules

What A series of short piece to camera (or talking head) videos. NHCP talking head videos are filmed with a variety of
healthcare workers speaking to the camera (learner) about particular communication skills and their experience of using
them in healthcare conversations. Talking head videos are designed to engender an emotional response in the learner.
This is important as an emotional response is memorable and encourages the learner to take the desired action from this
video (remember and use the skills in their conversations with the people who use our services).
Why To provide additional opportunities for staff/NHCP facilitators to review and consider communication skills discussed
during relevant workshops
Where Available on webpage and in NHCP App
When At any time, both proactively to support facilitators in their task and to provide staff with additional opportunities to review
and consider skills discussed during NHCP workshops
How • By discussing the relevant videos during training workshops
• By referring all healthcare workers with access to the internet to the website/NHCP App where the videos are featured.
This can be done by giving the web address/asking staff to download the App during training/workshops
Who Users: NHCP Facilitators
Targets: All health and social care staff

Patient experience videos (available in App and webpage):

20 patient experience videos spread across 11 Modules

What The series of animated videos capturing the voices of the people who use our services talking about their experience of
care. Each care experience story is selected to depict relevant communication skills for each training Module.
Why Stories of patient experiences can have great impact on healthcare workers. These videos provide additional
opportunities for staff/NHCP facilitators to understand the impact of particular communication skills on the care
experience (positive examples and opportunities for improvement).
Where Available on webpage and in NHCP App
When At any time, both proactively to support facilitators in their task and to provide staff with additional opportunities to review
and consider skills discussed during NHCP workshops
How By discussing the relevant videos during training workshops. By referring all healthcare workers with access to the
internet to the website/NHCP App where the videos are featured. This can be done by giving the web address/asking staff
to download the App during training/workshops.
Who Users: NHCP Facilitators
Targets: All health and social care staff

Communication skills module workshop training videos (used in workshops):

• 36 training videos spread across 11 Modules

• Accompanying skills debriefs to explain the content and communication skills for the different scenarios
What A series of videos to demonstrate the key communication for healthcare conversations for each Module. Aims to show
staff how to apply a common framework (the Calgary-Cambridge Guide) for different types of conversation, by different
healthcare workers in a variety of settings (Modules 1 to 4 contain videos for acute/maternity/paediatric settings).
Why To provide additional opportunities for staff/NHCP facilitators to review and consider communication skills discussed
during relevant workshops
Where • During Module workshops organised by the healthcare facility for all healthcare workers
• During Module workshops organised by the NHCP for Programme Facilitators
When At any time, both proactively to support facilitators in their task and to provide staff with additional opportunities to review
and consider skills discussed during NHCP workshops
How By discussing the relevant videos during training workshops
Who Users: NHCP Facilitators
Targets: All health and social care staff
National Healthcare Communication Programme - Guide to Implementation | 29
 Animated case studies

18 case studies (available on App and webpage)

What A series of animated case studies to demonstrate the key communication skills for healthcare conversations. Aims to
show staff how to apply a common framework (the Calgary-Cambridge Guide) for different types of conversation, by
different healthcare workers in a variety of settings (acute/maternity/community and so on).
Why To provide additional opportunities for staff/NHCP facilitators to review and consider communication skills discussed
during relevant workshops
Where Available at [Link], on webpage and in NHCP App
When At any time, both proactively to support facilitators in their task and to provide staff with additional opportunities to review
and consider skills discussed during NHCP workshops
How • By discussing the relevant case studies during training workshops
• By referring all healthcare workers with access to the internet to the website/NHCP App where the videos are featured.
This can be done by web address/asking staff to download the App during training/workshops
Who Users: NHCP Facilitators
Targets: All health and social care staff

PODCASTS

Podcasts: 4 podcasts (available on App and webpage)

What A series of podcasts featuring interviews and discussions with people across healthcare about their communication
experiences, talks by international leaders, and highlights from NHCP events
Why To provide additional opportunities for staff/NHCP facilitators to review and consider communication skills discussed
during relevant workshops
Where Available on webpage and on a number of podcast platforms
When At any time, both proactively to support facilitators in their task and to provide staff with additional opportunities to review
and consider skills discussed during NHCP workshops
How • By discussing the relevant podcasts during training workshops
• By referring all healthcare workers with access to the internet to the website/NHCP App where the podcasts are
featured. This can be done by web address/asking staff to download the App during training/workshops
Who Users: NHCP Facilitators
Targets: All health and social care staff

PUBLICATIONS

Key NHCP Publications

What A list of publications to direct interested parties to information and commentary regarding communication skills in
healthcare
Why To provide additional sources of information on communication skills that may be of interest or use to staff and NHCP
facilitators
Where During training sessions/within a healthcare facilities’ library
When At any time, both proactively to support facilitators in their task and to alert healthcare workers to the background
scientific information on communication skills as required when questions around the evidence base arise
How • By presenting the list of key publications during training workshops
• By referring all healthcare workers with access to the internet to the website/NHCP App where the publications are
featured. This can be done by web address/asking staff to download the App during training/workshops
Who Users: NHCP Facilitators
Targets: All health and social care staff interested in learning more about communication skills

30 | National Healthcare Communication Programme - Guide to Implementation

2.3. Evaluation and feedback 2.3.2. Tools for evaluation and feedback – tool
2.3.1. Definitions and overview descriptions
The range of tools available to support evaluation and
Evaluation and repeated monitoring of a range of indicators
feedback is represented in the following pages.
reflecting communication skills practices and the importance
of communication skills at the healthcare facility is a vital
Communication skills improvement at healthcare facility
component of the National Healthcare Communication
level requires at least annual cycles of evaluation in order
Programme. Evaluation should not be seen as a component
to achieve sustainability. Monitoring and evaluation with
separated from implementation, but rather as an essential
feedback therefore continues over a period of years, with
step in identifying areas deserving major efforts. Evaluation
the frequency determined by the NHCP Lead and key staff
also feeds crucial information into the quality improvement
involved in the quality improvement initiative.
plan for local implementation of the most appropriate
interventions. Continuous monitoring is very helpful in
Data entry and analysis are an important part of the overall
measuring the changes induced by implementation and
evaluation. If the facility does not have an epidemiology/
to ascertain whether the interventions have been effective
statistics unit where the data can be managed, it will be
in improving knowledge, competence and performance in
necessary to identify a person to whom this task can be
relation to communication among healthcare workers and in
allocated. The appointed person should be able to use basic
improving healthcare outcomes. Kirkpatrick’s (1967) hierarchy
computer programmes (e.g. Microsoft Office) and ideally have
of levels of evaluation provides a useful framework to
some basic statistical analysis/epidemiology skills.
consider how impact might be assessed (see below).

Feedback of the results of these investigations is an integral

part of evaluation and makes the evaluation meaningful. After
the baseline evaluation (see Step 2, Section 3.2.2., page 57)
Evaluation of results
Level 4 (transfer or impact on society) in a facility where the communication skills improvement
programme is being implemented for the first time, data
indicating gaps in good practices and knowledge, or a poor
perception of the problem, can be used to raise awareness
Evaluation of behaviour
Level 3 (transfer of learning to the workplace) and convince healthcare workers that there is a need for
improvement. On the other hand, after implementation (see
Step 4, Section 3.2.4., page 58), follow-up data is crucial in
Evaluation of learning order to demonstrate improvement and thereby sustain the
Level 2 2a. changes in attitude and self-efficacy motivation to use good communication skills and to make
2b. objective assessment of acquired learning
and skills continuous individual and healthcare facility efforts. This
data is also very useful for identifying areas where further
efforts are needed (e.g. certain professional categories that
Level 1 Evaluation of reaction demonstrated limited or no improvement in communication
(satisfaction or happiness)
skills competence).

CARE
The results of the surveys can be either disseminated in
written reports or other means of internal communication or
Conducting a baseline evaluation (see Step 2, Section 3.2.2.,
shown during educational and data feedback sessions.
page 57) is important across all levels of the communication
skills improvement continuum, but it is particularly crucial
Other means of feedback also exist, and each facility should
for a facility where a communication skills improvement
decide how best to communicate the results of the data
programme is being implemented for the first time. It is
analysis.
needed in order to collect information that realistically reflects
current communication skills knowledge, competence
A successful strategy would see improvements across all
and performance. Following the baseline evaluation, the
measured activities, behaviours and also healthcare worker
surveys carried out using the tools described below should
perception.
be repeated post implementation (see Step 4, Section
3.2.4, page 58) to follow-up progress and confirm that
implementation of the quality improvement initiatives translate
into improvements in communication skills and improvement
in the patient experience. Repeating the surveys will ensure
consistency, comparison of results and measurement of
progress.

