The Science of Communication

We recently had the opportunity to sit down with the amazing Harriet Downing , Senior OVA Clinical Consultant and Neuropsychologist at Western Health , to learn more about the skills frontline workers can use to prevent occupational violence and aggression.?

What is the origin behind Reframe Your Response?

Reframe Your Response was a slogan that Elisa Ilarda generated and the idea was how do we recognise what we're bringing to an interaction with somebody else and how do we realise that we've got more control than we might immediately think we have over the outcome of a situation. There is a quote from Viktor Frankl that says something along the lines of, ‘between stimulus and response is a space and in that space is our power to choose’. So what we're trying to do in Reframe Your Response is to teach that behaviours of concern and occupational violence don't come from nowhere. They exist in a relationship between, say patients and family members and staff. So how do staff reflect and plan for what they're bringing to a situation and use soft skills in order to minimise the chances of things escalating.

How difficult can it be for people to realise they have a choice in their response?

It can be difficult to demonstrate the impact that somebody has in their choices of interaction particularly in a conflict interaction. In an educational space, role play goes some way into practising these things but I think one of the benefits of virtual reality is that you can track or make tangible where different responses can lead to different outcomes.

One of the things I noticed during the production is that a conflict can take different paths, sometimes you can resolve a situation succinctly, other times you can easily put your foot in your mouth. Is it possible to recover from a bad conversation?

I'd say that there are multiple opportunities in any interaction for things to wobble and get back on track. There's no perfect way to have a conversation or an interaction with somebody else. So sometimes we react automatically. That's very, very human. Partly that's about that human thing of mirroring somebody's level of energy. If somebody's really up and high, we get really up and high. If someone's low we'll join them down there too. So part of this is recognising when you have that automatic reaction, and then taking that space to say, okay, that's this other person's stress or distress, and shift from that empathic distress into compassion where we say, okay, I recognise the suffering of this other person. I'm going to hold a non judgmental space and seek to connect and understand what's going on for them and then help them to take action to relieve this. In terms of when you connect or disconnect with somebody, you might find that that's partly because you're reacting along the way automatically. Sometimes we just have to take steps to regulate ourselves or tone down our own stress response, so that we can maintain agency to have a goal and get where we want to go in that interaction.

I remember when we were recording the motion capture session, you and Lisa Spong were sharing ways that a nurse or frontline worker would manage emotions that bubble up in these difficult engagements. What would you suggest folks do in those situations?

So one of the first things that we encourage people to do is to be aware of their own reactions: What are they thinking, feeling and how are they wanting to behave and so on. Then they can take steps to reduce their stress. So focusing on their breathing and their self-talk, like “I've got this", "I'm going to see it from their perspective”. If it's something like, "I'm noticing that I want to say something like, “You're overreacting!”, we use that as a cue to say “Okay, I'm bringing in judgement here. I need to step back and see it from their perspective”. So it's about recognising when you're reacting and creating that space, but it's also about modelling calm so that the other person can match where you're at, and you can slow things down. You might slow down how quickly you’re talking and how quickly you're moving. You focus on your body language, and it's about sending ‘Signs of Safety’. So open body language, it might be about having your tone of voice and not even being super warm and super smiley but at least neutral, super non threatening. We also lower our pitch because when someone is in that fight or flight state where the person has shown behaviours of concern or is likely to be in that state, the auditory system picks up on the lower frequencies frequencies, we can miss some of the higher ones so it's about lowering your tone of voice as well when you speak. Then reflect back to the person some of the key words that they're using and try to help them to identify what their main concerns are and how they're feeling.

In these scenarios should you look to get a resolution quickly or do you need to give the conversation time?

Yes, connection is key. One of the tendencies in the workplace is to get things done quickly: I don't have time for this; I've got all these tasks I need to do. But actually what we need to do in this space where there's a chance of things going pear shaped and having an episode of occupational violence and aggression, is to not rush people. That means giving the time that's needed. We have a de-escalation model that starts with Stay Safe or asking "is it safe to be here?". The next step is validation; so connecting with the person; taking as much time here as you need to connect with their emotional state and their understanding of the situation. You really need to spend time understanding this. And that will take as long as it takes. Often it won't be long, it really depends on the person, but if you can show them that you're there with them and that you're wanting to understand, you are understanding and helping them to articulate what's going on for them. Often that won't take very long. But it's not until you've sat with that person and they can regulate as well that you move on to the final step of collaborative problem solving. There's a tendency sometimes for us not to spend enough time just sitting with another person in their distress. We want to solve things with people. We want it to be okay but actually sometimes that's not our job. Or sometimes we can't do that completely and it's just about showing up for someone and sitting in a difficult situation with them.?

With the immense workload and time pressures that the average nurse is under, I can imagine that it is easy to rush these types of difficult interactions.

