Training of Trainer Manual on Soft Skills

Training of Train ainer er  Ma  M a n u a l on S of t Sk Skiills

“The biggest disease today is not leprosy or tuberculosis, tuberculosis, but rather the feeling of being unwanted.” Mother Teresa

Training of Trainer   Manual on Soft Skills Skills

© World Vision India, Axshya India, August 2010

Dear Participant,

Greetings!

We appreciate your participation in this TOT organised by World Vision, under the aegis of Axshya India This manual contains the following sections: Section A – Session Plan of Soft Skills Modules Module 1 - Effective Communication and Interpersonal Skills Module 2 - Team Building Module 3 - Conflict Resolution Module 4 - Time Management Section B – Soft Skills Content Section C – Facilitation Skills Suggested References & Bibliography Before we plunge into the world of soft skills, it is recommended that you familiarize yourself with the principles, techniques and toolkits of facilitation provided in Section C of the manual. This will empower you to effectively conduct soft skill training sessions. We are grateful to Global Fund which provided funding for printing this manual under round 9 grant and we acknowledge Stanley & Associates for their contribution in the making of this manual.

Happy Interactions! With Best Regards, Team, Axshya India

C  O  N TE    N T S  

Section A – Session Plan of Soft Skills Modules

1

Section B – Soft Skills Content

39

Section C – Facilitation Skills

99

References and Bibliography

124

 SEC T I    O  N   A 

Session Plan of Soft Skills Modules

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SESSION PLAN FOR SOFT SKILLS MODULES Module 1 - Effective Communication & Interpersonal Skills

(4 hours)

1. A. B. C.

Introduction and Icebreaker Orientation to Importance of Communication Skills for TB Professionals Communications Theory Barriers and Filters

(40 min)

(20 min)

2. A. B. C. D. E. F. G.

Skills needed for Effective Communication Active Listening Non-Verbal Communication Feedback Dealing with Feelings Empathy Building Questioning Techniques Skill Practice

(30 min) (30 min) (35 min) (15 min) (10 min) (10 min) (40 min)

Module 2 - Team Work

(4 hours)

A. B. C. D. E. F.

(30 min) (1 hour) (15 min) (45 min) (45 min) (45 min)

Importance of Working in Teams Elements of Team Work Stages of Team Formation Effective Teams – Concept Trust & Communication How not to Function as Dysfunctional Teams

Module 3 - Conflict Resolution

(4 hours)

A. B. C. D. E.

(30 min) (30 min) (45 min) (45 min) (1 hour)

Understanding Conflict, Conflict Resolution Conflicts in the TB Arena – a discussion Conflict Resolution Styles Negotiation Skills Role plays on Conflict Resolution

Module 4 - Time Management

(4 hours)

A. B. C. D. E. F. G.

(35 min) (15 min) (10 min) (45 min) (1 hour) (30 min) (30 min)

Need and Importance of Time Management Daily Time Map Barriers to Time Management SMART Goals Tools & Techniques of Time Management Getting Organised Time Management in Meetings

 Module I

Effective Communication Skills & Interpersonal Skills

1. Introduction and Icebreaker

40 min

A. Orientation to Importance of Communication Skills for TB Professionals Effective communication skills are important in any line of work, but particularly important when dealing with people regarding their health. Whether you are listening to symptoms that may help diagnose a problem, or relaying information that is important to someone's well being, effective communication skills are necessary. You must be able to communicate effectively with co-workers, patients and Health officials alike. The specialized vocabulary of the TB health care industry includes many terms specific to the field. You must know these medical terms, and be able to explain them effectively to those who do not. If you are giving a diagnosis, for example, give the medical term, and then explain it in layman's terms to the patient or to the family/Community audience. Good communication contributes to quality care and improved health status. It is our belief that clear, candid, accurate, culturally and linguistically competent communication is essential for the prevention, diagnosis, treatment, and management of TB in India. Consider the following situations: You are working with a colleague, who is senior to you, and with whom you  have had frequent friction in the past –and now you need his support for an assignment  You are taking a case history from a family  You are in a meeting with District TB officials. The District Magistrate, who is chairing the meeting, asks you for your assessment of the low rate of progress in combating TB in your district. How will you respond?  You are to present a report on the TB status in your area –how will you present it?  There is a conflict in your team. Two members are on a constant argument. You need to calm tensions before you can complete the work on hand. How will you communicate this to your warring colleagues? Training of Trainer



You have to increase awareness in the Community, and obtain the support of the influencers in the Community to RNTCP initiatives –how will you make your case?

In each of the above cases, you not only need to communicate, but to communicate effectively. Which situation is easy, and which one would you find it difficult to handle? This module is about communication strategies to cope with such situations. There is no single perfect way of ensuring that you will be completely understood by others –but there are several straightforward of helping you to communicate with others more effectively. And, considering that every little improvement in your communication can directly or indirectly lead to desirable positive outcomes such as: improvements in case detection rates,  decrease in default cases,   more TB suspects coming in for treatment,  increased awareness of TB and its effects;  greater community involvement  lowering of mortality rates Then, you have a tremendous case for not only understanding the communication process and how to apply it in your work life, but you also have an enormous realization of what it can do to increase your own productivity. More importantly, how it can accomplish the noble cause of saving lives, vulnerable to the deadly scourge of Tuberculosis –which is what the Axshya India Project is all about.

Objectives of the TOT Workshop This module will help define, assimilate and embed among the TB trainees the following competencies: Effective Communication Team Building Conflict Resolution Time Management Facilitation Techniques RNTCP priorities      

Slide No. 3

1.1 Facilitator to introduce himself, speak about the genesis of the Axshya India Project and the expectations of all stakeholders about the outcome of this Training.

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1.2 Training aids used are depicted as per the pictures shown below: Slide

Whiteboard/blackboard

Flip Chart

Participant Workbook

1.3 Speak about the importance of communication for people working in Axshya India project (Refer Section B, Module 1, 1. Introduction)

Day 1: Effective Communication & Interpersonal Skills for TB Staff 

Slide No. 4

1.4 Bring out objectives of the program

Objectives Understand communication and its components Role of body language in communication How do we listen to people – active listening. How to convey our perceptions about actions; Behaviour – feedback. How do we deal with our feelings? How we can apply all of the above to improve our performance in TB control     

Slide No. 5 Training of Trainer

1.5 Set ground rules along with the participants. Announce timings of program and break timings. (interaction, phones on silent mode, confidentiality, punctuality, fun, silly mistakes, etc.) Stick up flip chart on a wall for the rest of the program to remind them.

1.6 Icebreaker – Celebrity Introductions Procedure: Ask participants to pair up with the person sitting next to them. Each pair has to come up in front of the class and introduce the partner as if he/she is a celebrity. Enact/ ask a volunteer to enact a TV anchor introducing a celebrity guest on the show. Introductions have to be high on energy and enthusiasm. Give 5 min for preparation.

B. Communications Theory 1.1 What is communication?

What is Communication

? Slide No. 6 Invite responses, and write down the responses on the board. Pick out the ones you want after they finish. So we see that you define communication as The sharing or exchange of information (i.e. thoughts, ideas, and opinions) between two or more persons. Is this a sufficient definition? Anything else required? The last sentence of this definition should be “…so that there is common understanding between them.” Talk about “sharing information” and “common understanding” with examples to make the definition complete.

(Refer Section B, Module 1, 2. Communications Theory)

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C. Barriers & Filters

20 min

Barriers & Filters to Effective Communication

Slide No. 7 The external obstacles are distractions which exist outside both the sender and receiver, and prevent effective communication. These are called as Barriers. Prompt for examples.

(Noise, language, cross-talk, distance, mechanical failure, jargon, visual distraction etc.) The internal obstacles are those which exist within the sender and the receiver. These prevent the undistorted flow of communication. In other words, they tend to distort communication, and hence they are called as Filters. These are the feelings that exist inside both parties. Prompt for examples. (Shyness, superiority complex, disinterest, pre-conceived notions or opinions, rigid attitudes, anger, disappointment, sorrow etc.)

Filter Example of a filter: The case of a senior Consultant from WHO visiting the district. Some may assume that he does not know about the ground realities. This is a typical example of a filter. Can you list 5 such cases of filters?

Slide No. 8

(Refer Section B, Module 1, 3. Barriers and Filters) Training of Trainer

Exercise on Barriers & Filters 10 min Procedure: Divide class into 4 groups. Give the groups one situation each. Ask them to read the situation and discuss their responses in their groups, the barriers and filters in the situation and jot down in the table provided. At the end of 10 min, ask each group to read out their situation and share with the class. Facilitator will give additional inputs, if any, at the end. (Refer Section B, Module 1, 4. Exercise on Barriers and Filters)

2. Skills needed for Effective Communication A. Active Listening

30 min

1.1 Active Listening – The Mother Skill of Communication is used to remove barriers and filters and bring about effective interpersonal communication. Ask participants if there is a difference between listening and hearing. (Refer Section B, Module 1, 5. Active Listening)

1.2 How does one listen actively? Prompt for responses. 1.3 Active Listening Toolkit Show slides, explaining with the help of an illustration. (Refer Section B, Module 1, 6. Active Listening Toolkit)

To be proficient in Active Listening

1. Suspending Judgement

Slide No. 9

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Learn to actively listen and understand the facts of a case before passing judgments regarding the same. ‘Suspend’ your judgments until then!

