Mandatory communication training of all employees with patient contact

Abstract

In 2010 a communication program that included mandatory communication skills training for all employees with patient contact was developed and launched at a large regional hospital in Denmark. We describe the communication program, the implementation process, and the initial assessment of the process to date.

Method
The cornerstone of the program is a communication course based on the Calgary Cambridge Guide and on the experiences of several efficacy and effectiveness studies conducted at the same hospital. The specific elements of the program are described in steps and a preliminary assessment based on feedback from the departments will be presented.

Results
The elements of the communication program are as follows: 1) education of trainers; 2) courses for health professionals employed in clinical departments; 3) education of new staff; 4) courses for health professionals in service departments; and 5) maintenance of communication skills.
Thus far, 70 of 86 staff have become certified trainers and 17 of 18 departments have been included in the program.

Conclusion
Even though the communication program is resource-intensive and competes with several other development projects in the clinical departments, the experiences of the staff and the managers are positive and the program continues as planned.

Full text

Educational/Counseling
Model
Health
Care
Mandatory
communication
training
of
all
employees
with
patient
contact
Jette
Ammentorp
a,
*,
Lars
Toke
Graugaard
a
,
Marianne
Engelbrecht
Lau
b
,
Troels
Præst
Andersen
a
,
Karin
Waidtløw
a
,
Poul-Erik
Kofoed
c
a
Health
Services
Research
Unit,
Lillebaelt
Hospital/IRS
University
of
Southern
Denmark,
Vejle,
Denmark
b
Stolpegaard
Psychotherapy
Centre,
Mental
Health
Services,
Copenhagen,
Denmark
c
Department
of
Paediatrics,
Lillebaelt
Hospital/IRS
University
of
Southern
Denmark,
Kolding,
Denmark
1.
Introduction
Several
studies
published
during
the
last
three
decades
have
shown
that
communication
skills
training
has
a
positive
effect
on
the
communication
style
of
health
professionals
[1–4]
and
influences
patient
outcome
[3,5–7],
although
the
impact
on
patient
outcomes
is
less
convincing
due
to
the
methodologic
challenge
of
measuring
indirect
outcomes
[8].
The
studies
have
typically
been
conducted
in
individual
departments,
often
by
implementing
single
interventions
and
without
any
follow-up
[4,9].
Furthermore,
it
is
unknown
if
any
of
these
studies
have
ever
been
translated
into
praxis
on
a
larger
scale.
It
has
been
suggested
that
large-scale
effectiveness
studies
should
be
conducted
to
include
elements
that
can
improve
a
sustainable
adoption
and
implementation
of
the
intervention
[10,11].
Studies
that
also
take
the
complexity
of
the
clinical
praxis
into
account
[12].
Even
so,
it
has
not
been
possible
to
find
any
large-scale
scientific
studies
meeting
these
criteria.
Based
on
the
experience
of
implementing
a
communication
skills
training
course
in
four
different
clinical
departments
at
the
hospital
and
on
findings
from
both
efficacy
[13,14]
and
effective-
ness
studies
[15,16]
conducted
in
two
of
these
departments,
we
were
encouraged
to
provide
the
course
to
the
entire
hospital
[17].
A
project
plan
that
included
an
estimate
of
the
costs
for
implementing
the
communication
program
was
prepared
and
accepted
by
the
managers
of
the
departments
and
the
hospital.
The
economic
estimate
showed
that
a
department
would
spend
1.6
person-years
for
each
100
staff
participating
in
the
course,
and
that
the
total
operating
expenses
would
be
approximately
2
million
Danish
kroners,
corresponding
to
270,000
EUR.
The
estimate
was
based
on
the
assumption
that
there
will
be
no
decrease
in
production.
In
this
article
we
describe
the
communication
program,
the
implementation,
and
an
initial
assessment
of
the
process
thus
far.
Patient
Education
and
Counseling
95
(2014)
429–432
A
R
T
I
C
L
E
I
N
F
O
Article
history:
Received
21
October
2013
Received
in
revised
form
21
February
2014
Accepted
2
March
2014
Keywords:
Communication
skills
training
Communication
program
Mandatory
training
Educational
model
Effectiveness
study
Translation
research
A
B
S
T
R
A
C
T
In
2010
a
communication
program
that
included
mandatory
communication
skills
training
for
all
employees
with
patient
contact
was
developed
and
launched
at
a
large
regional
hospital
in
Denmark.
Objective:
We
describe
the
communication
program,
the
implementation
process,
and
the
initial
assessment
of
the
process
to
date.
Method:
The
cornerstone
of
the
program
is
a
communication
course
based
on
the
Calgary
Cambridge
Guide
and
on
the
experiences
of
several
efficacy
and
effectiveness
studies
conducted
at
the
same
hospital.
The
specific
elements
of
the
program
are
described
in
steps
and
a
preliminary
assessment
based
on
feedback
from
the
departments
will
be
presented.
Results:
The
elements
of
the
communication
program
are
as
follows:
(1)
education
of
trainers;
(2)
courses
for
health
professionals
employed
in
clinical
departments;
(3)
education
of
new
staff;
(4)
courses
for
health
professionals
in
service
departments;
and
(5)
maintenance
of
communication
skills.
Thus
far,
70
of
86
staff
have
become
certified
trainers
and
17
of
18
departments
have
been
included
in
the
program.
Conclusion
and
practice
implications:
Even
though
the
communication
program
is
resource-intensive
and
competes
with
several
other
development
projects
in
the
clinical
departments,
the
experiences
of
the
staff
and
the
managers
are
positive
and
the
program
continues
as
planned.
ß
2014
The
Authors.
Published
by
Elsevier
Ireland
Ltd.
This
is
an
open
access
article
under
the
CC
BY-NC-ND
license
(http://creativecommons.org/licenses/by-nc-nd/3.0/).
*Corresponding
author
at:
Health
Services
Research
Unit,
Vejle
Hospital,
Kabbeltoft
25,
Bygning
S100,
7100
Vejle,
Denmark.
Tel.:
+45
23845345.
E-mail
address:
Jette.ammentorp@rsyd.dk
(J.
Ammentorp).
Contents
lists
available
at
ScienceDirect
Patient
Education
and
Counseling
jo
ur
n
al
h
o
mep
ag
e:
w
ww
.elsevier
.co
m
/loc
ate/p
ated
u
co
u
http://dx.doi.org/10.1016/j.pec.2014.03.005
0738-3991/ß
2014
The
Authors.
Published
by
Elsevier
Ireland
Ltd.
This
is
an
open
access
article
under
the
CC
BY-NC-ND
license
(http://creativecommons.org/licenses/by-nc-
nd/3.0/).

