(patients/clients/relatives of patients/colleagues) then I hope that - - PDF document

WHO YOU ARE – WHY WE ARE ALL HERE

• Thanks for being here on time and welcome to the SAGE & THYME Foundation

Level workshop.

• My name is….. My background is … and I’ve been trained specifically to run this

workshop about listening skills.

• It’s a national initiative to teach the whole workforce. This is a three-hour

practical workshop about emotional support.

• I’m working with two colleagues who are also qualified trainers of this workshop

they are …. and …. This slide is about the trainers feeling and sounding confident – have it up before you start and then move on to the next slide quickly – start on time and get off to a quick start – don’t waffle. 1

IF YOU COME ACROSS WORRIED, DISTRESSED, ANXIOUS OR UPSET PEOPLE IN YOUR ROLE - THIS WORKSHOP IS FOR YOU IT’S NOT COMPLEX – AND IT’S SUITABLE FOR EVERYONE

• If you meet worried, distressed, anxious or upset people in your role

(patients/clients/relatives of patients/colleagues) then I hope that you will see the direct relevance to your work as we go through the workshop.

• Give some relevant examples to fit your audience:
• For example, if you are a medical secretary, you might often have anxious

patients ringing you about their test results.

• If you are a volunteer working in the café, you might have contact with

someone worried about a relative in the hospice/hospital.

• It may be a reminder for some of you but you may also learn some new things –

either from us facilitators or from other learners.

• We are going to be teaching everyday skills for everyone.

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IT’S ABOUT US - AND IT’S ABOUT THEM

• Good communication matters because careful and skilful communication is

known to be good for the emotional health of the person listening and for the person being listened to.

• We get lower levels of staff burnout and better job satisfaction.
• Patients have lower levels of anxiety, lower usage of medicines and fewer

symptoms.

• Poor communication is also the most common reason why people are dissatisfied

with a service. 3

SOMETIMES WE’RE NOT ACTUALLY LISTENING AT ALL

• It’s really hard to listen carefully when we have such a lot to say.
• We can be tempted to give: advice – information – reassurance – similar

experiences. 4

WE’LL TAKE YOU STEP BY STEP - THE WHY AND HOW OF CAREFUL LISTENING

• Our job as facilitators is to walk you step by step through the evidence and the

skills.

• Your job is to tell us about what you already know and to follow us through the

steps. 5

WE SHOW YOU HOW - AND WE COVER THE EVIDENCE

• This is a practical workshop built from the published evidence that meets national

guidance.

• The evidence is described in a handout (THE TOP PICTURE IS OF THE HANDOUT)

so that you can read for yourself and reflect after the workshop on what has been covered.

• I will be mentioning some of the evidence behind SAGE & THYME in a moment.
• There are also several articles in textbooks and journals that you could read to

learn more about SAGE & THYME. 6

• The workshop is structured as follows: we start by listening to you—what you

already know about listening and responding.

• Then I will explain with a 25 minute presentation where listening goes wrong and

how to listen well - I’ll explain to you what SAGE & THYME is—it’s simply a reminder to keep you organised.

• Then we will ask you to work a second time in small groups to give us your

thoughts about structured listening.

• Then you’ll get a break and coffee.
• After the break, we’ll rehearse. We call it rehearsal because it’s not the real

thing—but it is a chance to practice using the listening skills—we will rehearse— you can give us a situation to apply it to. We have time to let one of you rehearse in the safety of this room – if nobody really wants to practice – we can show you twice.

• Finally, we’ll show you a short video and then ask you what you have learnt from

the workshop. 7

These are the GROUND RULES for the workshop:

• It’s common these days for people to have their phones even during training –

but we find that other learners are distracted by people checking their phones – if you need to take a call please leave the room to do so -otherwise please put your phones out of reach.

• Please don’t start talking to the person next to you – that also distracts other

learners.

• Please let everyone speak.
• Please don’t mention any colleague or patient or client in a way that reveals

their details.