National Healthcare Communication Programme - Guide to Implementation | 31

 Key success indicators
- improved knowledge of communication skills
- improved competence in communication skills
- improved performance in communication skills
- improved outcomes for patients (e.g. care experience)

TOOLS FOR EVALUATION AND FEEDBACK

EVALUATION LEVELS 1 AND 2

Pre and Post Training Evaluation

What Before and after (immediately and 2 months after) the training workshops all participants are asked to complete questionnaires
based on their use of core communication skills. The post-training questionnaire includes the same set of questions as the
pre-test questionnaire to measure the desired change in knowledge and skills relating to healthcare communication. In addition
the post-training questionnaire contains questions measuring the overall satisfaction with the training, also with the training
organisation and logistics.
Why To assess effectiveness of the communication skills training and benefits for participants. This information will be used to evaluate
and improve future content
Where • Before and after Module workshops organised by the healthcare facility for all healthcare workers
• Before and after Module workshops organised by the NHCP for Programme Facilitators
When • Pre-training evaluation (immediately preceding training)
• Post-training evaluation (Immediately after completion of training)
• Follow-up evaluation (2 months after training)
How Available digitally in the NHCP App
• What they found useful
• What learning they have used in practice
• Training impact on self
Who Users: NHCP Facilitators
Targets: All health and social care staff attending NHCP workshops

Evaluation by Facilitators
What The aim of this approach is to collect the reflections of the facilitators after each workshop. Both co-facilitators should jointly
complete one form per training, having discussed their opinions.
Why Evaluation by facilitators is aimed at providing input for possible further implementation. Having completed a training workshop,
the facilitators are in a position to identify strengths and areas for improvement which may impact on a wider roll-out of the
training workshop in their local context.
Where Immediately after Module workshops organised by the NHCP for Programme Facilitators. This evaluation form is meant to collect
the facilitators’ critical opinions based on their knowledge of the local context and the experience of the training that they have
conducted. The facilitators should not rely exclusively on the opinions given by the learners during the workshop. Rather they
should present their critical judgment taking into consideration the feedback from the learners.
When Recommend that both facilitators complete the evaluation together, as soon as feasible, preferably immediately after the training
workshop
How Available digitally in the NHCP App
Who Users: NHCP Facilitators

32 | National Healthcare Communication Programme - Guide to Implementation

Site visit
What The external evaluation (site visits) was included as a step in the training development when piloting the training modules in the 6
pilot acute hospital sites
Why An external evaluator present during the training session will provide and independent view on the training implementation. A form
to facilitate note-taking during such a site visit, as well as providing a structured feedback is provided (facilitator’s self-awareness
tool).
Where Individual sites where NHCP training is being delivered
When As required
How Available digitally [Link], on webpage and in the NHCP App
Who Users: NHCP Facilitators

OBSERVATION TOOLS

Observation Tool (Communication Competencies)

What A self-awareness tool outlining a set of communication skills competencies based on the stages of the Calgary-Cambridge Guide
Why • The tool can be used to asses current level of confidence and competence in relation to communication skills outlined in the
Calgary-Cambridge Guide
• The assessment is designed to help staff to identify the areas they might need to focus on to improve or maintain their
communication competency
Where Available at [Link], on webpage and in the NHCP App
When During regular training sessions for all healthcare workers and coaching sessions
How Describe and distribute the tool during training sessions
Who Users: NHCP Facilitators
Targets: All health and social care staff where the NHCP communication skills training programme

EVALUATION LEVEL 3

Follow-up Training Evaluation

What 2 months after the training workshops, all participants are asked to complete the follow-up questionnaire. The follow-up
questionnaire includes the same set of questions as the post-test questionnaire to measure the desired change in knowledge and
skills relating to communication skills.
Why To assess effectiveness of the communication skills training and benefits for participants. This information will be used to evaluate
and improve future content.
Where • After Module workshops organised by the healthcare facility for all healthcare workers
• After Module workshops organised by the NHCP for Programme Facilitators
When Follow-up evaluation (2 months after training)
How Available digitally in the NHCP App
• What they found useful
• What learning they have used in practice
• Training impact on self
Who Users: NHCP Facilitators
Targets: All health and social care staff attending NHCP workshops

National Healthcare Communication Programme - Guide to Implementation | 33

 EVALUATION LEVEL 4

Patient Impact
What • This level is associated with evaluating change in patient outcomes
• Sources of patient feedback including complaints and compliments may provide useful information as well as data from the
yearly
• National Care Experience Survey Programme
• Internationally, a brief point of care scale‘ collaboRATE’ (Elwyn et al., 2013) has been used to assess patient’s perceptions of
clinician’s communication directly after a consultation
Why Focusing on overall shifts in patient communication experience is preferable to trying to determine the specific impact of
communication skills training as this is difficult to isolate in practice. It will likely take time to demonstrate such change.
Where Healthcare facilities providing health and social care services
When Annual care experience surveys (frequency determined by the National Care Experience Programme)
How Analysis of patient feedback including complaints, surveys and compliments with a particular focus on feedback regarding our
communication skills
Who All staff with responsibility for analysing patient feedback

34 | National Healthcare Communication Programme - Guide to Implementation

2.4. Reminders in the workplace Other types of reminders are skills cards that individual
healthcare workers can carry in their pockets or view in the
2.4.1. Definitions and overview NHCP App, illustrations posted at the point of care and top
Reminders in the workplace are key tools to prompt and tips available digitally in the NHCP App.
remind health and social care workers about the importance
of communication skills and about the appropriate skills Reminders in the workplace should be a feature of the quality
and suggested phrases to use for particular healthcare improvement plans for facilities implementing communication
conversations. They are also means of informing the people skills improvement programmes at all levels. Reminders
who use our services of the standard of communication that should be used and displayed in all clinical settings of the
they should expect from their health and social care workers healthcare facility during the implementation phase and
with respect to communication skills. should be updated or refreshed regularly. Reminders can
be directed at health and social care workers, patients and
Posters are the most common type of reminder. The visitors.
implementation toolkit includes six standard posters to
visualise the 6 stages of the Calgary-Cambridge Guide and
the associated objectives and skills for each stage of the 2.4.2. Tools for Reminders in the Workplace –
healthcare conversation. tool descriptions
The range of tools that can be used as reminders in the
workplace is represented in the following pages.

TOOLS FOR REMINDERS IN THE WORKPLACE

Module 1: Making Connections

Building the Relationship

poster

What Poster visualising the four objectives and associated communication skills of the Building the relationship stage of the
Calgary-Cambridge Guide
Why To support healthcare workers to visualise and use the key communication skills for Building the relationship in
conversations with the people who use our services
Where To be displayed at the point of care and prominent areas throughout the healthcare facility
When To be displayed at all times and replaced/refreshed as necessary
How Display the posters at the point of care and refresh when necessary
Who Users: NHCP Lead or any person in charge of displaying the posters in all health and social care settings
Targets: All health and social care workers having direct contact with patients; the patients and their visitors to be aware of
excellence in communication skills practices

National Healthcare Communication Programme - Guide to Implementation | 35

 Communication skills
for Greetings and Introductions
Greetings and Introductions
illustration

Making conversations easier

What Illustration visualising a conversation where the healthcare worker is using good communication skills for greetings and
introductions
Why Illustrations assist healthcare workers in understanding concepts. This illustration translates the written word on
communication skills for greetings and introductions into a visual that is easy to understand and can be used as a
reminder of the skills for healthcare workers to use when greeting and introducing themselves to the people who use our
services.
Where To be displayed at the point of care and prominent areas throughout the healthcare facility
When To be displayed at all times and replaced/refreshed as necessary
How Display the illustration at the point of care and refresh when necessary
Who Users: NHCP Lead or any person in charge of displaying posters/illustrations in all health and social care settings.
Targets: All health and social care workers having direct contact with patients; the patients and their visitors to be aware of
best communication skills practices.

Building the relationship Listening Nonverbal

Skills cards for:
Communication
A leaflet for healthcare staff A leaflet for healthcare staff
A leaflet for healthcare staff
Building the Relationship
Listening
Non-verbal Communication

What 3 pocket at-a-glance reference cards summarising the key communication skills for building the relationship, nonverbal
communication and listening
Why Communication skills cards provide a concise way to organise information in a small space that is easy to use and read.
They serve as a cognitive aid and an effective way to support excellence in healthcare communication
Where To be distributed in healthcare settings where the NHCP communication skills improvement programme is being
implemented. Also available digitally to download to work computers/tablets and in the NHCP App.
When To be used during and after NHCP training workshops
How Distribute the skills cards during training workshops for healthcare workers to keep as a personal tool and reference
Who Users: NHCP Lead or facilitator(s) in charge of organising NHCP workshops in all health and social care settings
Targets: All health and social care workers having direct contact with people who use our services

Top tips for Building the relationship

(available on App)

What A brief summary and quick reminder of the communication skills and suggested phrases for building the relationship
Why To support healthcare workers to easily find specific information on communication skills for building the relationship
when they need it
Where Available digitally in the NHCP App
When To be used after NHCP training workshops
How Encourage healthcare workers to download the NHCP App to access the Top Tips for building the relationship
Who Targets: All health and social care workers having direct contact with people who use our services

36 | National Healthcare Communication Programme - Guide to Implementation

 Module 2: Core Consultation Skills

Calgary-Cambridge Guide
posters (5)