Slide No. 10

Attending Skills

!

ATTENTION Slide No. 11

Imagine the DTO briefing you about the new RNTCP schemes. Indicators (like the nodding of one’s head) to show that you are paying attention are called ‘Attending Skills’.

Slide No. 12 Training of Trainer

Clarification

Slide No. 13

While noting the patient’s medical history, for example, clarifications should be made regarding gaps in their medicine intake, reasons if any, difficulties faced, etc.

Slide No. 14

Summarization

Slide No. 15 Training of Trainer

Summarization is an important tool of active listening. For example,a typical example of summing up would be “After a month of cat-1 TB treatment starting from July 4th ,you stopped taking medicines from August 4th after you underwent a urine test and discovered you had  jaundice. Am I right my friend?”

Slide No. 16

Paraphrasing

Slide No. 17

Attending Skills

The new capacity building scheme of RNTCP is in a nutshell,all about enhancing the capacity of the District level and TU level institutions to improve their performance.

Slide No. 18 Training of Trainer

So how do we paraphrase? Let us take an example. You are working in a health center for two years. Another person has joined the health center two months ago, and has become your friend. One day, as the two of you are having tea together, the other person says to you:

“My boss, Mr. Raghavan, is a real tyrant. I have to work daily from 6 am to 9 pm. I am not able to pay any attention to my children. I am sick and tired of working in this health center” Ask class to analyze each sentence. Write down only the phrases on white board/ flip chart as follows and prompt class to say which part of the sentence has to be paraphrased: 1. “My boss, Mr. Raghavan, is a real tyrant” – contains a Name, Criticism, and Hard Words. 2. “I have to work from 6 am to 9 pm” – contains Facts. 3. “I am not able to pay attention to my children” – contains Facts. 4. “I am sick and tired of working in this health centre” – contains Criticism, Hard Words, and Controversy. Remember, while paraphrasing:    



Avoid Names, Cri�cisms, Hard/harsh words, and Controversy Only s�ck firmly to the facts Avoid the emo�onal content of the statement You start the paraphrase by using the words “In other words,” “I understand that,” “It appears that” etc, and Repeat the facts shortly to the speaker.

“It appears that your working hours do not allow you to pay attention to your children, is that right?” You will also observe that the above question is a close-ended question, i.e. the other person can only reply ‘yes’ or ‘no.’

B. Non-verbal Communication 1.1 Activity for non-verbal communication Procedure: Facilitator will stand before the participants and say

30 min 10 min

All of you please stand up. Now, I want all of you to follow me. All of you look at me, and stand straight. Now, lift up your right arm and point it at the ceiling. (Facilitator will perform the same action, and also do all the following actions as he says them aloud.) Next, keeping your index finger pointing at the ceiling, bunch the other fingers into a fist. Bend your right elbow, and take your right index finger slowly down so as to touch the centre of your forehead.

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Again point your finger at the ceiling. Take a deep breath. Again bending your right elbow, move your finger slowly downwards to touch your chin (Start moving your right hand downwards while saying this, and touch your NOSE. Most of them will do the same, and some will say, Chin, Chin. Then ask them to return to their seats.) Debrief: So what happened? How many of you touched your nose? Why did you do this? Because you did what I did, but not what I said. That is why this caused confusion. This same confusion is present in communication. If the words, the tone, and the body language are all in step, in synchronization, then the communication is said to be CONGRUENT. If any of the above elements is in dissonance, or not in synch, then the communication becomes non- congruent. The message becomes unclear to the listener, and a wrong meaning is carried away because of this non-congruent message. There is one more aspect that I would like to point out to you. What percentage of the message is conveyed by words, what percentage by tone, and what percentage by body language? (Ask them to guess) Flip chart 3Vs and then write percentages against each. Research has been carried out on this aspect, and it has been found that only 7 % of the message is conveyed by words, 38% by tone, and as much as 55 % by body language!

Show slides to reinforce.

55% Slide No. 19

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38% Slide No. 20

7% Slide No. 21

1.2 Demonstration 5 min Procedure: Facilitator will do the following, taking the help of one volunteer. (Ask someone to come to you, hand you a book, and say: “This is a very good book. You must read it!” This will be done 3 different times, and your response, though using the same words, will be different each time.) I think that this is a very interesting book. (Just look at the book. Then stare straight ahead, speak in a bored voice, don’t move any part of your body) I think that this is a very interesting book (Don’t even look at the book. Look down, speak in a very nervous voice, as if you are ready to cry)

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I think that this is a very interesting book (Glance through the book, meet the eyes of the lender, make your tone suitably pleasant, and move your head in an assenting gesture) Debrief: Now, which message did you find the most believable? Obviously the third one, because all the components were in step, isn’t it? So do you agree that body language is a very important part of communication? We have said that up to 93 % of communica�on is non-verbal. This includes tone of voice, eye movement, posture, hand gestures, facial expressions and more. The pressure of body language can especially be felt in emo�onal situa�ons. Body language usually prevails over words.

1.3 Body Language Nuances 10 min In your manual, there are guidelines for looking for the clues of body language, but they are not fool proof. They are to be understood in combination with verbal’s, vocals and the situation. Body language cues are also culturally different. There are many books and research material available; however, we will understand some positive and negative body language signs. In your manuals, there are some body language cues. Please read it for more information on body language. (Refer Section B, Module 1, 7. Non-Verbal Communication)

Why Body Language is important

Slide No. 22

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Let’s read body language at • • • • • •

At the CBO At the PHI At the Diagnostic centre Cat 1/11/111 session District level meetings State Level meetings

Slide No. 23

C. Feedback

35 min

Say, “Why do we give feedback? Do we want to criticize the other person, or pull his leg, or be happy over his failure?” “No, we want to be very impartial and fair in correcting something which we perceive to be not quite right.” For example, if I tell you (speak to one of the participants who is late to class), “You are a very irresponsible person. How can you always come late to class!” How will you receive this feedback? What will your response be? Talk about separating the person from the problem and addressing the problem. Ask participants, “What would happen in the absence of feedback?” (Refer Section B, Module 1, 8. Feedback)

1.1 Slide: Feedback Formula Champion the use of the feedback response. Explain each step with examples.

Feedback formula for effective communication

Behaviour Description Feelings Impact Request

Slide No. 24 Training of Trainer

Give the following example to the class and practise giving feedback with the entire class. You belong to a team of five persons, and one of you is being sent abroad by your company. Each member of the team is hoping to be that person. Your boss quietly lets you know that you will go abroad, and tells you to keep it confidential till it is announced. Another friend of yours, Ashok, who is also close to the boss, comes to know this. He rushes to your cubicle to congratulate you. He stands at the cubicle door and says loudly: “Congrats! I heard that you are going abroad!” You silently motion to him to keep quiet, and take him out of the office to the coffee machine. There, you give him feedback as per the four-step model. (Prompt for responses)

Behaviour Description

Ashok, when you said congrats loudly in the Office,

Feelings

I really felt embarrassed, since my teammates don’t know about it yet.

Impact

My friends will think that I’m cheating them in some manner.

Request

Could you please keep the matter a secret till it is announced by the boss?

Feedback Formula

Feedback Formula • • • •

Delayed Reports from District Ego clash at the STO Non cooperation at the CBO Silence during the family/patient interview • Stakeholders blame game

Slide No. 25

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D. Dealing with Feelings

15 min

Purists, however, say that feelings are bad to have in the work-place. Do you agree with them? (Get responses) So, are feelings good or bad to have in the work-place? (Get responses) Well, whether they are good or bad, we still continue to have them.

1.2 Feelings Toolkit Facilitator to elicit each skill from the toolkit with the example provided. (Refer Section B, Module 1, 10. Feelings Toolkit)

E. Building Empathy

10 min

What is empathy? Is there a difference between empathy and sympathy? How do we define Empathy? What we need to understand others more completely is empathy – the ability to re-create another person’s perspective, to experience the world from his or her point of view. It is impossible to achieve total empathy, but with enough effort and skill, one can come closer to this goal.

F. Questioning Techniques

10 min

Questions are used constantly, without them we would have very little communication. When we think about it, nearly half of what we say or use in general conversation is a question. We pose a question and get a response, then another question is directed at us and we respond and on.

Questioning Techniques • • • • • •

Open Ended Questions Closed Ended Questions Funnel Questions Probing Questions Leading Questions Rhetorical Questions

Slide No. 26

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G. Comprehensive Role plays

40 min

Materials required : Corresponding page in Participant Workbook Procedure: Divide the class into 5 groups. Write the role-play instructions on two separate pieces of paper and hand them out to two participants in each group. Preparation time 10 min. Role-play time for each group 5 min. Participants to share feedback in a two-fold manner – what the group did well and areas of improvement.

