Updated: Feb 1
In this article, we will explore some of the practical ways admin healthcare staff can be upskilled in managing difficult conversations — leading to better outcomes, reduced staff burnout and improved empowerment and job satisfaction.
The rise of the difficult conversation
There are increasing reports of patients venting anger, distress and even abuse at NHS staff — quite often reception and administration staff, who are very often the gatekeepers and triage front of health services.
Whilst nobody should suffer abuse or threats in their public service role, there is an in understanding that service users can be emotionally charged for a range of reasons, many of these being exaggerated in recent times — including:
reduced service capacity, meaning longer waits and fewer appointments available.
increased service user anxiety, due to COVID fears and the experience of healthcare access challenges.
access difficulty expectations, fueling a sense that those who ‘fight’ for their support may be more likely to receive them.
Increasing rates of difficult conversations are being blamed for the departure of 100s if not 1000s of NHS admin staff, with team managers often reporting to us and the press that it is increasingly difficult to retain staff who experience this on repeat.
Supporting the success of Admin staff
Here we will explore some of the support options, in teams, for admin staff that are observed to make a difference. This is in the context of realising that the challenges listed above are not going away quickly, and the current point of most leverage is likely in the skillsets and support systems put around admin.
7 approaches to empower Admin staff:
1. Supporting Admin to see the bigger picture and the bigger picture to see Admin.
It is easy to feel like an isolated pawn in a large system, in the NHS. Admin staff are often detached from clinical issues and the wider care team, perceived as a logistical support role both by others and themselves. It can be helpful to spend time with your admin team, exploring their awareness of the issues that services users may face, alongside their own — both within a health system that is less than ideal.
Service users come with an often desperate need to get their care needs met quickly and admin staff often have to manage this emotionally charged situation in the context of having less than the service user wants, in terms of healthcare access. This is not a win-win situation for the staff or the service users. There is a risk that admin staff learn to try and ‘explain’ the system issues to service users on loop — a narrative that emotional and worried people are not going to be ready or able to hear, most of the time.
It can help Admin staff to be asked to think about the list of service user challenges shown here, to frame the conversation as something that is not personal. Service users are not able to see the other two components of this model when in their worried or frustrated states, it is for the professional (the admin staff) to hold all three in mind. When they are able to, the staff member can learn to avoid receiving difficult conversations as personal attacks.
2. Supporting Admin to feel like professional conversation facilitators
When training Admin staff, we support them to consider their core professional skill/role as being expert and professional conversation facilitators. It is the rule to expect emotionally charged conversations, rather than the exception.
Service users may attend or call with fear, distress, grief, fatigue, panic, distrust, confusion, anger… likely any emotion. Rarely will service users call with total calm, when a health need is driving the interaction.
Framing the role as that of a professional conversation facilitator can help. We would all run from a burning house, but firemen run into them. This is their professional role — they expect to see fires when they arrive and they arrive with the mindset and toolkit enabling them to feel empowered in facing fires. It starts with being called a fireman, it can help for Admin staff to consider themselves with a label that includes conversation management
3. Supporting Admin to be compassionate
Beyond facilitation, staff can sometimes lose sight of the many variables that influence conversations beyond what might feel like an in the moment difficult service user. Staff can benefit from being softly reminded that service users represent the entire diverse range of people in the population, who include people experiencing:
cultural communication differences
The list is endless and the impact on communication can be a direct outcome of diversity or health symptoms, including:
In our professional roles, we can develop an ability to receive difficult conversations as a signal that there is a need to support the other person. Compassion in response to emotional distress or conversational difficulty is a central component of clinical care and admin are often the first step in a clinical pathway. They often don’t know the clinical needs of service users, but can assume that they exist for most who make contact.
I often ask staff to think about a child or relative who, when upset, needs support not matched anger/frustration. How do they stay calm, how do they manage the situation and how is compassion the driver rather than irritation, in these interactions. The same parts of us, we can bring to work as healthcare professionals — but often we need to realise that these parts can be activated and could be helpful.
4. Upskilling Admin in conversation skills
All of this sets the foundations for better conversations, but staff need actual key skills in what to say and when to say it. Staff can engage a service user well from the first moment, show that they are listening, direct the conversation to types of support, hold difficult emotions and learn when and how to get off a call that has turned bad. These are skills, like the skills of clinical assessment or triage — they can be taught and staff will feel empowered when they have them.
Explore training options for staff and equip them early.
5. Providing senior support for repeat offenders
Clinicians and managers can support admin staff by being available and curious about which service users are particularly difficult to support or who are prone to abuse or threat. Senior staff making contact with service users and explaining the expectations of the service and the role of admin can be supportive to service users and the staff. It is important to not confuse this with providing a clinical contact as a means of reducing the experience, as this can reinforce the idea that bad behaviour leads to clinical contact. Cautious judgement is needed in relation to who’s emotional need has created a need for clinical support versus who might be relentlessly fighting for services that just are not available.
6. Team scripts
Managers can work with admin teams to develop call scripts. What exactly to say when the call feels unmanageable. How to terminate a call, how and when to escalate to a manager — how to respond to patients with particular emotional presentations. There is a reason that so many call centres rely on scripts, they empower staff. This is not to replace all natural conversation but can be a crutch for staff when they feel that they themselves are losing emotional calm and struggling to remain empathic and professional.
7. Wellbeing routines
Recognise that this role, on repeat, is exhausting. It is not easy to be calm on loop to upset or angry people. Create ways for staff to take a break and to talk to each other or managers. Celebrate when staff have done well and show empathy to them for managing difficult calls. Create breaks from service user contact when difficult calls have increased. It can help staff to see a manager taking their role from time to time, both showing that you are willing to facilitate conversations and also showing them how.
Encourage team humour about these conversations, enabling staff to transform personal challenges into team banter. We have seen some teams create a bingo chart with particular phrases that are offensive or challenging. It enables the individual to quickly transform a potentially painful experience into a team conversation.
Be very present for lone admin staff, as a manager or clinician. Support their disclosure about their coping in relation to these experiences. Share management or clinical experiences that show shared experience and personal efforts to overcome.
Be creative :)
Admin staff should never experience abuse, but difficult conversations are likely a core part of their role and more expected in current times.
When staff feel competent and professionally connected to the idea that these conversations are their job and they are good at it, the dynamic shifts.
Even in this context, personal wellbeing is important. Be sure to support this in staff and to pass on any team wellbeing skills developed by managers, clinicians or more weathered admin staff.
For more support — see our Healthcare Admin Difficult Conversations training and support programme
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