What 5 Posters visualising the objectives and associated communication skills for the Initiating the conversation, Gathering
information, Providing information, Closing the conversation and Providing structure stages of the Calgary-Cambridge
Guide
Why To support healthcare workers to visualise and use key communication skills for Initiating the conversation, Gathering
information, Providing information, Closing the conversation and Providing structure with the people who use our services
Where To be displayed at the point of care and prominent areas throughout the healthcare facility
When To be displayed at all times and replaced/refreshed as necessary
How Display the posters at the point of care and refresh when necessary
Who Users: NHCP Lead or any person in charge of displaying the posters in all health and social care settings
Targets: All health and social care workers having direct contact with patients; the patients and their visitors to be aware of
best communication skills practices

Communication skills
for Gathering Information

Gathering Information
illustration

Making conversations easier

Making conversations easier

What Illustration visualising a conversation where the healthcare worker is using good communication skills for gathering
information
Why Illustrations assist healthcare workers in understanding concepts. This illustration translates the written word on
communication skills for gathering information into a visual that is easy to understand and can be used as a reminder of
the skills for healthcare workers to use when gathering information during healthcare conversations with the people who
use our services.
Where To be displayed at the point of care and prominent areas throughout the healthcare facility
When To be displayed at all times and replaced/refreshed as necessary
How Display the illustration at the point of care and refresh when necessary
Who Users: NHCP Lead or any person in charge of displaying posters/illustrations in all health and social care settings
Targets: All health and social care workers having direct contact with patients; the patients and their visitors to be aware of
best communication skills practices

National Healthcare Communication Programme - Guide to Implementation | 37

 Initiating the Consultation

A leaflet for healthcare staff

Gathering Information

A leaflet for healthcare staff

Providing Information
and Planning
Closing the Consultation

A leaflet for healthcare staff

Providing Structure

A leaflet for healthcare staff

Skills cards for
Initiating the Conversation/Gathering Information/
A leaflet for healthcare staff

Providing Information/Closing the Conversation/

Providing Structure

What 5 pocket at-a-glance reference cards summarising the key communication skills for initiating the conversation, gathering
information, providing information, closing the conversation and providing structure
Why Communication skills cards provide a concise way to organise information in a small space that is easy to use and read.
They serve as a cognitive aid and an effective way to support healthcare workers to use good communication skills for
initiating the conversation, gathering information, providing information, closing the conversation and providing structure
in healthcare conversations with the people who use our services
Where To be distributed in healthcare settings where the NHCP communication skills improvement programme is being
implemented. Also available digitally to download to work computers/tablets and in the NHCP App
When To be used during and after NHCP training workshops
How • Distribute the skills cards during training workshops for healthcare workers to keep as a personal tool and reference
• Encourage healthcare workers to download to NHCP App and/or digitally download the skills cards to their computers
tablets
Who Users: NHCP Lead or facilitator(s) in charge of organising NHCP workshops in all health and social care settings
Targets: All health and social care workers having direct contact with people who use our services

Top Tips for

Initiating the conversation
Gathering information
Providing information and planning
Closing the Conversation
Providing Structure (available on App)

What A brief summary and quick reminder of the communication skills and suggested phrases for initiating the conversation,
gathering information, providing information/closing the conversation and providing structure
Why To support healthcare workers to easily find specific information on communication skills for initiating the conversation/
gathering information/providing information/closing the conversation and providing structure when they need it
Where Available digitally in the NHCP App
When To be used after NHCP training workshops
How Encourage healthcare workers to download the NHCP App to access the Top Tips for initiating the conversation/gathering
information/providing information/closing the conversation and providing structure
Who Targets: All health and social care workers having direct contact with people who use our services

38 | National Healthcare Communication Programme - Guide to Implementation

 Module 3: Challenging Consultations

Communication skills
for Delivering Bad News

Delivering Bad News

illustration

Making conversations easier

What Illustration visualising a conversation where the healthcare worker is using good communication skills for delivering bad
news
Why Illustrations assist healthcare workers in understanding concepts. This illustration translates the written word on
communication skills for delivering bad news into a visual that is easy to understand and can be used as a reminder of the
skills for healthcare workers to use to deliver bad news to the people who use our services
Where To be displayed at the point of care and prominent areas throughout the healthcare facility
When To be displayed at all times and replaced/refreshed as necessary
How Display the illustration at the point of care and refresh when necessary
Who Users: NHCP Lead or any person in charge of displaying posters/illustrations in all health and social care settings
Targets: All health and social care workers having direct contact with patients; the patients and their visitors to be aware
of best communication skills practices

Communication skills
for Disclosing Errors

Disclosing Errors
illustration

Making conversations easier

Making conversations easier

What Illustration visualising a conversation where the healthcare worker is using good communication skills for disclosing an
error
Why Illustrations assist healthcare workers in understanding concepts. This illustration translates the written word on
communication skills for disclosing an error into a visual that is easy to understand and can be used as a reminder of the
skills for healthcare workers to use to disclose errors to the people who use our services
Where To be displayed at the point of care and prominent areas throughout the healthcare facility
When To be displayed at all times and replaced/refreshed as necessary
How Display the illustration at the point of care and refresh when necessary
Who Users: NHCP Lead or any person in charge of displaying posters/illustrations in all health and social care settings
Targets: All health and social care workers having direct contact with patients; the patients and their visitors to be aware
of best communication skills practices

National Healthcare Communication Programme - Guide to Implementation | 39

 Communication skills
for Responding to Strong Emotions

Responding to Strong Emotions

illustration

Making conversations easier

What Illustration visualising a conversation where the healthcare worker is using good communication skills for responding to
strong emotions
Why Illustrations assist healthcare workers in understanding concepts. This illustration translates the written word on
communication skills for responding to strong emotions into a visual that is easy to understand and can be used as a
reminder of the skills for healthcare workers to use to respond to strong emotions when talking to the people who use our
services.
Where To be displayed at the point of care and prominent areas throughout the healthcare facility
When To be displayed at all times and replaced/refreshed as necessary
How Display the illustration at the point of care and refresh when necessary
Who Users: NHCP Lead or any person in charge of displaying posters/illustrations in all health and social care settings
Targets: All health and social care workers having direct contact with patients; the patients and their visitors to be aware
of best communication skills practices

Six basic emotions

Paul Eckman, American Psychologist

Emotions
illustration

Making conversations easier

What Poster visualising the six basic emotions (Paul Eckman, 1972)
Why To support healthcare workers to read and respond to emotional expressions when having conversations with the people
who use our services
Where To be displayed at the point of care and prominent areas throughout the healthcare facility
When To be displayed at all times and replaced/refreshed as necessary
How Display the posters at the point of care and refresh when necessary
Who Users: NHCP Lead or any person in charge of displaying the posters in all health and social care settings
Targets: All health and social care workers having direct contact with patients; the patients and their visitors to be aware
of best communication skills practices

40 | National Healthcare Communication Programme - Guide to Implementation

 Delivering Bad News Disclosing Errors Responding to
Skills cards for
strong emotions
A leaflet for healthcare staff A leaflet for healthcare staff
A leaflet for healthcare staff
Delivering Bad News
Disclosing Errors
Responding to strong emotions

What 3 pocket at-a-glance reference cards summarising the key communication skills for responding to strong emotions/
delivering bad news and disclosing errors
Why Communication skills cards provide a concise way to organise information in a small space that is easy to use and read.
They serve as a cognitive aid and an effective way to support healthcare workers to use good communication skills for
responding to strong emotions/delivering bad news and disclosing errors in healthcare conversations with the people who
use our services.
Where To be distributed in healthcare settings where the NHCP communication skills improvement programme is being
implemented. Also available digitally to download to work computers/tablets and in the NHCP App.
When To be used during and after NHCP training workshops
How Distribute the skills cards during training workshops for healthcare workers to keep as a personal tool and reference.
Encourage healthcare workers to download to NHCP App and/or digitally download the skills cards to their computers
tablets.
Who Users: NHCP Lead or facilitator(s) in charge of organising NHCP workshops in all health and social care settings
Targets: All health and social care workers having direct contact with people who use our services having these types of
conversation.