Conclusion In analysing and proposing different communication behaviours there are no absolutely right or wrong answers. There are, however, alternatives. Each alternative can be discussed and the likely advantages and disadvantages can be determined. Health professionals should be able to learn that: • some strategies and skills are better than others; • communication behaviours can be functional or dysfunctional; • certain communication behaviours trigger generally predictable responses; and • communication skills can be identified, described, practised, learned and incorporated into normal professional communication behaviours. The ultimate aim in using these soft skills is for health care participants to be more effective, become better team players, work more productively and harmoniously on prioritised tasks and assignments and thus bring about significant progress on all indicators towards control and eradication of TB in India. The fervent hope is that the diligent and committed application of these soft skills will not only improve personal and group performance, but save lives. This is the underpinning of faith that defines these modules.

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 Module 2

Team Work

(4 hours)

A. Importance of Working in Teams in Axshya India

30 min

Slide No. 27 Good team working skills for health professionals calls for:   

Combination of skills, experiences and judgements Breaking down of barriers between departments within organisations Closer patient relationships

Teams, as opposed to individuals, have the potential to bring together the skills, experiences and disciplines required in these changing times. For professionals in the Axshya India project, healthy team work is essential to create quality conversations between patients and professionals, while also improving work relationships among team members. Typical results usually include stronger communication and motivated employees. That usually leads to happier and safer patients and colleagues.

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1. Objectives Bring out the objectives of the program.

Objectives In this program we shall consider the following: • Understand what a Team is. • Appreciate what the Elements of Teamwork are. • Understand the Stages by which a Group becomes a Team. • Appreciate the importance of Trust and Communication in Team Work to control and eradicate TB • Learn and understand how not to function as a Dysfunctional Team Slide No. 28 The ground rules for this program are the same as the ones you followed (or did not follow) in the other program.

2. What is a Team? Let us then understand what we mean by a Team.

Let’s take the Indian cricket team as the model for finding out what a team is. When we think of the Indian cricket team, how many players do we think of? Eleven, maybe 12 or more depending on whether you count the twelfth man, scorekeeper etc, right? So what comes immediately to mind? A GROUP. That is the first component. (Write it on the board) Then let us consider the opener Sehwag, and the middle order Dravid. By logic, can we say that Sehwag is a batsman; Dravid is a batsman, so Sehwag is equal to Dravid? And so also for the bowlers? (There will be many protests) Training of Trainer

Why not? Their styles are different. In other words, each of them is an INDIVIDUAL. That is the second component. (Write on the board) What does this group of individuals do? They play cricket for India. They are lucky that their play is also their work, but as a whole, they are WORKING TOGETHER for India. That is the third component. (Write on the board) Lastly, why do they work together? To win trophies for India. That is what the team strives for. That is their COMMON GOAL. That is the last component. (Write on the board) So we define a team as “A group of individuals working together to achieve a common goal.” The four components are the cornerstones of the group edifice. Okay, so now we know what a team is. So what? Why is the concept of a team important for us while working with TB patients? Why should we work in teams? (Get responses, and write them down on the board) Excellent. From the responses you have given, it is evident that working in a team leads to Co-operation, Co-ordination, Collaboration, Complementation, and Concentration. Can you give me the best example of a team? (Get responses) This team is very close to you. In fact, it is you. Can you guess? That’s right; it is your body, in which all the parts work as stated above. Why only the parts, even the cells work together in tandem! Is it not a wonderful thing? We find that as a collective we are far stronger than as an individual. Why? (Get responses) (Refer Section B, Module 2, 1. Importance of Teams, Groups Vs. Teams)

B. Elements of Team Work 1. Activity – Human Machine 1 hour  Procedure: Divide participants into 5 groups (Brief each participant as follows) First, decide on a machine or gadget or a mechanical process. Decide on who will play what role. Each of you must act as a component or part of the machine. No talking during enactment—however, sound effects are allowed. So, come on teams, let’s see how you perform as a “HUMAN MACHINE” Give participants 10 minutes to practice and 5 minutes to enact.

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Debrief: The most important thing in this exercise was that while working as a machine with different parts, what were you doing together? Let us put down your unconscious actions as components and see, what the elements of teamwork are:

Team – Elements of Team Work • • • • • •

Sharing information Listening and responding Giving others benefit of doubt Providing support Respect Disadvantages of teams?

Slide No. 29 (Refer Section B, Module 2, 3. Elements of Team Work)

C. Stages of Team Formation

15 min

Groups are formed and developed through several stages. They do not form overnight. No team starts out as a fully formed team. It does not even start out as a group. It is very interesting to find out what stages are gone through before a team, and a high performing team, is formed. Researchers Tuckman and Jensen identified five stages of development that all groups go through before performing as a fully mature and effective team. These five stages have been accepted and adopted by other researchers also.

Stages of Team Formation •  •  •  •  • 

Forming Storming Norming Performing Adjourning

Slide No. 30 (Refer Section B, Module 2, 4. Stages of Team Formation)

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D. Effective Teams – Concept

45 min

Effective Teams - Concept • • • • •

SMART goals Leader Roles and Responsibilities Communications Trust

Slide No. 31 (Refer Section B. Module 2, 5. Effective Teams - Concept)

E. Trust and Communication in Team Work

45 min

There is no doubt that communication is an essential part of the team. As we said earlier, without communication there will be duplication, mistrust, and confusion; the jigsaw puzzle will not be complete. But what about trust? How important is it? Can we not do without trust? Cannot a team function and perform without trust? What do you think? There are two ways in which trust can be demonstrated to the other person. These are the two important skills that you have learnt in the previous session. Can you guess what these skills are? (Get responses from participants) The first skill is that of Active Listening. Do you remember the components of Active Listening? (Get responses, and recap active listening briefly) What are you doing when you are actively listening to another person? You are paying him your full attention. So you are respecting what he says. This respect on your part makes him respect you in turn. This builds up trust for each other. The second skill is that of Feedback. If feedback is given effectively in the sandwich and 4-stage models, and if the changed action or behaviour is requested for properly, and the solution is worked out jointly, then there is excellent sharing and growth, and the team will be healthy and robust. (Get responses from the participants) (Refer Section B. Module 2, 6. Trust and Communication in Team Work)

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F. How not to function as a Dysfunctional Team

45 min

Most teams have some dysfunction or the other to a certain level of degree. So, in this self-revelation activity, allow each team to flesh out all the aspects relating to the 5 Dysfunctions mentioned by Patrick Lencioni as given below: Inattention to Results  Avoidance of Accountability  Lack of Commitment  Fear of Conflict  Absence of Trust  (Use handout on The Five Dysfunctions of a Team) Once we have diagnosed and identified dysfunctions, we would then be in a position to consciously strive to minimize such dysfunctions in what we say and do.

Conclusion The concept of Team and its various aspects is significant as most work is performed by teams. And especially in the TB arena, it is the joint and concerted efforts by teams in the districts and the States as well as the national level that has been responsible for whatever gains RNTCP has achieved so far. So much more remains to be done. If the urgent objective of TB Eradication is to be achieved, only high-performance teams can make it happen. As they say, Team stands for - Together Everyone Achieves More.

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 Module 3

Conflict Resolution

(4 hours)

A. Understanding Conflict, Conflict Resolution

30 min

Conflict Resolution

Slide No. 32 Persons working with TB patients often have little training in interpersonal skills. They may have high IQs but lack emotional intelligence. Temper outbursts and loud profanity directed at any unfortunate person who happens to be near at hand—are no longer tolerated. Patients and their families have the right to be treated with respect, and they know it. The care provider presents an insidious cost to any practice or health care organization. He or she increases the stress in the work environment and the accompanying loss of efficiency. Morale and team spirit suffer, which results in an increased turnover of staff and a dysfunctional team. Once this stage is reached, various negative factors begin to interplay. Communication is poor, and staff and patients withhold information because of fear of an outburst. The information withheld may be vital for patient well-being. The TB official can lose staff support and may become isolated. Training of Trainer

Once this dysfunctional behavior pattern is recognized, an intervention should be made. This action is necessary not only for patient safety but also because lack of action could be interpreted as negligent or as condoning a hostile work environment. When a confrontation is necessary, a team approach should be used, and if possible, a member of the team should be a close acquaintance of the individual, setting up a “good cop–bad cop” scenario. If only one person is involved, the person involved may view the intervention as a personal confrontation instead of a peer-related issue. Specific incidents should be documented, and the focus should be on behavior, not personality. Empathy should be expressed but change must be demanded, with a delineation of the consequences if behavior is not improved. The communication should be direct and clear, with the subject not given an opportunity to respond until the end of the dissertation. In this manner, a potential indignant response is often overwhelmed by the data and the presence of peers, and the person involved in the conflict will respond positively to the guidance given or help offered. The goal is to correct the situation and allow the highly trained TB specialist to perform to an optimal degree. Those participating in the confrontation should look for the good in any situation. In this way, the good can be built on, and a positive outcome becomes more likely.