2.
Methods
2.1.
Setting
and
organization
The
program
is
implemented
at
Lillebaelt
Hospital,
a
regional
hospital
consisting
of
18
clinical
departments
and
10
clinical
service
departments.
The
total
number
of
health
professionals
is
approximately
3000.
A
steering
committee
is
responsible
for
monitoring,
adjusting,
and
further
development
of
the
program
and
the
course
administration
is
carried
out
by
the
hospital
administration
in
close
cooperation
with
the
research
group.
2.2.
The
program
The
program
includes
mandatory
and
continuous
communica-
tion
skills
training
to
all
health
professionals
employed
in
the
clinical
departments
and
to
staff
in
the
clinical
service
depart-
ments,
who
usually
has
shorter
patient
contact
(radiology
staff,
medical
laboratory
assistants,
secretaries,
and
hospital
porters).
The
communication
program
consists
of
the
following
parts:
(1)
Courses
for
health
professionals
employed
in
clinical
depart-
ments.
(a)
Training
of
the
trainers.
(b)
Education
of
the
staff.
(2)
Education
of
new
staff.
(3)
Courses
for
health
professionals
in
service
departments.
(4)
Maintenance
of
communication
skills.
The
training
course
is
the
central
part
of
the
program.
The
training
course
is
based
on
a
communication
course
founded
on
Albert
Bandura’s
theory
of
social
learning
[18],
and
on
the
description
of
the
specific
communication
skills
referenced
to
the
current
evidence
[19].
The
intervention
is
comprised
of
three
basic
elements.
The
first
element
is
a
tight
structure
of
the
communication
with
reference
to
The
Calgary
Cambridge
guide
[19],
the
second
element
is
a
communication
technique
that
focuses
on
how
to
listen,
how
to
help
the
patient
to
explain
his/her
problems,
and
how
to
ask
the
right
questions.
The
third
element
is
a
patient-centered
approach
focusing
on
how
to
elicit
and
respond
to
patient
concerns
and
needs
and
how
to
reach
a
mutual
understanding
of
the
problem
and
its
treatment.
The
training,
each
with
eight
participants,
is
based
on
lectures
developed
by
the
Danish
Medical
Association.
The
content
of
the
course
is
a
mix
of
role-plays
in
small
groups
and
theory
and
debriefing
in
plenum.
In
the
role-plays,
the
participants
act
as
patients
as
well
as
themselves
as
health
professionals.
They
are
given
feedback
during
role-plays
and
on
their
performance
in
the
videotaped
encounters.
Recording
a
videotape
of
an
encounter
with
a
patient
is
a
prerequisite
for
acceptance
of
the
course.
The
training
sessions
are
conducted
by
physicians
and
nurses
from
the
clinical
departments
who
have
been
trained
by
the
Danish
Medical
Association
to
become
certified
trainers
in
clinical
communication.
3.
Results
According
to
the
purpose
of
this
paper,
we
will
describe
the
content
of
the
communication
program,
the
implementation
process,
and
the
initial
assessment
to
date.
3.1.
Courses
for
health
professionals
in
clinical
departments
All
of
the
clinical
departments
are
included
in
a
stepwise
fashion
between
2011
and
2014,
and
to
the
extent
possible,
the
course
and
the
course
plan
are
customized
to
the
specific
department.
The
following
course
modules
are
mandatory
for
all
depart-
ments:
the
structure
of
the
dialog
(Calgary
Cambridge
guide);
psychological
reactions
to
somatic
disease;
and
video