Top tips for

Responding to strong emotions
Delivering bad news
Disclosing errors (available on App)

What A brief summary and quick reminder of the communication skills and suggested phrases for responding to strong
emotions/delivering bad news and disclosing errors
Why To support healthcare workers to easily find specific information on communication skills for responding to strong
emotions/delivering bad news and disclosing errors when they need it
Where Available digitally in the NHCP App
When To be used after NHCP training workshops
How Encourage healthcare workers to download the NHCP App to access the Top Tips for responding to strong emotions
delivering bad news and disclosing errors
Who Targets: All health and social care workers having direct contact with people who use our services

National Healthcare Communication Programme - Guide to Implementation | 41

 Module 4: Communicating with each other and promoting teamwork

Communication skills
for Clinical handover with ISBAR3

ISBAR3
illustration

Making conversations easier

What Illustration visualising a conversation where the healthcare worker is using good communication skills for clinical handover
with ISBAR3
Why Illustrations assist healthcare workers in understanding concepts. This illustration translates the written word on
communication skills for clinical handover with ISBAR3 into a visual that is easy to understand and can be used as a
reminder of the skills and structure for healthcare workers to use during clinical handover.
Where To be displayed at the point of care and prominent areas throughout the healthcare facility
When To be displayed at all times and replaced/refreshed as necessary
How Display the illustration at the point of care and refresh when necessary
Who Users: NHCP Lead or any person in charge of displaying posters/illustrations in all health and social care settings
Targets: All health and social care workers having direct contact with patients; the patients and their visitors to be aware
of best communication skills practices

Communication skills
Situational Awareness

Situational Awareness
Knowing what is going on around you

illustration

Making conversations easier

What Illustration visualising the elements of situational awareness

Why Illustrations assist healthcare workers in understanding concepts. This illustration translates the written word on the
elements of situational awareness into a visual that is easy to understand and can be used as a reminder of the elements
of situational awareness to assist healthcare workers in gaining and maintaining an understanding of what is going on
around them.
Where To be displayed at the point of care and prominent areas throughout the healthcare facility
When To be displayed at all times and replaced/refreshed as necessary
How Display the illustration at the point of care and refresh when necessary
Who Users: NHCP Lead or any person in charge of displaying posters/illustrations in all health and social care settings
Targets: All health and social care workers having direct contact with patients; the patients and their visitors to be aware
of best communication skills practices

42 | National Healthcare Communication Programme - Guide to Implementation

 Skills cards for
Team-based working
Team-based working Safer care with ISBAR3

A leaflet for healthcare staff Handovers occur at multiple points within

the healthcare delivery system. Preparation

Safer care with ISBAR3

is critical to effective handover.

I Identification

S Situation
LEADERSHIP

B Background

A
EFFECTIVE
COMMUNICATION Assessment
COMMON PURPOSE
Recommendation/
- SHARED GOALS
- CLEAR ROLES R Read back/Risk
SAFETY & TRUST

Your goal – and your responsibility

– is to be prepared

What 2 pocket at-a-glance reference cards summarising the key communication skills for team-based working and
clinical handover with ISBAR3
Why Communication skills cards provide a concise way to organise information in a small space that is easy to
use and read. They serve as a cognitive aid and an effective way to support healthcare workers to use good
communication skills for team-based working and clinical handover with ISBAR3
Where To be distributed in healthcare settings where the NHCP communication skills improvement programme is
being
implemented. Also available digitally to download to work computers/tablets and in the NHCP App
When To be used during and after NHCP training workshops
How • Distribute the skills cards during training workshops for healthcare workers to keep as a personal tool and
reference
• Encourage healthcare workers to download to NHCP App and/or digitally download the skills cards to their
computers
tablets
Who Users: NHCP Lead or facilitator(s) in charge of organising NHCP workshops in all health and social care
settings
Targets: All health and social care workers having direct contact with people who use our services

Top tips for

Conversations with colleagues (available on App)

What A brief summary and quick reminder of the communication skills and suggested phrases for team-based working and
clinical handover with ISBAR3
Why To support healthcare workers to easily find specific information on communication skills for team-based working and
clinical handover with ISBAR3 when they need it
Where Available digitally in the NHCP App
When To be used after NHCP training workshops
How Encourage healthcare workers to download the NHCP App to access the Top Tips for team-based working and clinical
handover with ISBAR3
Who Targets: All health and social care workers having direct contact with people who use our services

National Healthcare Communication Programme - Guide to Implementation | 43

 Module 5: Demonstrating Empathy

Communication skills
for Demonstrating Empathy

Demonstrating Empathy
illustration

Making conversations easier

What Illustration visualising a conversation where the healthcare worker is using good communication skills for demonstrating
empathy
Why Illustrations assist healthcare workers in understanding concepts. This illustration translates the written word on
communication skills for demonstrating empathy into a visual that is easy to understand and can be used as a reminder of
the skills for healthcare workers to use to demonstrate empathy when talking to the people who use our services.
Where To be displayed at the point of care and prominent areas throughout the healthcare facility
When To be displayed at all times and replaced/refreshed as necessary
How Display the illustration at the point of care and refresh when necessary
Who Users: NHCP Lead or any person in charge of displaying posters/illustrations in all health and social care settings
Targets: All health and social care workers having direct contact with patients; the patients and their visitors to be aware
of best communication skills practices

Demonstrating empathy
Skills card for
A leaflet for healthcare staff

Demonstrating empathy

What A pocket at-a-glance reference card summarising the key communication skills for demonstrating empathy
Why Communication skills cards provide a concise way to organise information in a small space that is easy to use and read.
They serve as a cognitive aid and an effective way to support healthcare workers to use good communication skills for
demonstrating empathy in healthcare conversations with the people who use our services.
Where To be distributed in healthcare settings where the NHCP communication skills improvement programme is being
implemented. Also available digitally to download to work computers/tablets and in the NHCP App.
When To be used during and after NHCP training workshops
How • Distribute the skills cards during training workshops for healthcare workers to keep as a personal tool and reference
• Encourage healthcare workers to download to NHCP App and/or digitally download the skills cards to their computers
tablets
Who Users: NHCP Lead or facilitator(s) in charge of organising NHCP workshops in all health and social care settings
Targets: All health and social care workers having direct contact with people who use our services

44 | National Healthcare Communication Programme - Guide to Implementation

 Module 6: Shared Decision Making

Shared Decision Making

Skills card for
Shared Decision Making
A leaflet for healthcare staff

What A pocket at-a-glance reference card summarising the key communication skills for shared decision making
Why Communication skills cards provide a concise way to organise information in a small space that is easy to use and read.
They serve as a cognitive aid and an effective way to support healthcare workers to use good communication skills for
shared decision making in healthcare conversations with the people who use our services.
Where To be distributed in healthcare settings where the NHCP communication skills improvement programme is being
implemented. Also available digitally to download to healthcare workers computers/tablets and in the NHCP App.
When To be used during and after NHCP training workshops
How Distribute the skills cards during training workshops for healthcare workers to keep as a personal tool and reference.
Encourage healthcare workers to download to NHCP App and/or digitally download the skills cards to their computers
tablets.
Who Users: NHCP Lead or facilitator(s) in charge of organising NHCP workshops in all health and social care settings
Targets: All health and social care workers having direct contact with people who use our services having these types of
conversations

Patient leaflet | Shared decision making

Ask 3 questions (for patients)
Ask 3 questions

Normally there are choices to make about your

healthcare. What you choose to do should
depend on what is important to YOU.

Ask your healthcare practitioner these three

questions:

1 What are my options?

2 What are the pros and cons of each

option for me?

3 How do I get support to help me make

a decision that is right for me?

What A pocket at-a-glance reference card to prompt people (patients) to ask questions about decisions relating to their care
Why Reference cards serve as a cognitive aid and an effective way to support the people who use our services to engage in
shared decision making with healthcare workers
Where To be distributed in healthcare settings where the NHCP communication skills improvement programme is being
implemented. Also available digitally to download to the phones of the people who use our services.
When To be used by people (patients) as necessary during their healthcare conversations with staff
How • Display the reference card at the point of care and refresh when necessary
• Encourage people who use our services to digitally download the reference card to their phone
Who Users: NHCP Lead or facilitator(s) in charge of implementing the NHCP communication skills improvement programme in
all health and social care settings
Targets: People who use our services

National Healthcare Communication Programme - Guide to Implementation | 45

 Module 7: Motivational Interviewing

Stages of change

Stages of change
Conversations about healthcare behaviours
MOTIVATIONAL INTERVIEWING

This is a model of the stages of change. It is important to note that people

typically move back and forth between the stages and move through the
stages at different rates.
The primary task at this stage is:

poster
Pre-contemplation
No recognition of need for ...raising awareness.
or interest in change

Contemplation ...resolving ambivalence/helping to

Thinking about changing choose change.

...to assist the person to identify

Preparation appropriate change strategies and
Planning for change provide support and encouragement.

Action
...to support the person to implement
change strategies & learn to eliminate
Adopting new habits
potential relapses.

Maintenance ...to support and develop new skills for

maintaining recovery.
Ongoing practice of new behaviour

...to help the person to cope with the

consequences and determine what to
Relapse do next.

Prochaska & DiClemente, 1982

Making conversations easier

What Poster visualising the Stages of Change (Prochaska & DiClemente, 1982)
Why To support healthcare workers to visualise and use the stages of change model when having conversations about
changing healthcare behaviours with the people who use our services
Where To be displayed at the point of care and prominent areas throughout the healthcare facility
When To be displayed at all times and replaced/refreshed as necessary
How Display the posters at the point of care and refresh when necessary
Who Users: NHCP Lead or any person in charge of displaying the posters in all health and social care settings
Targets: All health and social care workers having direct contact with patients; the patients and their visitors to be aware of
best communication skills practices

Readiness to change

Readiness to change
Conversations about healthcare behaviours
MOTIVATIONAL INTERVIEWING

The simplest way to assess the patient’s readiness to change

is to use a Readiness Ruler or a 0 to 10 scale, on which the
lower numbers represent no thoughts about change and the
higher numbers represent specific plans or attempts to change.