Objectives By the end of this module, the participants will be able to: • Identify exactly what conflict is, why it arises and how it can be utilized for maximum benefit • Identify the harm caused by a dysfunctional physician and explain how to intervene to prevent further disruptive behavior. • Utilize a variety of methods for managing conflicts successfully • Invest less time and energy in conflict and creating more productive relationships with others Slide No. 33

Ask, “What do you understand by the word conflict?” “What are the typical conflicts you have had with patients/ colleagues?” (Prompt for responses)

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So, why do conflicts arise? (Prompt for responses)

• Needs – ignoring others’, our own or group’s needs • Perceptions – people interpreting reality differently, differences in severity, causes and consequences of problems, perceptions of threat • Power – how people define and use power determines: the no. and types of conflicts, conflict management • Values – incompatible values or unclear values, one party refutes the other’s value • Feelings & Emotions – major influence over the way one deals with conflict, ignoring own or other’s feelings and emotions, difference over an issue • Differences in perception and competition over power levels • Scarce resources –time , money • Desire to be different rather than converge • Responsibility • Jurisdictional conflict • Values • Sensitivities –ego issues Slide No. 34 & 35 (Refer Section B, Module 3, 1. Understanding Conflicts, Ingredients of Conflict)

B. Discussion - Conflicts in the TB Arena

30 min

Procedure: Divide participants into 5 groups. Invite teams to share concerns and pain points experienced in the course of their work and thereafter teams to present. Give teams flip charts and pens. List of pain points to hang on the wall for examination by the team during the conflict resolution strategy discussion.

C. Conflict Resolution Styles

45 min

Ask participants to turn to the relevant page in their workbooks. The two conflict resolution styles discussed are: 1. Thomas Killman Conflict Styles (self-assessment questionnaire included) 2. Interest-based Relational Approach Facilitator ask for volunteers to read out aloud to the class. Training of Trainer

Facilitator to spend some time clarifying the various styles. Use slide no. 42 – 52 to reinforce learning.

D. Negotiation Skills

45 min

Negotiation Skills • • • • •

Separate people from the problem Interest Vs. Position Focus on interests, not position evelop optional solutions Develop objective criteria

Slide No. 36 Facilitator speak about each point, explaining with examples. (Refer Section B, Module3, 3. Negotiation Skills)

E. Case Study on Conflict Resolution

45 min

Ask participants to read the case study in their workbooks. Facilitator to promote discussion with the class. (Refer Section B, Module 3, 4. Case Study on Conflict Resolution)

Conclusion In these days of scare resources and paucity of time, conflicts are bound to happen. One cannot wish it away. However, by the prudent and skilful application of some of these techniques discussed so far, and noting that the key principle of conflict management is "addressing the issue, and not the person", one can channelise all the energies towards productive TB mitigation activities, rather than engage hopelessly in conflict mode.

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 Module 4

Time Management

(4 hours)

A. Need and Importance of Time Management

45 min

Time Management

Slide No. 37

Facilitator bring out the need and importance of Time Management for health care professionals in the TB field. Time management is an essential skill for health care professionals. Time is money as the saying goes, and maximizing both is a key element of success. To manage time well, it is important to be organized. Time management is an important skill for a health care professional. Without these skills, health care professionals can seem overwhelmed, sloppy and uncaring. Patients may also tend to doubt the knowledge base and medical skills of these individuals.

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Being On Time for Appointments In this fast-paced world, everyone is pressed for time. Timeliness is an asset and patients respect physicians, dentists, nurses and other health care professionals who make timeliness a priority. Waiting an hour or more after the set appointment time to be seen by a health care professional is not only annoying, but stressful. All too often, patients put off necessary health care visits because they know it can take several hours for their 15-minute appointment to actually transpire. On the other hand, patients do appreciate their health care professionals who spend quality time explaining and answering their questions.

Providing Quality Patient Care Health care professionals, who can organize and manage their time well, will bring to their practice an amazing ability to provide quality care for their patients. To do this they have to first be organized, and second mindful of time and how much time it should take to accomplish a task.

Prioritizing and Re-Prioritizing in Patient Care In addition to organizational skills, the health care professional needs to be able to prioritize. For instance, in a crisis, the most critical patient gets seen first. In everyday routine care, there may not be a crisis to deal with, but even the most mundane tasks must be prioritized. As the day or situation progresses, re-prioritizing may be necessary to keep things moving in a orderly and timely fashion. Understanding how to do this is another essential skill health care professionals must learn. Flexibility is yet another skill, or perhaps even characteristic, that is important for health care professionals to possess. Expecting the unexpected and being able to flex with the need is a must more times than most nurses, doctors and other health care professionals would care to think about, but it’s a reality in the day to day life for these professionals. No two days are ever exactly alike, and there is no way to predict how a day will turn out. This makes health care an exciting profession, but it also adds to the intensity and stress levels. The individual who is disorganized and has no concept of how to manage time, will quickly become overwhelmed and extremely stressed. This can greatly affect their ability to provide accurate as well as quality care. At the heart of time management is an important shift in focus: Concentrate on results, not on being busy Many people spend their days in a frenzy of activity, but achieve very little, because they're not concentrating their effort on the things that matter the most.

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Time is a man-made concept

We have become slaves to, rather than masters of time?

Slide No. 38

Objectives Bring out the objectives of the program. Show slide.

Objective By the end of this module, the participants will be able to: • Understand and appreciate the need and importance of time management • Use prioritization tools and techniques • Identify personal time wasters Slide No. 39

Fun Activity – Bank Account of Life Put up slide. Go through slides no. 56 – 62. Ask participants to answer.

B. Daily Time Map

15 min

The first step of effective time management is identifying how you are using your time. Procedure: Ask participants to turn to the corresponding page in their participant workbook.

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Make a list of the activities that you spend time on. Identify how much time the activities consume. Take note of activities you are keeping up with versus activities you are falling behind on. Make a list of all activities in micro detail from the time you got up till the time you went to sleep. Ask yourself: “What one thing could you do in your personal and professional life that, if you did on a regular basis, would make a tremendous positive difference in your life? Talk about the importance of having SMART Goals to manage time effectively. (Refer Section B. IV. 5.Goal Setting)

C. Group Discussion – Barriers to Time Management

10 min

Let’s have a discussion of common barriers to using time management skills. What are the barriers that you face in your everyday life because of which you find it difficult to manage your time? Elicit responses and flip chart. We also see that not many people are organized, effective and efficient because of the following barriers. Show slide.

Barriers to Time Management Why are so few people organized, effective and efficient? • Worries about decreasing spontaneity • Negative mental programming • Self-limiting beliefs

Slide No. 40

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D. SMART Goals

45 min

What sort of goals should we set? It is denoted by the acronym SMART.

3. Look At Your Options 4. Action Plan 2. Determine the Barriers 5. Review Progress 1. Develop a Goal  6. Celebrate Success

Specific Measurable Attainable Realistic Time-bound Procedure: Divide participants into 5 teams. Each team to brainstorm for 5 minutes on each point mentioned in the acronym SMART above and present. Invite participants to share a few dreams and then the teams would decide whether it meets the SMART goal criteria. Facilitator to add that goals – be professional or personal, short term or long term – can be achieved only if they conform to the SMART goal criteria. (Refer Module 2, 5. Effective Team – Concepts)

E. Time Management Tools & Techniques

1 hour

Lets now look at some time management tools and techniques.

Tools & Techniques • Pareto Principle – The 80:20 Rule • Time Prioritisation: Planning the Day – Things to do List • Steven Covey’s Time Management Matrix

Slide No. 41 Training of Trainer

Ask participants to go to the corresponding page of their manuals. Ask for volunteers to read out aloud to the class. Facilitator to demonstrate how to use Time Management Matrix with few of own examples. Suggested example is given below. Please think of more such examples. 1. Mobile Bill Payment – Today is September 4th. You have received your bill yesterday and the due date for payment is October 1st. Ask, “is it urgent/ important”, “which quadrant will you put it into?” 2. You have been very busy with your training programs and launch of a new project in your company. It is now October 1st and you have not paid your mobile bill. Ask, “is it urgent/ important”, “which quadrant will you put it into?” So, which quadrant should we all aim to be working in the most? (Quadrant II) If you go back to the exercise on Daily Time Map, which quadrant do you think you are operating in everyday? How can you move into Quadrant II – Quadrant of Quality and Leadership?

More Tools and Techniques 1. Use a time planner • Master list, calendar, daily list 2. Always work from a daily list • Write everything down 3. Organize your list by priority • Sort your daily list by value 4. Choose any system • Use it regularly 5. Set up a 45-file system • 31 file folders for days of the month • 12 file folders for months of the year • 2 file folders for next two years Slide No. 42 Say, the above time management tools and techniques can be either used by themselves or in combination with other techniques for maximum benefit.

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F. Getting Organised

35 min

Let’s continue by investigating ideas for how to better manage time with another discussion.

Getting Organized What is the primary difference between average people and highly effective people? Highly effective people are much better organized when they work with others Top 3% are persistent planners • Write and rewrite goals and activities • Think on paper • Continuously analyze and re-evaluate plans Slide No. 43

Talk about personal organization and how to manage interruptions. (Refer Section B, Module 4, 4. Getting Organised)

G. Time Management in Meetings

30 min

Since a considerable amount of time of a health professional is spent in and around meetings, it would be useful to manage meetings in such a manner that the available time resource – which is always a scarce resource, is optimized. To illustrate this point, allow the teams to narrate all the possible time wasters that make meetings ineffective.