• We will keep to time and we need you to come back promptly after the break.
• This workshop is about emotions – it’s ok to be emotional in the workshop – if

it’s too close to emotional issues for you, please feel free to step out of the room – we won’t come out after you - we need to stay in the room. Also, please do your best not to start describing your emotional upset in the small groups – the other learners start supporting you when we need them to be learning about supporting people!

• I’m about to show you a short video which is about emotions and what people

might be experiencing. We show it because we think it eloquently describes why we should all spend 3 hours reflecting on how to provide emotional support. It’s an American video but you will see that it applies equally well here. It is an emotional video – some people find it upsetting. Cleveland Clinic VIDEO here (type Cleveland clinic empathy YouTube into Google - https://www.youtube.com/watch?v=cDDWvj_q-o8) (Have the video ready before you start) 8

The link for the film (for which we have gained permission from Cleveland Clinic to use in the SAGE & THYME Foundation Level workshop) is here: https://www.youtube.com/watch?v=cDDWvj_q-o8 There is also a hyperlink to the film if you double click on the picture. 9

• Now I’d like to allocate you into three small groups to start the discussion.
• These are not questions to catch you out.
• We want to know what you know already – you have 10 min to discuss each

question in your group. 10

• People have worries or concerns and can be upset or distressed – this is natural

and common.

• It’s human to worry when things don’t go to plan – when illness disrupts your life
• r when major changes happen or are about to happen in your life.
• People are uncertain and they worry – they get upset – even panicky.

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Many people are not sure if they should talk about their worries:

• Who to ask?
• How to discuss them?
• When to discuss them?

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• We need to notice when our patients/clients, or indeed anyone else, is upset or

concerned.

• Equally, we need to avoid pushing people to talk about things that they don’t wish

to discuss. 13

THE WORMS AND THE TIME

• The term ‘can of worms’ means a situation that causes a lot of problems when

you start to deal with it.

• Opening a can of worms is unpredictable.
• We’re not confident that we have the time.
• We might have the skills to start the conversation but we’re not sure how to get
• ut again.

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• The brave ones among us try to help.
• We reach out but, in our attempts, we are sometimes unhelpful:
• We interrupt
• We change the subject
• We start to give advice
• or we focus on the physical and practical issues.
• Our intentions are good but it can be a bit clumsy.

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This can leave the worried or upset person feeling: misunderstood, frustrated and

• ut of control of their own situation.

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• But if we do have the skills
• We can listen carefully
• In a structured and organised way

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The published evidence helps us:

• It says that we shouldn’t make assumptions – you can’t guess what people are

thinking – you have to ask.

• It says that people have hidden concerns that they don’t tell you about unless you

ask more than once, to check that there isn’t some other concern that they’re only just able to put into words.

• The researchers tell us that we shouldn’t assume that people have one main concern

– we have to listen to all of the concerns.

• Plus, it’s helpful to hear the concerns that we can’t do anything about – the

unfixable worries.

• The research says that we can give advice and information and reassurance too

early – and that doing this distracts the person – jumping too quickly to solutions is unhelpful.

• The good news is that these findings can be followed using a structure that can help

us listen carefully and helpfully – it keeps our minds clear and organised.

• The research says that most people cope as a direct result of their own personal

resources (their own ability to process worries and think of solutions) and with the support of their families and friends.

• All of this evidence tells us how to be helpful – it gives us confidence that we can get

into and out of a conversation about emotions. 18

• The consequences of this can leave the worried person feeling:
• Involved
• listened to
• Respected
• And understood.
• They might even experience:
• Clearer thinking
• Feel more in control
• More able to cope
• And feel more like themselves.

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• Time is a constant worry for most of us.
• We have plenty of things to do - so we need to decide whether we can make

time for emotional support – there’s no doubt that it needs time, but perhaps not as much time as you think.