How important
is it for you to
change…? How confident
are you…?
poster
Importance and confidence ruler

0 1 2 3 4 5 6 7 8 9 10
Not at all Extremely

Making conversations easier

What Poster visualising the Importance and confidence ruler

Why To support healthcare workers to visualise and use the importance and confidence ruler when having conversations about
changing healthcare behaviours with the people who use our services
Where To be displayed at the point of care and prominent areas throughout the healthcare facility
When To be displayed at all times and replaced/refreshed as necessary
How Display the posters at the point of care and refresh when necessary
Who Users: NHCP Lead or any person in charge of displaying the posters in all health and social care settings
Targets: All health and social care workers having direct contact with patients; the patients and their visitors to be aware of
best communication skills practices

Conversations about change

An Introduction to
Motivational Interviewing Skills card for
Conversations about change
A leaflet for healthcare staff

An Introduction to Motivational Interviewing

What A pocket at-a-glance reference card summarising the key communication skills for motivational interviewing
Why Communication skills cards provide a concise way to organise information in a small space that is easy to use and read.
They serve as a cognitive aid and an effective way to support healthcare workers to use good communication skills for
motivational interviewing in healthcare conversations about changing healthcare behaviours.
Where To be distributed in healthcare settings where the NHCP communication skills improvement programme is being
implemented. Also available digitally to download to work computers/tablets and in the NHCP App
When To be used during and after NHCP training workshops
How • Distribute the skills cards during training workshops for healthcare workers to keep as a personal tool and reference.
• Encourage healthcare workers to download to NHCP App and/or digitally download the skills cards to their computers
tablets
Who Users: NHCP Lead or facilitator(s) in charge of organising NHCP workshops in all health and social care settings
Targets: All health and social care workers having direct contact with people who use our services having conversations
about changing healthcare behaviours

46 | National Healthcare Communication Programme - Guide to Implementation

 Top tips for
Conversations about change (available on App)

What A brief summary and quick reminder of the communication skills and suggested phrases for motivational interviewing
Why To support healthcare workers to easily find specific information on communication skills for motivational interviewing
when they need it
Where Available digitally in the NHCP App
When To be used after NHCP training workshops
How Encourage healthcare workers to download the NHCP App to access the Top Tips for motivational interviewing
Who Targets: All health and social care workers having direct contact with people who use our services

Module 8: Emergency Situations

Emergency Situations

A leaflet for healthcare staff

Skills card for
Emergency Situations

What A pocket at-a-glance reference card summarising the key communication skills for emergency situations
Why Communication skills cards provide a concise way to organise information in a small space that is easy to use and read.
They serve as a cognitive aid and an effective way to support healthcare workers to use good communication skills for
emergency situations in healthcare.
Where To be distributed in healthcare settings where the NHCP communication skills improvement programme is being
implemented. Also available digitally to download to work computers/tablets and in the NHCP App.
When To be used during and after NHCP training workshops
How • Distribute the skills cards during training workshops for healthcare workers to keep as a personal tool and reference
• Encourage healthcare workers to download to NHCP App and/or digitally download the skills cards to their computers
tablets
Who Users: NHCP Lead or facilitator(s) in charge of organising NHCP workshops in all health and social care settings
Targets: All health and social care workers involved in emergency situations

Top tips for

Emergency situations (available on App)

What A brief summary and quick reminder of the communication skills and suggested phrases for emergency situations
Why To support healthcare workers to easily find specific information on communication skills for emergency situations when
they need it
Where Available digitally in the NHCP App
When To be used after NHCP training workshops
How Encourage healthcare workers to download the NHCP App to access the Top Tips for emergency situations
Who Targets: All health and social care workers having direct contact with people who use our services

National Healthcare Communication Programme - Guide to Implementation | 47

 Module 9: Responding to Patient Feedback

Responding to
Patient Feedback
(including complaints)
Skills card for
Responding to Patient Feedback (including complaints)
A leaflet for healthcare staff

What A pocket at-a-glance reference card summarising the key communication skills for responding to patient feedback
Why Communication skills cards provide a concise way to organise information in a small space that is easy to use and read.
They serve as a cognitive aid and an effective way to support healthcare workers to use good communication skills for
responding to feedback from the people who use our services.
Where To be distributed in healthcare settings where the NHCP communication skills improvement programme is being
implemented. Also available digitally to download to work computers/tablets and in the NHCP App
When To be used during and after NHCP training workshops
How • Distribute the skills cards during training workshops for healthcare workers to keep as a personal tool and reference
• Encourage healthcare workers to download to NHCP App and/or digitally download the skills cards to their computers
tablets
Who Users: NHCP Lead or facilitator(s) in charge of organising NHCP workshops in all health and social care settings
Targets: All health and social care workers having direct contact with people who use our services having these types of
conversations

Top tips for

Responding to Patient Feedback (available on App)

What A brief summary and quick reminder of the communication skills and suggested phrases for responding to patient
feedback
Why To support healthcare workers to easily find specific information on communication skills for responding to patient
feedback when they need it
Where Available digitally in the NHCP App
When To be used after NHCP training workshops
How Encourage healthcare workers to download the NHCP App to access the Top Tips for responding to patient feedback
Who Targets: All health and social care workers having direct contact with people who use our services

48 | National Healthcare Communication Programme - Guide to Implementation

 Responding to
Patient Feedback
(including complaints)

Responding to Patient Feedback

INITIATE THE CONVERSATION GATHER PROVIDE CLOSE THE
(Prepare with intention) INFORMATION INFORMATION CONVERSATION
(What is important (Working together) (Final check and
to the patient?) next steps)

YOURSELF GREETINGS LISTEN CORRECT NEXT STEPS

How do I feel? Eye contact, leaning, AMOUNT & TYPE Actions, support,
Plan & practice Hello my name is... nodding, facing the Assess the patient's follow-up
person... starting point

poster
ENVIRONMENT SAFETY NET
“Just so I know where
Therapeutic to begin, could you tell Be specific,
space, private NONVERBAL me what you know contact details
Facial, body, vocal, already about...?”
space, time... Chunk & check If you are worried
about anything in
QUESTIONS the meantime...
Open, screening AID RECALL &
UNDERSTANDING
You said you were Use easy to
worried, can you tell SUMMARISE
understand language
INFORMATION EMPATHY me more about that?
Slow down
Shared
Gather information Organise & signpost understanding
I see... it sounds like...
and read
“There are three So, just to review,
SILENCE important things that I we talked about
Shhh... pause would like to discuss...
CLEAR, SHARED First...”
AGENDA SUMMARISE
Tell me... INCORPORATE CHECK
Facts & feelings
PERSPECTIVE
How are you feeling?
What is their I’m going to summarise Relate explanation
(thoughts, feelings,
perspective? so we’re all on the to patient concerns
expectations) same page, please tell
“You said you were
me if I've got it right... Something else?
annoyed that...”
Respond to
nonverbal cues

SHARED DECISION MAKING

Share your thinking
“I would like us to make this decision together”

Explore options
“I think there are 2 options we could discuss”

Negotiate the plan

“If I understand you correctly, you are inclined
to choose...”

Check with the patient

“Can I just check now what you think of the plan?”

Find out more: [Link]/nhcprogramme

What Poster visualising the objectives and associated communication skills of the stages of the Calgary-Cambridge Guide for
conversations about responding to patient feedback
Why To support healthcare workers to visualise and use the key communication skills for responding to feedback from the
people who use our services
Where To be displayed at the point of care and prominent areas throughout the healthcare facility
When To be displayed at all times and replaced/refreshed as necessary
How Display the posters at the point of care and refresh when necessary
Who Users: NHCP Lead or any person in charge of displaying the posters in all health and social care settings
Targets: All health and social care workers having direct contact with patients; the patients and their visitors to be aware
of best communication skills practices

Module 10: End-of-Life Conversations

Communication Guide for:

Communication guide
for end-of-life conversations

End-of-Life Conversations
This guide is intended to help and support staff through difficult
conversations with patients and their loved ones.

It includes guidance on particularly sensitive conversations, such as giving

unwelcome diagnostic news of a life-limiting condition or telling a someone
that their loved one has died. Time can sometimes be relatively short for
these conversations so it is important that staff use a clear set of skills to both
gather and provide information efficiently, effectively, and compassionately.

Making conversations easier

[Link]/nhcprogramme @NHCProgramme

What The focus of this Guide is to review core communication skills using the Calgary-Cambridge Guide, focusing especially on
skills for sensitive and difficult conversations
Why An additional source of information on communication skills for end-of-life conversations that may be of interest or use to
healthcare workers and NHCP facilitators
Where During training sessions/within a healthcare facilities’ library
When At any time, both proactively to support facilitators in their task and to alert healthcare workers to the background
scientific information on communication skills as required when questions around the evidence base arise
How • By presenting the list of key publications during training workshops
• By referring all healthcare workers with access to the internet to the website where the Key Publication’s list is featured.
This can be done by web address/asking staff to download the App during training/workshops
Who Users: NHCP Facilitators
Targets: All health and social care workers who has personal contact with people who are dying (whether suddenly or
over a long period) and who has personal contact with dying people’s close ones (partners, relatives). The large majority
of people who work in health (and social care) services will have contact with patients and family members who are in
this situation. Workers attending this module are encouraged to complete Modules 1 and 2 in advance of taking this
workshop.