Activity for Time Management in Meetings Procedure: Teams would enact a typical meeting with a hypothetical agenda, with one single objective to arrive at a decision within 10 min. Invite suggestions from the participants on how to minimize time wastage in meetings and build a consensus from the teams to end all team meetings within 10 min. Team that completes the meeting within the shortest possible time gets applauded. Debrief: This exercise reveals to us what we already know that – we can effectively manage time in meetings if we really want to.

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Conclusion In conclusion, we hope that you have enjoyed this journey through the world of soft skills --and soaked in the concepts of Effective Communication, Teamwork, Conflict Resolution and Time Management. The quiver of Facilitation techniques shall help you in turn to disseminate these skills to wider audience. It is hoped that you shall apply these skills in your personal and professional life, which will help you become more productive in your chosen field of Healthcare. We, at Axshya India, fervently hope that, as a result of this Soft Skills intervention, you are able to effectively contribute to the overall objectives of TB eradication and saving lives, which is at the heart of this laudable initiative.

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 SEC T I    O  N   B

Soft Skills Content

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SESSION PLAN FOR SOFT SKILLS CONTENT  MODULE I - Effective Communication Skills & Interpersonal Skills 1. Introduction 2. Communications Theory 3. Barriers and Filters 4. Exercise On Barriers And Filters 5. Active Listening 6. Active Listening Toolkit 7. Non-verbal Communication 8. Feedback 9. Dealing With Feelings 10. Feelings Toolkit 11. Building Empathy 12. Comprehensive Role-plays 13. Characteristics Of An Effective Communicator 14. Application In Health Care 15. Communication Skills Self- Assessment Exercise 16. Dealing With Complex Feelings 17. Exercise to practice toolkit Module 2 - Team Work 1. Importance Of Teams 2. Teams Vs. Groups 3. Elements Of Team Work 4. Stages Of Team Formation 5. Effective Teams – Concept 6. Importance of Trust & Communication in Team Work 7. Team Player Styles Module 3 - Conflict Resolution 1. 2. 3. 4.

Understanding Conflict Negotiation Skills Conflict Styles Case Study for Conflict Resolution

Module 4 - Time Management 1. Importance and Need for Time Management 2. Objectives 1. Activity - Daily Time Map 2. Goal Setting 3. Time Management Tools and Techniques 4. Getting Organised

 Module I

Effective Communication Skills & Interpersonal Skills

1. Introduction Effective communication skills are important in any line of work, but particularly important when dealing with people regarding their health. Whether you are listening to symptoms that may help diagnose a problem, or relaying information that is important to someone’s well being, effective communication skills are necessary. You must be able to communicate effectively with co-workers, patients and Health Officials alike. The specialized vocabulary of the TB health care industry includes many terms specific to the field. You must know these medical terms, and be able to explain them effectively to those who do not. If you are giving a diagnosis, for example, give the medical term, and then explain it in layman’s terms to the patient or to the family/Community audience. Good communication contributes to quality care and improved health status. It is our belief that clear, candid, accurate, culturally and linguistically competent communication is essential for the prevention, diagnosis, treatment, and management of TB in India. Consider the following situations:  You are working with a colleague, who is senior to you, and with whom you have had frequent friction in the past –and now you need his support for an assignment You are taking a case history from a family  You are in a meeting with District TB officials. The District Magistrate, who  is chairing the meeting, asks you for your assessment of the low rate of progress in combating TB in your district. How will you respond?  You are to present a report on the TB status in your area –how will you present it?  There is a conflict in your team. Two members are on a constant argument. You need to calm tensions before you can complete the work on hand. How will you communicate this to your warring colleagues?  You have to increase awareness in the Community, and obtain the support of the influencers in the Community to RNTCP initiatives –how will you make your case? Training of Trainer

In each of the above cases, you not only need to communicate, but to communicate effectively. Which situation is easy, and which one would you find it difficult to handle? This module is about communication strategies to cope with such situations. There is no single perfect way of ensuring that you will be completely understood by others –but there are several straightforward of helping you to communicate with others more effectively. Considering that every little improvement in your communication can directly or indirectly lead to desirable positive outcomes such as:  improvements in case detection rates,  decrease in default cases, more TB suspects coming in for treatment,  increased awareness of TB and its effects;  greater community involvement  lowering of mortality rates  Then, you have a tremendous case for not only understanding the communication process and how to apply it in your work life, but you also have an enormous realization of what it can do to increase your own productivity, but more importantly, how it can accomplish the noble cause of saving lives, vulnerable to the deadly scourge of Tuberculosis –which is what the Axshya India Project is all about.

2. Communications Theory

We define communication as the sharing or exchange of information (i.e. thoughts, ideas, and opinions) between two or more persons. The last sentence of this definition should be “…so that there is common understanding between them.” In the above definition, the most important features are:

Sharing – This is an integral part of communication. In fact, it is the foundation of communication. Some even go so far as to say that sharing itself is communication. Common Understanding – Why is it important? Words mean different things to different cultures. E.g.: By making a statement like “Delhi is a dry city,” one may mean a lack of water, or rainfall, or liquor, or life itself. One has to be very specific if you have to understand me. Such examples are galore. Our ability to communicate has a direct bearing on our relationships – personal and professional. It affects the level of respect or support we receive from others and dictates our ability to have our ideas and feelings accepted. How well we share ideas and information in turn determines how well we solve problems, make decisions and resolve conflicts. Training of Trainer

Research shows that only 1/7 messages are effective. Interpersonal communication skills are invaluable at all levels of the Axshya India project and are powerful tools to help cure patients, and thereby, to control TB.

3. Barriers and Filters Barriers to communication can arise from sender, message, channel and receiver. There exist external and internal obstacles which hinder effective communication. The external obstacles are distractions which exist outside both the sender and receiver, and prevent effective communication. These are called as Barriers . E.g.: Noise, language, cross-talk, distance, mechanical failure, jargon, visual distraction etc. The internal obstacles are those which exist within the sender and the receiver. These prevent the undistorted flow of communication. In other words, they tend to distort communication, and hence they are called as Filters. These are the feelings that exist inside both parties. E.g.: Shyness, superiority complex, disinterest, pre-conceived notions or opinions, rigid attitudes, anger, disappointment, sorrow etc.

3.1 Communication barriers at interpersonal level There are various obstacles to communication at the interpersonal level due to perceptions, judgments, emotions, social values and language problems of people. 

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Barriers at the sender’s level - Ignorance about the receiver – if we are not well acquainted with the personality profile, needs, value system and the background of the receiver, the chances are that we may not communicate at the same level of understanding as the receiver. Inadequate knowledge of the topic/subject  – if we do not know the topic/subject well, our presentation may be poor. We may also not be able to clarify any doubts or misconceptions. Inappropriate use of language - words are the principal tools in our interaction with people. Improper selection of words is a big barrier to communication. In addition, words that we use do not mean the same thing to different people.

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Inadequate talking and listening skills - Poor talking skills will affect the quality of a presenta�on. Poor listening skills will also affect our communica�on. If we do not listen properly to what the receiver is saying in his or her feedback, we will not be able to find out if the message has been properly interpreted. The receiver, in turn, may also stop listening.

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Wrong volume – the volume of our voices could also be a barrier to communication, being too low or too loud. Inappropriate timing – choosing the proper timing for conveying a message, selling an idea, or making a presentation, is essential. Limited perception – we communicate our messages whether verbally or non-verbally, in the way we perceive them. This may not match the receiver’s perception unless care is taken to avoid misunderstandings that could occur.

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Wrong assumptions – there are times when we assume that the other person we are talking to is aware of the problem and we start with discussing the solution. This can lead to a complete breakdown in communication, if the person does not even know that there is a problem at all. Negative attitudes – lack of respect, trust, or sensitivity can cause the receiver to become defensive or hostile, and this can lead to a breakdown in communication. We need to be open and create an atmosphere where the receiver is encouraged to seek clarifications. Poor questioning skills  – Asking proper questions at the proper time can help ensure that the message is interpreted correctly and can help clarify doubts at higher levels. Conversely, staff at the highest level may not have opportunities to communicate easily with middle-and lower-level staff. This is often the result of policy, specific written orders or, as is more often the case, just be the culture and tradition of the organization. Attitude of the boss - One common barrier that employees often identify is the ‘boss’, the top person in the organization. If the boss is unwilling to communicate, all channels of communication are choked. Some bosses consider suggestions from their staff a challenge to their authority. Bosses can also tend to be highly opinionated and not tolerate any deviation from orders issued by them.

3.2 Structural Barriers Each organization develops structures, rules and regulations for achieving its objectives. This involves basic determination of “who says what, who what jobs, who makes what decision, who tells what to whom.” There is a chain of command for reporting at various levels of authority, based on the principle of unity of command. Rules and regulations prescribe that all upward communication should flow through proper channels and generally, senior staff insist on the strict observance of this procedure. 

