Published: 24/02/2005, Volume II5, No. 5944 Page 23 25

A new training scheme in Hertfordshire is taking a thespian approach to conf lict resolution - with dramatic results.

Chris Mahony reports

No profession has a bigger reputation for being difficult and highly strung than those who tread the boards.

There is therefore a certain logic to deploying highly skilled actors in a training programme that equips NHS staff to deal with challenging, aggressive and violent behaviour. Throw in a TV clinical psychologist who comes across as the thinking person's Davina McCall and you are probably on to a winner.

The Department of Health thinks so, having awarded beacon status to the Relating to People programme developed by the NHS in Hertfordshire.

The programme has four modules, with duration and material shaped by the needs of staff.

The first is a one-day course aimed at equipping administration staff and health professionals working in the community with the skills and confidence to handle hostility and verbal abuse.

The other extreme is a five-day course on active intervention techniques for those in clinical settings where violent or very challenging behaviour is more common.

HSJ was recently invited to the one-day option, which is intended for clinicians such as community nurses as well as office-based staff who encounter patients, clients or their relatives.

The courses are led by Dr Tanya Byron, a consultant clinical psychologist who developed the programme seven years ago with Sarah Childerstone, director of workforce development at Bedfordshire and Hertfordshire strategic health authority.

Dr Byron has recently found fame advising parents on their difficult toddlers in the BBC series Little Angels and she is now filming a similar project featuring adolescents. She adds a touch of TV stardust to proceedings, even while leading participants on a quick jaunt through NHS complaints procedures.

But the bulk of the course is taken up with theatrical demonstrations of the right and wrong ways to handle verbally aggressive people whose aggression might turn physical, and responding to verbal complaints.

The first demonstration features an unpleasant, angry patient demanding to see a GP but instead being wound up by a 'receptionist' whose bureaucratic haughtiness would not have been out of place on a Soviet-era Aeroflot booking desk. She suggests the man is behaving 'like a typical male' and that he would know of the shortage of locum GPs 'if he read a big paper - like The Independent'.

Some of the 16 trainees gasp in shock at the performance, with several observing that the unpleasant patient was drawn from real life. That is surely the ultimate accolade for any actor, and it is echoed at the day's end, when the trainees provide universally positive feedback. A couple of trainees comment that the actors were 'very real' - and it is obvious that they are veterans of stage and screen rather than amateur dramatics.

We are split into groups to come up with suggestions for improving both the verbal and non-verbal communications of the receptionist, not a difficult task. Dr Byron acknowledges that much of this is 'not rocket science'.

She says: 'I am not going to tell you what to do - you know what to do. It is about helping you to think more specifically about how you can manage your own anxiety enough to deal with a person who is being aggressive. It will not be your skills but your anxiety that stops you doing it [defusing an aggressive person].' This is backed up by Dr Byron's run-through of our in-built physiological, psychological and behavioural responses to anxiety. The angry man screaming fit to burst a vein in the GP surgery reception is simply reverting to a primitive state, where the parts of his brain normally used for reasoning are under-resourced with oxygen that has been diverted to prepare the muscles needed to fight or flee.

As one of the trainees said: 'Next time someone is screaming at me I will just think that he is only using two-thirds of his brain.' The serious point is that there is no point in trying to reason with such a person or taking personally the abuse emerging from him.

Dr Byron says it is a matter of assessing and managing the client's journey along the 'arousal curve' while 'managing your own anxiety'.

'You have to work out why they are being aggressive. Only then can you solve the problem.' Challenging the client's behaviour while he or she is at the peak of the 'arousal curve' can have devastating consequences, we were warned.

There is a lot of enthusiastic intervention from the 16 trainees and Dr Byron insists this is fairly typical - and not just because this particular cohort is entirely female and therefore likely to be blessed with superior communication and empathy skills (according to some).

'On other modules we get many more male staff but the interaction is usually just the same.

That is why we spend so long warming up with the introduction.' That warm-up takes the form of chatting to, and introducing your neighbour.

The day ends with role-playing, with the actors doing what the profession has a reputation for doing - complaining. Sadly HSJ did not perform too well with a stressed 'solo mother' but, reassuringly, the NHS staff did rather better.