National Healthcare Communication Programme - Guide to Implementation | 49

 End-of-Life Conversations
DIAGNOSIS OF A LIFE-LIMITING ILLNESS
End-of-Life Conversations
WHEN A PERSON IS DYING IMMINENTLY
End-of-Life Conversations
GIVING SAD NEWS OF DETERIORATION
OR DEATH OVER THE PHONE
Skills card for: End-of-Life Conversations
Diagnosis of a life limiting illness
A leaflet for healthcare staff A leaflet for healthcare staff
A leaflet for healthcare staff

Conversations when a person is dying imminently

Giving sad news of a death over the phone

What 3 pocket at-a-glance reference cards summarising the key communication skills for diagnosis of a life-limiting illness/
conversations when a person is dying imminently/giving sad news of a death on the phone
Why Communication skills cards provide a concise way to organise information in a small space that is easy to use and read.
They serve as a cognitive aid and an effective way to support healthcare workers to use good communication skills for
diagnosis of a life-limiting illness/conversations when a person is dying imminently/giving sad news of a death on the
phone.
Where To be distributed in healthcare settings where the NHCP communication skills improvement programme is being
implemented. Also available digitally to download to work computers/tablets and in the NHCP App.
When To be used during and after NHCP training workshops
How • Distribute the skills cards during training workshops for healthcare workers to keep as a personal tool and reference
• Encourage healthcare workers to download to NHCP App and/or digitally download the skills cards to their
computers tablets
Who Users: NHCP Lead or facilitator(s) in charge of organising NHCP workshops in all health and social care settings
Targets: All health and social care workers having direct contact with people who use our services having these types of
conversations

Top tips for End-of-Life Conversations (available on App)

What A brief summary and quick reminder of the communication skills and suggested phrases for diagnosis of a life-limiting
illness/conversations when a person is dying imminently/giving sad news of a death on the phone
Why To support healthcare workers to easily find specific information on communication skills for diagnosis of a life-limiting
illness/conversations when a person is dying imminently/giving sad news of a death on the phone when they need it
Where Available digitally in the NHCP App
When To be used after NHCP training workshops
How Encourage healthcare workers to download the NHCP App to access the Top Tips for diagnosis of a life-limiting illness
conversations when a person is dying imminently/giving sad news of a death on the phone
Who Targets: All health and social care workers having direct contact with people who use our services

50 | National Healthcare Communication Programme - Guide to Implementation

 Module 11: Communications Skills for Healthcare Leaders

Communication Skills
Skills card for:
Communications Skills for Healthcare Leaders
for Healthcare Leaders

A leaflet for healthcare staff

MODULE: FACILITATOR GUIDE

Communication Skills
for Healthcare Leaders

What A pocket at-a-glance reference card summarising the key communication skills for the four domains of emotional
intelligence (self-awareness, self-management, social-awareness and relationship management)
Why Communication skills cards provide a concise way to organise information in a small space that is easy to use and read.
They serve as a cognitive aid and an effective way to support leaders to use good communication skills for conversations
with the people that they work with.
Where To be distributed in healthcare settings where the NHCP communication skills improvement programme is being
implemented. Also available digitally to download to work computers/tablets and in the NHCP App.
When To be used during and after NHCP training workshops
How • Distribute the skills cards during training workshops for healthcare leaders to keep as a personal tool and reference
• Encourage healthcare workers to download to NHCP App and/or digitally download the skills cards to their computers
tablets
Who Users: NHCP Lead or facilitator(s) in charge of organising NHCP workshops in all health and social care settings
Targets: All health and social care workers in leadership positions

Communication skills for

healthcare leaders

5 step guide to managing conflict

5 STEP GUIDE TO MANAGING CONFLICT

PREPARE INITATE GATHER PROVIDE CLOSE THE

(Prepare with (Getting off INFORMATION INFORMATION CONVERSATION
intention) to a good start) (What is important (Working together) (Final check and
to the person?) next steps)

YOURSELF GREETINGS LISTEN RIGHT AMOUNT NEXT STEPS

How do I Eye contact, & TYPE Actions, support,
Hello follow-up
feel? Plan & leaning, Assess the person's

poster
practice nodding, starting point
facing the person... SUMMARISE
Just so I know where to Shared
ENVIRONMENT NON-VERBAL
QUESTIONS begin, could you tell me understanding
Quiet, private space SKILLS what you know already
Open about...?
Facial expression, So, just to review,
body posture, vocal we talked about
What would help
tone, time you right now? Chunk & check
AID RECALL & CHECK
Screening UNDERSTANDING
How are you feeling?
Use easy to
You said you were understand language
INFORMATION EMPATHY worried, can you tell
Slow down
me more about that?
Gather information Organise & signpost Something else?
I see... it sounds like...
and read
There are three important
Clarifying things that I would like to
discuss with you. First... AFTER
CLEAR, SHARED How would you like Document
things to be different?
AGENDA Reflect What?
INCORPORATE Debrief So what?
Tell me... PERSPECTIVE Action Now what?
SILENCE Relate explanation
CONSIDER Shhh... pause to the person’s concerns
What is their (thoughts, feelings,
perspective? expectations) Respond to
You said you were annoyed that..
SUMMARISE
non-verbal cues
Facts & feelings
I can’t stand it when…
You feel uncomfortable SHARED DECISION MAKING
with… So, just to recap, we
talked about… Share your thinking I wonder if it might
be helpful to...

Structures for managing conflict Explore options

The Harvard Method REFRAME I think there are a number of options

Treat people Focus on

Negotiate the plan
and problems interests
separately not positions

Generate as
many solutions
Choose the best/most
reasonable solution based
If I understand you correctly, you are inclined to...
as possible on available evidence

Check with the person

I have shared a lot of information with you

Find out more: — let’s pause — I’d like to hear what questions you have
[Link]/nhcprogramme

What Poster visualising the 5 steps and associated communication skills of the stages of the Calgary-Cambridge Guide for
conversations relating to managing conflict. The guide is based on the Harvard Method for conflict negotiation
Why To support leaders to visualise and use the key communication skills for managing conflict between healthcare staff
Where To be displayed at the point of care and prominent areas throughout the healthcare facility
When To be displayed at all times and replaced/refreshed as necessary
How Display the posters at the point of care and refresh when necessary
Who Users: NHCP Lead or any person in charge of displaying the posters in all health and social care settings
Targets: All health and social care workers in leadership positions

National Healthcare Communication Programme - Guide to Implementation | 51

 Communication skills for
healthcare leaders
GIVING FEEDBACK

Giving Feedback
PREPARE INITATE PROVIDE GATHER CLOSE THE
(Prepare with (Getting off INFORMATION INFORMATION CONVERSATION
intention) to a good start) (Working together) (What is important (Final check and
to the person?) next steps)

YOURSELF GREETINGS USE A LISTEN NEXT STEPS

How do I STRUCTURE Eye contact, Actions, support,
Hello leaning, follow-up
feel? Plan & Situation-Behavior
nodding,
practice -Impact (SBI) facing the SUMMARISE
Situation person... Shared understanding

poster
ENVIRONMENT NON-VERBAL
Quiet, private space SKILLS Joe, at Monday’s
QUESTIONS So, just to review,
Facial expression, team meeting
Open we talked about
body posture, vocal
tone, time Tell me what
Behaviour was going on?
CHECK
You ensured that
the meeting started Screening
How are you feeling?
on-time and that
everyone had the
correct information What would help
INFORMATION EMPATHY in advance you right now?
Gather information Something else?
and read I see... it sounds like...
Impact
REFLECTIVE
AFTER
We were able to LISTENING
CLEAR, SHARED make informed Document
AGENDA decisions. Thanks
So you felt that the
Reflect
for your hard work. Debrief
room was tense and
Could we talk you were being Action
about that for a strong about it and
few minutes?
CONSIDER DESC not shouting
What? So what?
What is their Describe Now what?
perspective? (thoughts, feelings,
expectations) When you start
shouting, I want to REFRAME &
end the conversation CLARIFY
Structures for giving feedback immediately
So you’re saying Find out more:
you’re concerned
Express concerns about patient safety
[Link]/
Assertive (Imminent risk) on the ward. What nhcprogramme
I feel attacked & upset concerns you most?
C – I am Concerned Two challenge rule
U – I am Uncomfortable First challenge is in the form of a question:
“Do you need a pair of gloves?”
S – This is a Safety issue
S – STOP Second challenge:
Suggest
“Please stop and I will get
I am concerned you some gloves”
If you see something,
say something and that
way we’ll do what’s I need you to... Consequences
Is that something
best for the patient.

Assertively voice your

concern at least two we could work on? Speaking to each
times to ensure it has other with respect
been heard helps us all to work
together in a more
Assertive (Non-imminent risk) collaborative way

D – Describe the specific situation Situation-Behavior-Impact (SBI) Coffee Cup Conversation

or behavior Is it
Step 1: Describe the behaviour
E – Express what your concerns are alright if
Step 2: State your concerns I...
S – Suggest other alternatives
Step 3: Invite a response
C – Consequences should be stated What
Step 4: Conclude I saw
I don’t feel that this is safe
I can see was...
this has
upset you...