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Fears - Organizational communication is also hindered because of the fear among staff as to how their message will be received. Other barriers include fear of exposing a lack of knowledge, having too little to offer, or even fear of punishment, especially when offering frank criticism or expressing a grievance. Situational constraints – situational factors also cause barriers to interpersonal communication. In a formal setting, people may not speak openly; junior staff, for example, may maintain a certain reserve in an office meeting. Gender insensitivity – gender insensitive attitudes and behaviour are reflected in the way people communicate, especially in the language they use. This is increasingly being recognized as an important deterrent to effective communication. Insensitivity to non-verbal communication – if we fail to observe the non-verbal cues that the receiver is sending through body language, we will not be sensitive to his/her needs. Insensitivity to feedback – the importance of feedback in communication has already been explained. If a sender is insensitive to the feedback given by the receiver, the communication is unlikely to be effective. This feedback may be non-verbal, as is the usual practice, or may be no response at all. However, if the sender does not pick up this feedback and take necessary action, the receiver may soon stop listening.

3.3 Barriers at the message level 

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Incoherence – if the message lacks coherence the receiver is likely to be confused. A long, rambling, disorganized message with lack of clarity and focus, will confuse the receiver. The message needs to be brief, to the point, organized and on the “need-to-know” basis. Attenuation – in the process of transmission, particularly through hierarchical channels, there is often some loss of content of the original message. Delay – one of the most serious problems is the time lapse between the transmission of message and completion of the communication loop. Inappropriate language –Assumptions, use of jargon, code words and acronyms unfamiliar to the receiver can lead to confusion. Judgemental language may make the receiver distrustful and aggressive.

Poor non-verbal presentation is when we are not aware of the messages we might be sending through body language. Our postures, gestures, facial expressions and eye contact with the receiver, all send non-verbal messages. Non-verbal messages should be consistent with verbal messages, for communication to be effective.

3.4 Barriers at the receiver’s level 

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Misperception or selective perception – selective perception means seeing what one wants to see. In our day-to-day activities, we tend to see those things which we find interesting, and to reject or ignore unpleasant things. Also, as noted earlier, the receiver’s perception might be different from that of the sender. Misinterpretation and language/semantic problem – as already stated, words mean different things to different people. If we assume that the other person uses words in the same way as we do, we are likely to be misunderstood. Preconceived ideas, cynicism and biases  – these build attitudes that do not easily accept the rationality of the messages being conveyed. Distrust – if the listener does not trust the person who is talking, the entire effort in this regard may be counter-productive. Low levels of trust develop when people try to manipulate, filter information, are insincere, hypocritical or deliberately or unconsciously hold back relevant information. Evaluation – listeners often have a tendency to jump to conclusions even before getting the full message. Evaluating a message in this manner hinders communication.

3.5 Noise 

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Distracting environmental noises – These acts as barriers to interpersonal communication as they prevent or reduce the sending and receiving of messages. Distracting “internal” noise – Pre-occupation, mental worry, day dreaming etc. all act as internal noise and interfere with proper communication. Interruption – Constant irrelevant interruptions from external sources tend to destroy the communication process, as they use up the time necessary for the entire communication to take place. Timeframe – Sometimes the time available for transmitting information is too short, especially when one is required to explain an intricate subject in a matter of minutes to someone who knows nothing about it. Distortion – Communication is distorted as it passes from one person to another. The greater the number of people involved in transmitting the message, the greater the chances of distortion. Training of Trainer

4. Exercise on Barriers and Filters Situation 1 During your visits to the field as the district TB officer, you discover that the DOTS provider is seldom found in the villages covered by him. You are upset about this and on your return to your office, meet with concerned staff to deal with the problem.

Situation 2 You have recently taken over as the state/province TB Programme Manager. On your rounds of some of the districts you are told that there is a rising trend among people to go to private practitioners for treatment instead of to government clinics. You want to know the reasons for this and meet with concerned staff in your office to address the problem.

Situation 3 You are a Medical Officer talking to a newly diagnosed TB patient. You suspect him to be a TB suspect. The Patient does not believe he has TB. He agrees for an X-ray, but not for sputum examination.

Situation 4 You are speaking to an old lady, a new patient and taking down history. She looks very weak and you are concerned about her timely treatment. You have to also prepare your presentation for an impending team review meeting that evening. Just then, Dr. Anjali, the most beautiful doctor in the hospital passes by and waves to you.

The problem

Situation 1

Situation 2

Situation 3

Situation 4

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What are the possible communication barriers/ filters?

What skills will you apply to overcome these barriers/ filters?

5. Active Listening There is a common misconception that communication is about talking to people. So, by logic, more communication means more talking. The problem is that this doesn’t work that way. Communication is not merely about talking to people. The people also have to listen. So communication is not complete until the listener registers the message. For this, barriers have to be overcome, and filters should not block out the message. All this can be achieved only by a skill known as Active Listening. First of all, let us understand the difference between hearing and listening. E.g: husband having his breakfast, and reading the paper at the same time while in a hurry to go to work, and the wife wants to tell him all the gossip. Is he hearing or listening, and how to find out? What is the difference between listening and active listening? Listening refers to the process of hearing, in this process; there will not be any interaction, especially if we are listening to the radio, TV etc. Active listening is listening carefully, with the added effort of trying to understand the speaker’s thoughts and feelings. Then showing that you understand him. So, active listening means showing or telling the other person that you have understood his message or his feelings. While doing so, you do not give any advice, you do not analyze the speech, nor do you question the speaker. In short, you set aside your own thoughts, feelings, wishes and needs to start talking. Do not try to solve any problems. Just try to understand what the speaker wants to say, and show him that you understand him. By this process, you are telling the speaker that you value his words. Active listening is quite difficult. You must listen carefully to what the speaker says, and at the same time understand him correctly. This requires concentration and discipline.

“Wait till you hear my news!”

“Who is she trying to fool this time?”

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6. Active Listening Toolkit 1. Suspending Judgment This skill consists of keeping an open mind. You do not have any pre-conceived notions about the speaker or the subject, and filter out any likes or dislikes about the style, delivery etc.  Concentrate on understanding the speaker.  Hear his complete message without interrupting him.  Make him aware that you have understood him. So, while suspending judgment,  You do not agree or disagree with the speaker. You do not ask him questions.  You do not give advice.  You do not start solving problems.   You do not speak, but let the other person speak. While not doing so many things, should you just be staring at the speaker? No, you use the next skill of active listening.

2. Attending Skills This consists of giving a response to the speaker, while he is speaking, by doing the following  Maintaining eye-contact.  Head nods.  Making suitable sounds.  Making verbal responses.

3. Clarification This means doing two things  Checking the meaning of words you do not understand.  Checking with the speaker whether you have followed the subject correctly.  During technical discussions, this skill should be used extensively for both the words and the subject matter.

4. Summarization After the speaker finishes speaking, you repeat back to him, in a very short manner, the main points of what he has said to you. Apart from the skills mentioned above, there is one more skill which is undoubtedly the most important skill of active listening. It is called

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5. Paraphrasing A person is speaking to you. While doing so, he pauses to find out your reaction. At that time, if you repeat back to him shortly, in your own words, what you have understood him to say, then you have paraphrased him. So, in paraphrasing, you capture, in a short statement, the essence of what he has said. In active listening, you paraphrase for two reasons  To check whether you have understood what the person has said.  To show him that you are trying to understand him. At the same time, he comes to know that you are paying attention to him. Paraphrasing has two positive uses: Even if you have paraphrased the other person wrongly, he will have the  opportunity to correct you, and the misunderstanding will be removed. If someone asks you a difficult or unclear question, and you cannot answer  at once, paraphrasing will give you time to think and answer. Remember, while paraphrasing,  Avoid Names, Criticisms, Hard/harsh words, and Controversy  Only stick firmly to the facts  Avoid the emotional content of the statement  You start the paraphrase by using the words “In other words,” “I understand that,” “It appears that” etc, and  Repeat the facts shortly to the speaker.

“It appears that your working hours do not allow you to pay attention to your children, is that right?” You will also observe that the above question is a close-ended question, i.e. the other person can only reply ‘yes’ or ‘no.’

7. Non-verbal Communication

I can see it in your eyes. You can’t fool me.

Body Language Nuances

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Head position is a great one to play around with, with yourself and others. When you want to feel confident and self-assured, keep your head level both horizontally and vertically. You can also use this straight head position when you want to be authoritative and what you’re saying to be taken seriously. Conversely, when you want to be friendly and in the listening, receptive mode, tilt your head just a little to one side or other. You can shift the tilt from left to right at different points in the conversation.

The eyes communicate more than any other part of the human anatomy. The ancient Chinese proverb says: “The eyes are the windows, the mirrors of the soul.” Staring or gazing at others can create pressure and tension in the room. Maintained eye contact can show if a person is trustworthy, sincere or caring. Shifty eyes, too much blinking can suggest deception. People with eye movements that are relaxed and comfortable, yet attentive to the person they are conversing with, are seen as more sincere and honest.

Eyebrow muscles draw the eyebrows down and toward the centre of the face if someone is annoyed. If someone is empathetic and caring during dialogue the eyebrows will not show the annoyed facial grimace.