Find out more

For more information contact Marie Wiles of Bedfordshire and Hertfordshire strategic health authority workforce development directorate, 01727-792895



Bored of written assessments and dreary presentations? Try enrolling on one of these exciting training courses Combating stress Former adult education course leader Betty Sutherland has carved a niche for herself as the 'health managers' tai chi master' after a nurse attending her classes suggested that the calming movements of the martial art could be beneficial to stressed-out health managers.

Ms Sutherland followed-up the idea and began holding classes at Rotherham and Wednesbury West Bromwich primary care trusts.

'I had a particularly good response from NHS workers, ' says Ms Sutherland.

'I place an Eastern emphasis on the art so that people are learning how to meditate and relax while doing the movements. It brings you a great sense of well-being and helps to regulate your breathing, which calms you down.' Ms Sutherland runs about two classes a month in Yorkshire, where she lives, and she regularly travels around the UK to lead sessions.

'Alternative approaches are now being embraced by the NHS. Stress is becoming one of the major threats to life and the onus is now on the employer to reduce stress in the workplace, ' she adds.

Classes cost around£150 for a twohour session.

Contact Betty Sutherland via Already Sorted Ltd on 0870-444 8501 or e-mail tim.tavanyar@alreadysorted. com

Communication skills

Talent retention specialist Learnpurple offers classes in which senior managers are asked to make balloon animals with one arm tied behind their back.

'As you can imagine, this is quite difficult, ' explains Learnpurple managing director Jane Sunley. 'But people quickly learn how to work together to get the job done.

'We stage a few silly tasks such as the sheep game, where half the people in the room are blindfolded and the other half are the 'controllers'. They have to herd the blindfolded 'sheep' into a pen just by using sounds or making noises.

After the initial silliness, we find that everyone calms down and starts to listen to each other - so It is great for teaching communication skills.' Learnpurple also offers classic wacky training techniques and learning exercises such as building an indestructible bridge with drinking straws, which is good for developing problem-solving skills.

Ms Sunley is adamant that all of Learnpurple's techniques are both helpful and effective: 'People at a high level do happily engage in these types of exercises, but there does have to be a serious meaning to it to ensure that everyone benefits. What we do helps people to become more productive and motivated in their working lives.'

Contact Jane Sunley on 020-7836 6999 or visit www. learnpurple. com


Spy Mission is an interactive team development event, designed to test your planning, delegation, communication and time- and teammanagement skills.

Groups can meet up anywhere in the UK and the organisers will provide your group with a base station and access to the internet. Once you are split into teams, you can access your online mission briefing, which outlines the mission scenario and your objectives.

After providing participants with relevant advice and clues, you are given a sets of training notes, a spy kit list and some helpful hints before the countdown to mission end begins. Each of the teams set off to complete the mission, which can range from infiltrating 'enemy quarters' to retrieving 'top secret' information from nearby locations.

The event is designed to help form a strong working bond between colleagues, although budding James Bonds can also use it as an opportunity to test their leadership skills.

Spy Mission can take four hours or last all day and the cost depends on how long you want your mission to last and how many people take part.

Contact ChilliSauce on 08454 507 450 or log onto www.chillisauce. co. uk

Staying calm

Andrew Henley has been a criminal barrister and a keen meditatator for over 20 years. He holds one-day yoga seminars once every three months in central London for overworked professionals.

'The classes are mainly attended by lawyers, ' explains Mr Henley, 'but none of the impute has anything to do with law, so the class is open to everyone.' Mr Henley works with ananta yoga to offer a structured schedule that encourages participants to examine the causes and effects of stress and combine it with practical exercises such as breathing techniques.

'The seminar aims to increase each participant's awareness of the internal causes of stress and teaches them how to relax and meditate, ' says Mr Henley.

'It helps to counteract the effects of stress by the use of practical exercises which, with regular practice, will also help to reduce the build up of stress, ' he adds.

Contact ahenley@furnivallaw. co. uk

Key points

The Relating to People programme aims to broaden the communication skills of NHS employees called up to face difficult behaviour.

Typically divided into four modules, the programme can be tailored to meet your needs.

The programme is dominated by demonstrations of good and bad ways of facing anxious situations.