It's not only that you have the time, but you have the permission to use the time. At Western Health, there's a policy that says 'It's Okay to Step Away' and that comes down from the CEO. I think it's tricky for some people to know when to step away and when not to and there are a lot of tasks and demands on nursing staff. Where there is a risk of OVA, staff need also to know that they're allowed to take the time they need. With some of these soft skills that we talk about, there are tangible ways to use them and when it seems like you might really disagree with this person and their perspective or not really like them, you can still show up and use the skill of non-judgement. You can show up and use the skill of respectful language. You can use the skill of validation. And then at the end of that, when you're safe you can debrief with appropriate professional supports as well.

Prior to our collaboration, I would immediately easily react to confrontation like ‘they've got a sword and I'm going to put up a shield, here we go!’. However, you started to educate me on how emotions work, the range of emotions and that there’s actually primary and secondary emotions. Are you able to share with us a 101 on emotions?

I would probably have to look it up to give you a really accurate one but basically, it's about a person's different levels of emotion. Anger is what we consider to be a secondary emotion because often underneath anger is something else like fear or anxiety and so on. It's when we're in that threat state that we show anxiety for example by becoming angry because that's what's easiest for us in the moment. Sometimes we're not very good at being assertive and saying this is what I need at this time. Maybe we've never had that skill or never been able to be assertive. So we just communicate that need or that emotional state in the only way we know how.

You’ve just reminded me of this amazing Instagram story I watched the other day about a kindergarten teacher consoling a little? boy who was upset with another student for doing something that he didn’t like. It was amazing to watch the teacher give the boy that was upset some space to process the tears and then coached him to not just cry but to let the other student know that he didn’t like what he was doing. Then I just thought, oh this is so applicable to the workplace.?

Everybody has their triggers, right? There are things that set us all off but sometimes we're triggered into a strong emotional reaction that might not seem to fit the reality of our situation. It's because of stuff that's happened in the past so that we might be showing up as an adult, we're not acting at the age we are now because there's something that's brought us back to this previous point in time. So when we're absolutely not in our most mature space, that's where that self-regulation piece comes in to help you get on top of that. We can also consider things like, how do you communicate requests? How do you communicate boundaries? Where's the conversation that's happening to ask what people's expectations are and to communicate our own? And then to clarify things and provide the right information. There's such a space for technology, for communication skills, for all these things just to clarify expectations and give people more control over a situation that is really destabilising.

I feel like from working on this OVA prevention training, I’ve unlocked a greater appreciation of how hard good communication often is and how easy it can be a source of conflict.

It sounds obvious, but you're absolutely right that communication is really hard. If we could just articulate our needs and feel comfortable in articulating them, putting ourselves out there and being okay with a response, that would be nice. Having some pushback and that be okay. Just being able to sit with a disagreement and that be okay...It's not a reflection that you're a bad person or something.

During my career I’ve learnt about unhealthy peace and I try to encourage my staff to not shy away from disagreement. If everyone is also agreeing then I’ll know something isn’t right. Maybe we don’t have a diverse team or there is a fear of speaking up.?

Absolutely. I think in any human interaction, there's a space for these sorts of discussions, this sort of training, even. In the Western Health setting, we have such a diverse population. So many different cultures, language groups, ages, socio economic background and things, but we're all humans. It's that common humanity piece. How do we bring it back to that every day? We're all people. Every person has worth and value and a right to be here.

What a beautiful point to close out our discussion, we always need to focus on our humanity. Before we wrap things up though, what educational sources would you recommend for folks looking to learn more about better communication?

I follow a bunch of people on Instagram and I can recommend several different books. I've really liked Dr. Gabor Maté. So partly it's about understanding diversity, understanding lived experiences that are different from your own. So for things like addiction, drug and alcohol problems, I really love Gabor Maté’s ‘In The Realm Of Hungry Ghosts’. He also has a fantastic book on ADHD called ‘Scattered Minds’ and the book called ‘Hold On To Your Kids’ (with Gordon Neufeld), which has themes that have come out in both his other books, that so much of what's showing up for many dysfunctional adults is their life experiences and these people were all children at one stage. So understanding what is it that's important about childhood and attachment and how important that is. Our society is structured in a way that's not conducive to really healthy relationships in a lot of situations. So Gabor Maté is one. I really have enjoyed the work of Brené Brown, she's got her own research, but also draws on a lot of other people's research. So she references people such as Kristin Neff, who is a researcher in self compassion. And I think Paul Gilbert is another one in that space. I follow people on Instagram who work in the hostage negotiation space, people like Chris Voss. I try to read an eclectic mix of topics and various formats from books on communication to research papers on compassion and everything in between.

Thank you so much to Harriet for taking the time to educate us on the science behind communication and how we can reframe our response to aid in preventing occupational violence and aggression. To hear more about Western Health's ground breaking programme, please visit their website.