I noticed
that...

What Poster visualising the objectives and associated communication skills of the stages of the Calgary-Cambridge Guide as
applied to conversations relating to giving feedback to staff. Structures include CUSS, DESC-it, SBI and the coffee-cup
conversation (Vanderbilt Intervention)
Why To support healthcare leaders to visualise and use the key communication skills for giving feedback to healthcare staff
Where To be displayed at the point of care and prominent areas throughout the healthcare facility
When To be displayed at all times and replaced/refreshed as necessary
How Display the posters at the point of care and refresh when necessary
Who Users: NHCP Lead or any person in charge of displaying the posters in all health and social care settings
Targets: All health and social care leaders

Communication skills
for healthcare leaders
INFLUENCE AND MOTIVATION

Influence and motivation

ENGAGE FOCUS EVOKE PLAN
(I am here to help) (What will we work on?) (Why work on this?) (How to change?)

PREPARATION CLEAR, SHARED AGENDA QUESTIONS RIGHT AMOUNT & TYPE

Prepare yourself It sounds like you want to talk Ask permission
So what strategies have
Prepare the environment about....
you found so far that Can I share some
Prepare your information Will we talk about that for seem to work for you? feedback with you?
a few minutes?
GREETINGS
If you made this change, If you’re interested, I have a few
how might it benefit you? ideas about time management
Hello
GROW questions (GOAL) that you might find helpful?

What specifically do you

want to achieve? How will Neutral question GROW questions (OPTIONS)

poster
you measure it?
NON-VERBALS What thoughts are What else could you do?
you having now?

ACTIVE LISTENING Check starting point

Eye contact, leaning, nodding, GROW questions (REALITY) Tell me a little about
INVOLVING THE PERSON facing the person... what you know about...?
What have you done
Share your thinking about it so far?
OPEN QUESTIONS
I wanted to ask you a AID RECALL & UNDERSTANDING
few questions to make Tell me what you have Chunk and Check - Teach back
sure that I understand... been doing to help What resources do you have?
manage your workload? I’ve given you a lot of information.
It would be helpful to me to hear
That’s a good your understanding about what
SCREENING strategy. What we have discussed.
DEMONSTRATING What would help you right now? else? Tell me
EMPATHY more.
Explicitly refer to the emotions
the person may be feeling by INCORPORATE THE PERSON’S
naming the emotion. PERSPECTIVE
REFLECTIVE LISTENING REFLECTIVE LISTENING GROW questions (WILL)
Selectively reflect change talk
I can see that you are worried... I’m sick and tired of everyone To what extent does this
You sound upset. You’re wondering if... meet your objectives?
being on my case

You’re sick and Reframe and clarify

tired and ready SHARED DECISION MAKING
ESTABLISH INITIAL for a change So you’re saying you’re concerned
RAPPORT about... What concerns you most? Which options do you prefer?
Use the person’s name
I believe in your potential &
I wonder... You are not sure I am confident that if you
That sounds like it was very Summarise
and you want to Affirm decide to make a change,
tough for you Evelyn you’ll find a way to do it!
make the right
I notice... decision.
Next
steps Where do we go from here?

Structures for influence and motivation

Is this what
Reaffirm you plan to
commitment do?

Motivational interviewing GROW OARS

Find out more: [Link]/nhcprogramme

What Poster visualising the objectives and associated communication skills of the stages of the Calgary-Cambridge Guide as
applied to conversations relating to influencing and motivating staff. Structures include the MI (motivational interviewing)
model, GROW and OARS
Why To support healthcare leaders to visualise and use the key communication skills for influencing and motivating healthcare
staff
Where To be displayed at the point of care and prominent areas throughout the healthcare facility
When To be displayed at all times and replaced/refreshed as necessary
How Display the posters at the point of care and refresh when necessary
Who Users: NHCP Lead or any person in charge of displaying the posters in all health and social care settings
Targets: All health and social care leaders

52 | National Healthcare Communication Programme - Guide to Implementation

2.5. Creating a climate for excellence On a continuum of progress communication skills excellence
must become deeply-rooted in the healthcare facility tradition
2.5.1. Definitions and overview and approach.
Creating a climate for excellence refers to creating an
environment and the perceptions that facilitate awareness- Influential healthcare workers and individuals can contribute
raising about excellence in communication while guaranteeing greatly to the successful development of a climate for
consideration of communication skills improvement as a high communication skills excellence. In addition to professionals
priority at all levels, including: working at the healthcare facility, these influential people
• active participation at both the healthcare facility and may come from external organisations and professional
individual levels; bodies that can give advice on effective strategies to improve
• awareness of individual and healthcare facility capacity to communication skills.
change and improve (self-efficacy); and
• partnership with patients and patient organisations. In settings where communication skills promotion is very
advanced, senior managers and leaders will have repeatedly
At the healthcare facility level, this component of the demonstrated commitment to communication skills by long-
communication skills improvement programme represents term allocation of resources and will be proud of the excellent
the foundation for implementing and sustaining the standards achieved at their facility. Communication skills will
communication skills improvement programme which must be used as a quality indicator on a regular basis.
be embedded in a climate that understands and prioritises Particularly but not only in these settings, patients will
excellence in communication. be involved in the creation of a climate for excellence in
communication. Patient awareness and understanding
At the individual level, this component of the strategy is of communication skills are important aspects to be
important with respect to advocacy of communication skills considered in the quality improvement plans of a multimodal
by all healthcare workers as a priority and for their motivation communication skills improvement programme. Positive
to practice optimal communication skills as an act showing encouragement by patients of health and social care workers
their commitment to improve the care experience and quality to motivate them to implement good communication skills
and safety of care for the people who use our services. can improve use of good communication skills. Using good
Through the creation of an healthcare facility communication communication skills with the patient can promote patient
skills excellence climate, both the healthcare facility and confidence and partnership between patients and health and
each health and social care worker become aware of their social workers. Good skills will also help to improve the care
capacity to make a change and catalyse improvement across experience and quality and safety of care.
all indicators.

The creation of a climate for excellence must be a priority 2.5.2. Tools for creating a climate for excellence –
for all communication skills promotion, regardless of the tool descriptions
level of progress in communication skills improvement at the The range of tools that can be used for creating a climate
facility, and is essential during any implementation phase of for excellence is represented in the following pages:
the programme. Much effort must be made at the beginning
to create the motivation for embarking on communication
skills promotion (Step 1, facility preparedness phase, Section
3.2.1., page 56).

It is important that decision-makers and influential people are

engaged in the planning process at the earliest possible stage
and that this engagement continues during implementation
and beyond.

National Healthcare Communication Programme - Guide to Implementation | 53

 TOOLS FOR CREATING A CLIMATE OF EXCELLENCE

Template letter to advocate/communicate NHCP Communication Skills Improvement Programme to Managers

What A template letter for use and adaptation by a local NHCP Lead to communicate with key decision makers concerning investment
in/actions relating to communication skills improvement
Why To help a local NHCP Lead or person(s) interested in introducing or reinvigorating communication skills improvement initiatives
within a healthcare facility, to communicate important messages concerning the improvement initiatives to key senior managers/
leaders
Where Management unit of the healthcare facility
When At the initial stages of a communication skills improvement programme
How The user can insert local information or modify the text of the template letter to reflect local style
Who Users: Local NHCP Lead or person(s) interested in introducing or reinvigorating communication skills improvement initiatives
within a healthcare facility
Targets: Senior managers/clinicians at the healthcare facility

Use this link to access this letter

[Link]

NHCP promotional PowerPoint/Video

What A short presentation/video to promote communication skills and National Healthcare Communication Programme
Why To inspire healthcare workers to use good communication skills during healthcare delivery and motivate patients to participate in
communication skills improvement initiatives
Where To be shown at meetings, awareness sessions and public areas in a facility where patient empowerment is promoted, as an
impactful way to inspire and advocate communication skills
When At the initial stages of a communication skills improvement programme
How Show the short presentation to healthcare workers or the public before providing more details on communication skills
initiatives to provide context and a powerful message about communication skills in healthcare
Who Users: Local NHCP Lead, senior managers, facilitators
Targets: All healthcare workers and people who use our services

Use this link to access The NHCP promotional presentation

[Link]

54 | National Healthcare Communication Programme - Guide to Implementation

 Part 3
The five steps
to change
5. Continuous
improvement

4. Evaluate impact

3. Implement

2. Evaluate baseline

1. Prepare

National Healthcare Communication Programme - Guide to Implementation | 55

 Overall template Quality Improvement Plan
It covers a wide range of actions as regards progress of
Part 3 of the Guide to Implementation provides
communication skills at facility level: from basic actions
the following additional elements to help the
to be undertaken to inaugurate a communication skills
implementation of the NHCP implementation
programme to advanced activities indicated in facilities
toolkit:
where communication skills promotion is very advanced.
The template also helps to identify roles and responsibilities,
• a template quality improvement plan listing the
to establish a time line for action execution and budget
actions that could be undertaken in order to
implications and to track progress.
achieve the implementation of each component of
the toolkit in facilities at both basic and advanced
level of progress in communication skills promotion; 3.2. Five steps to change
and
The five steps to change help to develop and plan the
• the five steps to change approach as a model
communication skills improvement programme over time and
for implementation in healthcare facilities newly
according to a rational sequence of activities.
committing to communication skills improvement.