supervision.
However,
some
of
the
modules
are
compulsive
and
the
managers
are
asked
to
choose
4
out
of
10
optional
course
modules
(e.g.,
motivational
interviewing,
the
serious
message,
the
short
dialog,
communicating
with
the
angry
patient/relative,
and
communicat-
ing
with
the
anxious
patient).
Based
on
the
selection
of
these
modules,
a
specific
course
program
is
made
for
the
respective
department.
Meetings
are
held
with
the
managers
of
each
department
approximately
6
months
before
the
trainer
course
begins,
halfway
through
the
process,
and
after
completing
the
last
course.
At
the
first
meeting,
the
managers
and
a
local
co-
ordinator
are
informed
about
the
process
and
expectations
for
the
process
are
discussed.
Midway
and
at
the
end
of
the
implementation
process
we
meet
in
order
to
identify
if
there
are
any
problems
and
elucidated
needs
for
adjustments
and
evaluation
of
the
process.
3.1.1.
Training
of
the
trainers
At
each
department,
4–8
health
professionals
(depending
on
the
size
of
the
department)
are
trained
to
conduct
the
communi-
cation
skills
training
of
the
staff
from
their
own
department.
The
training
of
the
trainers
included
a
recruitment
course
conducted
by
experienced
local
trainers.
The
recruitment
course
is
a
2
+
1
day
course,
similar
to
the
course
offered
to
all
clinical
staff;
however,
at
these
courses
the
suitability
of
the
course
participants
is
assessed
and
based
on
these
evaluations
the
head
of
the
department
selects
the
participants
suitable
for
training
the
trainer
course.
To
ensure
that
it
is
the
staff
most
suitable
as
trainers
that
becomes
certified
trainers,
we
have
found
it
necessary
to
enroll
twice
as
many
course
participants
in
the
recruitment
course
as
the
number
needed
as
certified
trainers
(Fig.
1).
The
trainer
course
is
a
2
+
3
day
course
conducted
by
trainers
from
The
Danish
Medical
Association.
Based
on
an
assessment
of
the
pedagogical
skills
and
understanding
of
the
training
concept,
the
participants
could
become
certified
trainers
of
the
communi-
cation
course.
3.1.2.
Education
of
the
staff
The
course
for
the
clinical
staff
is
a
2
+
1
day
course.
During
the
4
week
period
separating
the
two
parts
of
the
courses,
the
participants
rehearse
and
make
video
recordings
of
one
of
their
own
consultations.
The
departments
are
encouraged
to
appoint
a
coordinator
responsible
for
sending
out
course
material
and
for
ensuring
that
all
staff
members
attend
the
course.
3.2.
Education
of
new
staff
members
After
having
conducted
the
communication
course
for
all
health
professionals
at
the
departments
all
newly
recruited
staff
members
must
attend
the
same
2
+
1
day
course,
as
described
above.
The
courses
are
conducted
for
staff
from
several
departments;
therefore,
the
course
program
deviates
from
the
department-
specific
program.
Two
programs
covering
communication
modules
relevant
for
the
clinical
departments
have
been
designed;
one
program
contains
a
module
about
‘the
motivational
interview’
and
the
other
program
contains
a
module
about
‘the
serious
message.’
Furthermore,
the
program
also
allowed
for
the
possibility
of
addressing
other
communication
issues
based
on
the
desires
of
the
course
participants.
J.
Ammentorp
et
al.
/
Patient
Education
and
Counseling
95
(2014)
429–432
430

