International Journal of Healthcare Simulation

Background and aim:

Effective communication is a vital skill in healthcare, whether discussing sensitive or challenging topics, explaining decisions, supporting colleagues, welcoming staff, de-escalating situations, reviewing accolades and complaints or building rapport. Many people find it difficult to initiate, hold, conclude and follow-up conversations. Simulation-based education (SBE) has been identified as an effective way to improve communication skills, however, a structured communication skills framework is necessary. A plethora of established communication skills frameworks [1-3] exist, each excellent within their own sphere. Our purpose was to develop a generalizable, transferable framework to suit the broad range of communications covered in SBE; a framework which can be repeated, practised, and easily memorized.

Methods:

Experts in communication skills, healthcare education, and SBE reviewed existing communication skills frameworks. The new framework’s foundations were key skills, within every conversation, between healthcare professionals and colleagues, patients or relatives/carers, or between non-healthcare professionals and colleagues/clients. Thematic analysis of data from participants of sessions from the previous five years identified these themes:

Why, when, where and how to start a conversation

The best time to have a conversation

Showing empathy and listening (verbal and nonverbal skills)

Providing support, without being solution orientated

How to sense-check ourselves and others, after the conversation

The STEPS framework was developed two years ago and has been used by our facilitators in SBE, to assist participants to be confident in structuring and having conversations.

Results:

The five-step framework has a memorable mnemonic STEPS; Start, Time, Empathy, Provide-support, and Sense-check. STEPS has been well received by over 500 participants. They have reported that it is easy to remember and highly applicable to situations in and out of work. Post-intervention surveys showed significant improvement in learners’ confidence and perceived competence in holding conversations. Focus group discussions revealed that learners found the STEPS approach helpful in managing their own emotions and in creating an open dialogue with others.

Conclusion:

The STEPS approach is a generalizable communication skills framework that can be implemented in SBE activities to improve people’s understanding of structuring conversations. It has had a positive impact on participants particularly regarding their perceptions of having ‘challenging’ conversations. The STEPS approach can be used to guide healthcare and non-healthcare professionals in various settings and is a valuable tool in improving person-centred communication. STEPS helps people initiate, structure and navigate a conversation with kindness and in a way that makes constructive outcomes possible.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.