This approach is proposed for consideration especially

by facilities newly implementing a communication skills
improvement programme based on the NHCP. In a defined
Quality Improvement Plan template sequential order, it walks the reader through the path to
be followed to implement the programme with a wide
Use this link to access an interactive range of activities and the support of all tools of the NHCP
document with Quality Improvement implementation toolkit.
Plan templates
[Link]
3.2.1. Step 1: Prepare
Step 1 is meant to ensure the overall preparedness of the
facility to put in place a communication skills improvement
3.1. Preparing a Quality Improvement programme. This includes getting the necessary resources
Plan (both human and financial) and infrastructure in place
The template Quality Improvement Plan is proposed to along with the key leadership for the communication skills
help prepare the local quality improvement plan. It is very improvement programme, including the NHCP Lead and his/
comprehensive but it does not take into account local issues. her deputy.
Therefore, healthcare facilities should identify elements that
apply to their local situation and amend the template by Facilities are recommended to consider implementing initially
adding further activities to reflect local needs. The template is in teams/departments where motivation and interest are high
not intended to indicate a chronological order for undertaking and the gain (patient safety/quality/care experience) is likely
the actions proposed but to give an overview of all actions to be substantial and subsequently have an impact on others.
necessary to secure the implementation of each element of
the NHCP implementation toolkit, according to the details Consider the feasibility of matching required activities
given in Part 2 of the guide. to available human and financial resources. In order to
demonstrate the economic benefit of the intervention and
to ascertain what funding will be required to implement the
quality improvement plan to improve communication skills,
it may be necessary to formalise a financial plan at this early
stage in establishing the scope and extent of the intervention.

56 | National Healthcare Communication Programme - Guide to Implementation

NHCP Lead
Possible methods of communication
Profile A healthcare worker with an understanding
of communication skills and ideally a broader Word of mouth
experience on quality and safety; he/she should
be well-respected and able to access high-level
management staff within the facility. Electronic (email) if available

Tasks To propose a consistent quality improvement

plan to implement the communication skills
Newsletter or similar bulletin
improvement strategy according to the NHCP and
in line with the current progress of communication
skills promotion at the facility level; to discuss Formal and informal training
it with senior managers and to coordinate its
implementation at all stages; in addition, to lead
the training of facilitators. To provide feedback to Posters/reminders
senior managers and relevant committees involved
in the implementation of the NHCP/improving the
care experience at the healthcare facility. Presentations in medical and
nursing staff meetings
NHCP Team/Committee
CEO address to healthcare staff
Profile A group of key internal stakeholders and in
particular influential leaders (nurse managers,
clinical directors, leads from other disciplines,
senior managers) along with those involved in Key players involved in Step 1:
learning and development. • NHCP Lead
• Deputy Lead
Tasks To support the NHCP Lead and share decision
• NHCP Facilitators/Clinical skills facilitators/Practice
making; to meet regularly (at least monthly at the
development coordinators/CNME representatives
beginning of the programme; then less frequently)
• Senior managers/healthcare facility administrators
to oversee progress, to highlight any issues or
• Learning and development professionals
concerns, propose solutions, and review the
• Patient advisory liaison managers
emerging data.
• Senior clinicians (nurse managers/clinical directors/
leads from other disciplines)
NHCP Facilitators • NHCP committee/team
• Patient representatives (at least two)
Profile A professional preferably with experience of
education and of delivering healthcare. Evidence
indicates that facilitators do not need to be in 3.2.2. Step 2: Evaluate baseline
clinical practice but the experiential, learner-
Step 2 is meant to be focused mainly on conducting baseline
centred methods require them to have, as a
evaluation of communication skills knowledge, competence
minimum, prior working experience of the
and performance. It is vital to assess the current situation at
communication encounters covered in the NHCP
the healthcare facility level in order to tailor and refine quality
workshops.
improvement plans for implementation. Activities taking place
Tasks To facilitate NHCP workshops and support staff to in step 2 are vital also because they will provide reference
improve their communication skills. To review the information for any comparison and assessment of progress
workshop evaluations and provide feedback to as the NHCP is being implemented.
the NHCP Local Lead.

Key players involved in Step 2:

• NHCP Lead
• Deputy Lead
• Facilitators
• Data managers
• NHCP committee/team

National Healthcare Communication Programme - Guide to Implementation | 57

3.2.3. Step 3: Implement 3.2.5. Step 5: Continuous improvement
Step 3 (Implement) is the key phase to achieve improvement Step 5 is a crucial step for reviewing the entire cycle of
and it consists of implementing all the interventions planned implementation put in place during the previous steps and
in Step 1 (Prepare) and using the core findings from Step for developing long-term plans to ensure that improvement
2 (Evaluate baseline) to motivate improvement. It is vital is sustained and progresses. Developing and implementing
for raising awareness of the importance of communication quality improvement plans while ensuring that there is a
skills knowledge, performance and competence, to improve constant review cycle is essential if the overall aim to embed
knowledge and skills, to put in place elements of system communication skills as an integral part of the healthcare
change and eventually to catalyse behavioural change. facility culture is to be achieved long-term. Implementation
plans must be designed with the aim of achieving sustainable
Key players involved in Step 3: communication skills improvement kept in mind at all times.

• NHCP Lead
Communication skills improvement is not a time-limited
• Deputy Lead
process: communication skills promotion and monitoring
• NHCP Facilitators/Clinical skills facilitators/Practice
should continue once implemented.
development coordinators/CNME representatives
• Senior managers/healthcare facility administrators
Planning and reviewing are crucial to the success of any
• Learning and development professionals
programme of work. Key actions throughout can be helpful
• Patient advisory liaison managers
in ensuring that progress with plans is maintained and
• Senior clinicians (nurse managers/clinical directors/
changes to plans are adopted when necessary to ensure
leads from other disciplines)
the best outcome for communication skills improvement. A
• NHCP committee/team
communication skills improvement plan cannot remain static
• Patient representatives (at least two)
and must be rejuvenated at set intervals, with plans to ensure
this built in from the outset. With the appropriate changes
according to the long-term quality improvement plan, the
3.2.4. Step 4: Evaluate impact entire cycle using the five steps to change approach should
Step 4 has very important aims: to follow-up progress and be repeated over a minimum of five years.
confirm that implementation translates into improvements
in communication skills knowledge, performance and Most improvement programmes are reviewed at some point
competence. The surveys carried out for baseline evaluation to ensure that they are likely to be delivered on time and that
during step 2 should be repeated to obtain follow-up they meet the objectives set within the budget allocation.
data adequate to compare the periods pre- and post- Therefore, by adopting the quality improvement planning and
implementation. It is, however, important to understand that review cycle approach from the outset, the communication
since it will be carried out shortly after implementation, this skills programme can take the lead in providing such
evaluation will provide information only about the immediate information rather than being asked for it.
impact of the programme. To gather long-term impact data
it is necessary to undertake further evaluation on the basis
Key players involved in Step 5:
of a longer follow-up and to invest in continuous monitoring
of key indicators. Short-term impact information is, however, • NHCP Lead
crucial to aiding future decisions and actions (step 5). It • Deputy Lead
is also important to acknowledge that during this step, • NHCP Facilitators/Clinical skills facilitators/Practice
communication skills improvement activities should continue development coordinators/CNME representatives
according to the local quality improvement plan. • Senior managers/healthcare facility administrators
• Learning and development professionals
Key players involved in Step 4:
• Patient advisory liaison managers
• Senior clinicians (nurse managers/clinical directors/
• NHCP Lead leads from other disciplines)
• Deputy Lead • NHCP committee/team
• NHCP committee/team • Patient representatives (at least two)

58 | National Healthcare Communication Programme - Guide to Implementation

References
Elwyn, G., Barr, P.J., Grande, S.W., Thompson, R., Walsh, T. and Ozanne, E.M. (2013) Developing CollaboRATE: a
fast and frugal patient-reported measure of shared decision making in clinical encounters. Patient Education and
Counseling, 93(1), pp.102-107.

Kirkpatrick D. (1967) Evaluation of training in Hutchinson L. (1999). Evaluating and researching the effectiveness
of educational interventions. BMJ (Clinical research ed.), 318(7193), 1267–1269.

Kurtz, S. and Cooke, L. (2017) Learner-centred communication training in Kissane, D., Bultz, B., Butow, P.,
Bylund, C., Noble, S. and Wilkinson, S. (eds) Oxford Textbook of Communication in Oncology and Palliative
Care. 2nd edn. Oxford: Oxford University Press, pp 61-70.

Arthanayake, N. (2022) Let’s Talk: How to Have Better Conversations. Orion Publishing Group, Limited.

Reader Information

Title NHCP Guide to Implementation

Document Reference Number NHCP‐D‐012‐4

Version Number V4.0

Author National Healthcare Communication Group

Review Date January 2027

National Healthcare Communication Programme - Guide to Implementation | 59

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