3.3.
Courses
for
health
professionals
in
service
departments
For
radiology
staff,
medical
laboratory
assistants,
secretaries,
and
hospital
porters
working
in
the
service
department
individual
two
day
course
has
been
designed.
The
programs
are
developed
based
on
information
gathered
at
meetings
with
the
professionals.
The
programs
remain
in
concordance
with
the
concept
of
the
main
course
for
the
clinical
staff,
and
therefore
also
include
the
Calgary
Cambridge
guide
and
role
playing,
but
the
video
recordings
are
omitted.
3.4.
Maintenance
of
communication
skills
It
has
been
the
intention
to
establish
a
program
that
is
maintained
after
the
project
phase
and
which
continues
to
develop
and
improve
the
communication
competences
of
the
employees.
To
accomplish
this
goal,
a
guideline
for
maintenance
of
communi-
cation
skills
has
been
developed.
Thus,
a
network
for
the
trainers
intended
to
serve
as
a
forum
for
exchange
of
experiences,
knowledge,
and
for
inspiration
has
already
been
established.
Furthermore,
the
trainers
will
be
given
the
opportunity
of
training
in
specific
communication
tasks.
Finally,
the
departmental
management
is
expected
to
plan
yearly
refresher
programs
for
the
staff.
The
document
has
been
approved
by
the
Council
of
Quality
at
Lillebælt
Hospital.
3.5.
Initial
evaluation
To
date,
54
health
professionals
have
been
educated
as
certified
trainers,
and
we
plan
to
educate
another
32
trainers.
Five
departments
have
finished
the
training
courses
for
their
staff,
9
departments
are
conducting
the
courses,
and
5
departments
have
started
the
training
of
trainers
or
will
start
within
the
next
6
months.
Based
on
the
feedback
from
7
halfway
meetings
between
the
managers
of
the
departments
and
the
first
and
the
second
author
only
minor
adjustments
have
been
made,
such
as
revision
of
the
course
material,
clarification
and
formalization
of
the
process
of
selecting
the
trainers
and
adjustment
of
the
information
to
the
course
participants
and
the
managers
of
the
departments
in
order
to
clarify
the
scope
of
the
expected
time
consumption.
Nevertheless,
based
on
these
positive
experiences
reported
from
the
clinic
and
another
halfway
meeting
held
between
all
the
managers
of
the
departments
and
the
hospital
managers,
it
was
concluded
that
even
though
the
training
of
the
staff
is
resource-
demanding,
the
program
will
continue
as
planned.
In
ongoing
studies,
of
which
two
are
Ph.D.
dissertation
studies,
we
are
investigating
the
effect
of
the
training
courses
on
communication
with
patients,
patient
complaints,
and
the
self-
efficacy
of
health
professionals.
Furthermore,
we
will
identify
barriers
and
facilitators
influencing
the
implementation
process.
4.
Discussion
and
conclusion
4.1.
Discussion
As
the
departments
are
included
in
a
stepwise
fashion,
it
has
been
possible
to
evaluate
the
process
continuously.
This
evaluation
has
only
necessitated
minor
adjustments,
and
although
the
program
is
resource-demanding,
the
departments
included
thus
far
have
had
a
positive
experience.
If
the
communication
program
is
to
be
a
long-term
success,
one
of
the
main
challenges
is
to
ensure
that
the
communication
program
continues
and
develops
further
after
the
project
period.
Translation
of
research
into
practice
is
very
often
hampered
by
inadequate
infrastructure
and
a
lack
of
an
organization
that
can
take
over
after
the
project
period
[20,21].
Therefore,
in
accordance
with
suggestions
from
the
implementation
literature
[11,21],
we
have
focused
on
elements
that
promote
the
sustainability
of
the
program
by
establishing
an
organization
that
can
ensure
that
all
new
employees
participate
in
the
communication
course
and
that
yearly
refresher
courses
are
established.
The
fact
that
the
trainers
are
recruited
from
the
departments
where
they
will
be
teaching
the
staff
is
also
considered
a
strength
that
can
contribute
to
the
maintenance
of
the
program.
The
trainers
are
deemed
to
have
a
strong
interest
in
supporting
and
developing
the
communication
courses,
thereby
having
a
very
important
role
as
ambassadors
for
the
communication
concept.
Finally,
the
circumstance
that
all
staff
members,
including
the
managers,
will
have
participated
in
the
course
might
influence
the
communication
culture
and
enhance
the
focus
on
communication
as
a
core
skill
in
clinical
praxis.
4.2.
Conclusion
Being
this
far
along
in
the
process,
we
are
confident
that
we
will
succeed
in
implementing
the
entire
program
as
planned,
although
Recruitment course
2+1 da
y
8 partcipants
Recruitmen
t course
2+1 da
y
8 partcipants
T
rain the tra
iners cour
se
3+2 days
8 participants
Comm
unicat
ion
Course
2+1 da
y
8 partcipants
Training of the trainers Training of the clinical
5- 8 month staff 6 – 18 month
Comm
unicat
ion
Course
2+1 da
y
8 partcipants
Comm
unicat
ion
Course
2+1 da
y
8 partcipants
Comm
unicat
ion
Course
2+1 da
y
8 partcipants
Fig.
1.
Implementation
of
the
communication
course
at
the
individual
clinical
departments,
including
training
of
locale
trainers
and
training
of
the
staff.
J.
Ammentorp
et
al.
/
Patient
Education
and
Counseling
95
(2014)
429–432
431