The nose doesn’t move much, but when you wrinkle your nose, it means that you don’t like something; it expresses disgust or distaste more than words can do.

The smile. There are 50 or so different types of human smiles. By analyzing the movements of over 80 facial muscles involved in smiling, researchers can tell when a smile is true. Authentic smiles are smiles that “crest” or change rapidly from a small facial movement to a broad open expression. The smile is often reflected in the eyes if it is a heartfelt one.

Mouth movements can give away all sorts of clues. We purse our lips and sometimes twist them to the side when we’re thinking. Another occasion we might use this movement is to hold back an angry comment we don’t wish to reveal. Nevertheless, it will probably be spotted by other people and although they may not know the comment, they will get a feeling you were not too pleased.

Vocal cues can predict deception. More and lengthier pauses during conversation; a lot of such sounds as “uh,” “um,” word repetitions; intruding sounds not part of the actual speech, less lengthy answers or explanations where they would be expected to be.

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Ears play a vital role in communication with others, even though in general terms most people can’t move them much, if at all. However, you’ve got two ears and only one mouth, so try to use them in that order. If you listen twice as much as you talk you come across as a good communicator who knows how to strike up a balanced conversation without being me, me, me or the wallflower.

Posture is the next thing to master; get your posture right and you’ll automatically start feeling better, as it makes you feel good almost instantly. An erect posture shows that you are confident and alert and ready for anything. A drooping posture shows that you have admitted defeat.

Angle of the body in relation to others gives an indication of our attitudes and feelings towards them. We angle toward people we find attractive, friendly and interesting and angle ourselves away from those we don’t, it’s that simple!

Gestures communicate. Hand signals can communicate without the use of any speech. Touching communicates. Touching can be friendly or it can be aggressive. The way a person stands reflects their level of confidence and comfort level. When you want to come across in the best possible light, crossing the arms is a no, no in front of others. Obviously if someone says something that gets your goat, then by all means show your disapproval by crossing them!

Palms slightly up and outward is seen as open and friendly. Palm down gestures are generally seen as dominant, emphasizing and possibly aggressive, especially when there is no movement or bending between the wrist and the forearm. This palm up, palm down is very important when it comes to handshaking and where appropriate we suggest you always offer a handshake upright and vertical, which should convey equality.

Legs are the farthest away from the brain; consequently they’re the hardest bits of our bodies to consciously control. They tend to move around a lot more than normal when we are nervous, stressed or being deceptive. So it is best to keep them as still as possible in most situations, especially at interviews or work meetings. Be careful, too, in the way you cross your legs. Do you cross at the knees, ankles or bring your leg up to rest on the knee of the other? This is more a question of comfort than anything else. Just be aware that the last position mentioned is known as the “Figure Four” and is generally perceived as the most defensive leg cross, especially if it happens as someone tells you something that might be of a slightly dubious nature, or moments after.

Space is important. Personal space is needed and if it is invaded intentionally and at times by oversight can cause an individual to feel uncomfortable or threatened. Studies have shown that individuals that do not respect others space are less popular and often rejected by others. When you interact socially develop your listening and observations skills. The above are a guide for looking for the clues to deception, but they are not fool proof.

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8. Feedback A person, a group, or an organization may do something or behave in a particular manner. This action or behaviour may either have good effects or bad effects. Information to the concerned persons regarding the good or bad effects is called Feedback.

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Purpose of Feedback Sharing

If you have the ability to give and receive feedback freely, then you will have the best personal and professional relationships. So, objectivity is the key parameter for successful feedback. Unfortunately, though it is a very important skill, feedback is the least used or practiced skill, for obvious reasons. While giving feedback, the following three things should be kept in mind: 1. Make your intentions for for giving feedback very clear. clear. You You are giving feedback only to remove any misunderstandings or grey areas in the communication, so as to make communication more effective. 2. Always use words that have common meaning to both of you, so that there is no gap in the understanding. 3. Check to see that what is received by the other person is exactly exactly what you wanted him to receive. Negative feedback is normally given in the sandwich method. In the sandwich, you have a slice of bread on top, then the stuff in between, and then another slice of bread at the bottom. In the same way, when giving negative feedback, you first give good feedback, then the negative feedback, and then finally good feedback again. “You are all very intelligent people. But you have the bad habit of coming late from the breaks. However, I am sure that you will get over this habit soon.”

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The tool we use for giving feedback is called the Feedback Response . It is a four-step model, and can be used for all situations, whether negative or positive feedback is to be given. The four steps are:

Behaviour description Tell the other person exactly what he said or did, without your assumption/  judgment

Feelings Tell the other person what we felt because of his action or behaviour. Feelings refers to emotions – SAD, MAD, GLAD, AFRAID

Impact Tell the other person what was, or would be, the effect of his action or behaviour on self/ others.

Request Request the other person for a change in his action or behaviour which would correct the situation.

Feedback Formula Giving feedback is easy enough, but the receiving of feedback is a slightly more difficult matter, especially if it is negative. However objective we may be, receiving feedback is tough, since we feel that the other person is criticizing us, and attacking our pet positions. So, here are some tips for receiving feedback.

Tips for Receiving Feedback 

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Accept the feedback gracefully. Do not start giving the other person reasons why you did or said something, and why it was correct. The other person is only stating his impressions, which may be right or wrong. So clarify the matter further before you start explaining. Paraphrase the feedback, using the method that was told to you earlier. Ask him whether you have understood him correctly. While paraphrasing, do not appear either defensive or aggressive. Maintain a neutral body language, or even a positive body language. Ask the other person for the specific and exact description of your action or behaviour which he wants you to change. Feedback will normally be over some portions of your work, not the entire thing. So ask him what is bothering him. While asking for the above, make sure to reassure him that you are asking for this information so that you can take corrective action, and not because you are angry or anything like that. Then, and only then, explain your point of view and actions. Ask him further what change would make him more comfortable, or has your explanation satisfied him. Thank the other person for his feedback.

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9. Dealing with Feelings Researchers have found that we should have Emotional Intelligence, measured as EQ. It is not your IQ; it is not even a number. But emotional intelligence is the best predictor of success in life, redefining what it means to be smart. In the health sector, it’s not just because of IQ that you get hired, but it is EQ that gets you promoted and also helps you excel. It is why some people remain buoyant in the face of troubles that would sink others. Deficient emotional skills may be the reason why more than half of all marriages end in divorce. EQ is not the opposite of IQ. Some people are blessed with a lot of both, some with little of either. What is important is how they complement each other. For success, researchers generally agree, IQ counts for about 20%. The rest depends on luck, social class, and EQ.

10. Feelings Toolkit a) Awareness and labelling Let us say that you are having an important meeting with a colleague. Normally, he should have switched off his cell-phone, but he is also expecting an important overseas call. So he answers every call, and the tempo of the meeting is lost every time he gets a call. After some time, you are aware that you are irritated. How irritated are you? If this has been occurring for an hour, you are annoyed; if for more than 3 hours, you are angry; if for the whole day, you are furious. So you have become aware of a feeling, and you have labelled it depending on its intensity. Now you can go to the next step.

b) Taking action This you can do in any number of ways. You might tell him politely that his cellphone is a source of disturbance. You may suggest taking a break till he gets his call. You may ask him to send an e-mail or SMS to the caller asking what time he should expect the call. Or you may ignore the interruptions, and find a way to keep up the continuity of the meeting.

c) Reporting your feelings Here you tell the other person what your feelings are because of these interruptions. You use “I” statements, and also use very soft or neutral words like upset, annoyed etc, instead of angry, mad, sorry etc. You also try to make it in the form of a close-ended statement or question. So the reporting in the above case would be: ‘I am upset by these interruptions. Can we first decide what to do about them, and then get on with the meeting?’ In such circumstances, it would not help to speak unfeelingly to your colleague, using harsh and explosive words. That would create one of two situations; he would become defensive, and withdraw effectively from the meeting, or he could become aggressive, in which case the atmosphere would become vitiated.

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d) Feel it now, deal with it later  In some sensitive situations, it may not be possible to either take action or report your feelings. In such situations, become aware of the feelings now, and deal with them later, when the atmosphere and the circumstances are more conducive to a balanced transaction. Sometimes, doing nothing is the best way to do something.

Why deal with feelings? Won’t they just go away?? The problem is that if we do not consciously deal with our feelings, they will no doubt go away temporarily, but they will come back to haunt us in 3 different ways: 1. The feelings build up inside us, causing stress, which would lead further to psychosomatic diseases. 2. Worse still, these stresses could turn into resentment, and build up to such levels that they come bursting out when we least expect it and don’t want it to. 3. We may unknowingly express the ignored feelings in the form of sarcastic statements, negative body language, or even indirect statements. So you see why dealing with our feelings is so essential.

11. Building Empathy Perception checking can help decode messages more accurately, but it doesn’t provide enough information for us to claim that we fully understand another person. For example, a TB officer who uses perception checking might learn that a patient’s reluctance to ask questions is due to confusion and not lack of interest. This information would be helpful but imagine how much more effective the TB officer would be if he could get a sense of how it feels to be confused and consider how the treatment that is so familiar to him appears to the patient who is undergoing treatment for the first time.