• At the end of the workshop we’re going to show you a video of listening and

responding in just 6 minutes – beginning to end. 20

Listening skills:

• There’s a lot of evidence about how to listen.
• And there’s a pattern to it.
• It involves taking turns to ask and then to listen, then to ask again, and then to

listen again.

• The pattern looks like this….

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• Ask about worries - then listen to the worries.
• Repeat the worries back (to prove that you’ve heard) then ask if there are other

worries.

• Then listen again to other worries - then repeat again and ask if there are still

more worries.

• Repeat this approach until the worried person has described all of their worries.
• This simple pattern of active listening is the basis of careful and systematic

listening.

• Yes, we’re suggesting that you allow people to open the can of worms – and tell

you what’s going on in their minds. 22

Once we know this pattern of questions:

• We can place these skills in a structure – or a sequence of helpful questions:
• Questions about the worries or concerns.
• Questions about the support that the worried person has – as people

who have social support cope better than people who don’t.

• Questions about what the worried person thinks might help with their

worries. 23

This slide and the next one is a suggested structure to help you be organised (for your consideration). The slides cover a step by step guide to listening and responding in a careful and organised way.

• The S of SAGE is Setting: When you notice someone is worried, anxious, upset or

distressed, think first about the setting. Have you got the time – should you come back later? Is there space and time for the upset person to speak freely – is there privacy?

• The A is about Asking: ask about the worries.
• The G of SAGE is Gather: use the pattern of skills described earlier of reflecting

what you hear and asking about other concerns “Is there something else?”– keeping going until you have them all – summarising.

• E is for Empathy: When you have all the worries and concerns say something to

show that you’ve noticed how difficult it all is or perhaps “That sounds tough.”

• r “That’s a lot to be dealing with.”

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• The T and the H of THYME are about the support that people have (of course not

everyone has support).

• In T ask about who they have to support them.
• In H ask about how those people help. Remember the patterns of listening skills

– asking - listening – reflecting back and asking for more.

• The Y and the M of THYME are about planning - the plans that fit with the

concerns.

• The Y of THYME is the patient centred question where the person gets to think

themselves about what would help – the same pattern of listening skills is used here “Is there something else that would help?”

• There are two sections to the M of THYME:
• The first is “Is there something that you think I could do to help?”
• The second is the opportunity for the listener to offer supportive

ideas/information/guidance/advice if appropriate and if wanted by the worried person: “I wonder if I could suggest…” or “I wonder if you’ve thought about….” so it’s OK to give advice or guidance or reassurance if appropriate at this point.

• The E of THYME is a summary of the concerns (from G), the support from T and

H, and the plans from Y and M.

• Then a closing sentence where agreement is made about who is doing what and

the follow up. Then – “Can we leave it there for now?” 25

• Good listeners are not just waiting to speak.
• They’re not just waiting to tell their story or waiting to give advice.
• They are listening and asking for more.
• We shouldn’t expect ourselves to have the answers to other people’s emotional

concerns – we should just be good at listening. 26

• There’s no need to pretend that we have all the skills to cope with any concerns
• r worries.
• Some people will be thinking about self-harming or have complex relationships
• r reveal what we call ‘safeguarding issues’ (issues where their safety or the

safety of others is at risk).

• We have people trained to deal with these issues.
• When we feel out of our depth we should recognise that and politely explain.
• And then get someone else involved.

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• To notice distress, listen carefully and respond helpfully, we need:
• Time
• Careful skills
• A structure.

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• We’d like you to return to the smaller groups.
• Describe your first reactions to this structured way of listening.
• Look back at the thoughts you had earlier and see how they are similar to the

SAGE & THYME structure. 29

You might want this slide up during rehearsals unless the projector is noisy. 30

Please go back to the groups for the last time.

• Before you get the evaluation form out ….
• Please say to the others in the group one thing that you’re taking from this

workshop.

• It’s helpful to know what others have learned.
• Thank you everyone.

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