there
has
been
and
still
will
be
many
competing
agendas
in
the
departments.
4.3.
Practical
implications
At
this
stage
of
the
process
we
have
only
been
able
to
present
preliminary
results;
still
we
hope
that
our
experiences
and
considerations
so
far
can
be
used
as
inspiration
for
health
professionals
who
want
to
take
up
similar
challenges.
Funding
The
study
was
supported
by
the
Region
of
Southern
Denmark
and
Lillebaelt
Hospital.
The
sponsors
were
not
involved
in
study
design;
in
collection,
analysis
and
interpreting
of
data;
in
the
writing
of
the
report;
and
in
the
decision
to
submit
the
paper
for
publication.
Conflict
of
interest
No
conflict
of
interest.
Acknowledgments
The
authors
want
to
thank
the
trainers
from
the
Danish
Medical
Association
for
their
training
of
the
local
trainers.
Also,
thanks
to
the
hospital
management
and
the
head
of
the
departments
for
their
commitment
and
for
making
it
possible
to
implement
the
communication
program
at
Lillebælt
Hospital
and
to
the
Patient-
and
Hospital-secretariat
for
the
excellent
cooperation
in
the
planning
of
the
courses.
Finally,
thanks
to
all
of
the
trainers
at
Lillebælt
Hospital
for
their
involvement
in
the
program.
Appendix
A.
Supplementary
data
Supplementary
data
associated
with
this
article
can
be
found,
in
the
online
version,
at
http://dx.doi.org/10.1016/j.pec.2014.03.005.
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