How do we define Empathy? What we need to understand others more completely is empathy – the ability to re-create another person’s perspective, to experience the world from his or her point of view. It is impossible to achieve total empathy, but with enough effort and skill, one can come closer to this goal.

Empathy has three dimensions: Empathy involves perspective taking – the ability to take on the view point of another person. This understanding requires a suspension of judgment so that for the moment you set aside your own opinions and take on those of the other person. Empathy also has an affective dimension – what social scientists term emotional contagion. That means that we experience the same feelings that others have. We know their fear, joy, sadness, and so on.

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The third ingredient of empathy is a genuine concern for the welfare of the other person. Not only do we think and feel as others do, but we have a sincere interest in their well-being.

Requirements for Empathy Empathy may be valuable, but it isn’t always easy to achieve. In fact, research shows that it is hardest to empathise with people who are radically different from us: in age, sex, socio economic status, intelligence and so on. Several skills and attitudes like open-mindedness, imagination and commitment need to be developed. Making an effort to put oneself in another’s position can produce impressive results.

12. Comprehensive Role-plays Scenario 1: First visit of the Multi Purpose Worker to a patient who has been newly diagnosed as suffering from TB MPW: You are a female MPW who is visiting a patient’s home for the first time. The patient has been newly diagnosed as suffering from TB. You want to make sure that the patient understands his disease and what will be required for treatment. Patient: You are a male patient who has recently been diagnosed as suffering from TB. You are afraid that you will die from it. The MPW is coming to your home for her first visit.

Scenario 2: MPW visiting a patient near the end of the intensive phase MPW: You are a male MPW and have visited the home of this patient who is near the end of the intensive phase. The patient has gained weight, has developed a good appetite and cough has considerably improved. The objective is to find out the welfare of the patient and to continue monitoring him for completion of treatment. Patient: You are feeling better and think you are probably cured.

Scenario 3: MPW visiting a patient who has interrupted treatment MPW: You are a female MPW who is visiting the home of a patient who has stopped coming to the health unit for treatment. Patient: You are a female patient who has been on treatment for about two months and you are feeling well. You have decided that it is too much trouble to continue going to the health unit for DOT so you have stopped going.

Scenario 4: MPW talking with a patient’s husband who wants his wife to return to her village MPW: You are a female MPW and you are going to your patient’s house to talk with her husband because he wants his wife to go back to her native village with him.

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Husband of Patient: You are the husband of a patient who is on RNTCP treatment and you want your wife to go back to her native village with you. So, you are talking with the MPW who provides DOT for your wife.

Scenario 5: MPW finds that treatment cards have not been updated by the Anganwadi worker  MPW: You are a female MPW who has discovered that the treatment cards have not been updated by a DOT worker who is an Anganwadi worker. Anganwadi Worker: You are an Anganwadi worker who is also a DOT worker but you do not have the time to update the treatment cards because you have more important things to do with your time. You are also not very confident about your writing.

13. Characteristics of an Effective Communicator Effective communication is a two way process. This calls for establishment of dialogue. As a health worker one is both in the situation of the sender and the receiver. As a sender a good communicator should: Make sure he has the full attention of the communication partner   Speak in a loud and clear voice  Formulate the message clearly in a way that can be easily understood  Explain technical terms  Be able to adapt the same (health) messages to the educational background of the receiver As a receiver a good communicator should:  Encourage the client to speak openly  Give full attention to the client  Listen carefully  Ensure that the message is understood  Show by the way of acknowledgment that the message was understood Take questions and concerns of clients seriously  Answer any questions fully  To be effective, the communicator should aim to develop some of the following attributes:  Adequate knowledge of subject : Knowledge of the subject matter under discussion  Knowledge of the target group : Have in-depth knowledge of the people in terms of their wishes, needs, concerns, hopes and interests  Confidence: Trust one’s own ability  Credibility: Should be accepted and trusted by the community  Friendly/courteous: Be kind, pleasant and helpful, polite, respectful and considerate  Empathy: Ability to share another’s feelings as if they were your own  Tactfulness : Skills not to offend the other; ability to create a favourable impression by saying or doing the right thing Flexibility: Ability to adapt to the needs of people   Tolerance/ patience: Ability to bear with something one does not agree with, staying calm and keeping temper in control  Training of Trainer

14. Application in Health Care 1. History-Taking: Each intervention begins with a thorough analysis of the existing situation in a given field. The objective of history-taking is for the provider to gather all the information needed to make an accurate diagnosis and to initiate appropriate treatment. Question-asking techniques, listening to the patient, and probing skills are particularly important to successful history-taking.

Standard: During the history-taking session of the encounter, the health service provider will use interviewing skills to effectively elicit from the client the information needed to make an accurate diagnosis. Interviewing skills include question-asking, listening, and dialogue. Guidelines: The following list of specific norms related to the content and methods used in an interview can help the health service provider communicate more effectively. This list is illustrative, and is not intended to be exhaustive. These norms may be adapted according to the local context. 

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Effective Listening: Health service providers show concern and interest while the client is speaking; they demonstrate understanding by acknowledging the clients statements and do not interrupt the client unnecessarily, etc. Dialogue: Good communication means that the client has the opportunity to give information and to ask questions. Probing: Health service providers encourage client inputs by using methods such as probing, paraphrasing when appropriate, and encouraging clients to tell them more about their conditions. Appropriateness: Effective questions take into account factors such as the social and cultural context, the medical condition in question, the educational level of the patient, etc. Completeness: A complete interview includes questions about all symptoms and all relevant medical history.

2. Channeling: The objective of channeling is to motivate the community to utilize the preventive and curative health services offered. This is carried out through oneto-one communication and group education sessions.

a. Counseling: The objectives of counseling are:  To share information about the disease and treatment options;  To promote compliance through negotiation with the client over positive treatment and behaviour changes.  To help clients make informed decisions. Effective giving of information, checking for understanding and comprehension, establishing achievable behavioral objectives with the patient are important counseling skills. Counseling is of high quality when the information is sufficient, relevant, comprehensive and acceptable. Skills such as verification, organization of information into blocks, and the employment of social support networks when possible are some methods which enhance counseling. Training of Trainer

Standard: During the counseling session of the encounter, the health service provider effectively uses information-giving and educational skills to orient the client about his or her condition. To promote compliance with medical treatment and/or behavioral changes that will improve the health of the client, the provider uses negotiation skills. There is need to:  create rapport with client;  allow client to tell their side of the story without interruption;  listen actively;  give information and education to orient the client about her condition;  Help client to make an informed decision. Guidelines: The following list of specific norms related to the content and methods used in counseling can help the health service provider communicate more effectively. This list is illustrative and not intended to be exhaustive. These norms may be adapted according to the local context. 

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Appropriate Language: The health service provider delivers counseling in the client’s language of fluency. Local language and/or translations should be used when necessary. Comprehension: The health service provider communicates in ways that are easy to understand, i.e. avoiding technical jargon, and by taking into account the cultural and educational level of the client. Organization of information: The health service provider presents the information in blocks according to a few categories in order to make it easier for the client to remember. Acceptability: The health service provider presents treatment options, solicits information about client preferences, and involves the client in decision-making, in order to ensure that the treatment and other recommendations are acceptable to the client. Sufficiency: The health service provider gives enough information to the client to enable him or her to understand the illness, participates in decisions about treatment, and follows the treatment protocol. Relevance: The health service provider focuses on the information that is most important to the client during the particular encounter, thus reflecting an awareness of the priority and relevance of the message(s). Empowerment: Counseling enhances the client’s self-esteem, confidence, and sense of competence in order to promote compliance and behaviour change specific to the condition, as well as overall health and well-being. Behavioural recommendations: The health service provider makes recommendations in concrete, behavioral terms, rather than in terms of outcomes. For example, rather than telling a client to lose 25 kgs, the provider might recommend specific behaviours (daily walks, cutting out sweets) that will help the client to move gradually toward the goal. Good recommendations also take into account the client’s social, cultural and economic context (e.g. can the client afford to follow the recommendations?), as well as enabling and reinforcing factor for behaviour being promoted specifically to the client. Utilise social support networks: The health service provider explores the client’s social network in order to determine whether these supports can be used to enhance treatment. Verification: The health service provider checks for client comprehension and understanding during the session at the end of the session by asking Training of Trainer

the client to repeat key messages by posing questions such as, “What are the most important things that you are going to do when you leave?” rather than a less effective question: Did you understand what to do at home?

b. Dialogue with Patients/clients: The objective of dialogue is to:  Determine what services are needed by the clients/patients and what the best way to provide those services is. This dialogue provides an opportunity to learn how patients/client understands health and disease, and negotiate with them about the organization and delivery of services.  Management of diseases, conditions and rehabilitation of patients and clients when they go to health institutions. There are a lot of opportunities that can be utilized in the communication process this context and are discussed below as follows:Overall Socio -Emotional Communication: The objectives of effective socio-emotional communication are: To establish and maintain a positive rapport with the patient throughout the encounter. This is an integral part of all Interpersonal Communication.  To enhance patients to open up and comply. Socio- emotional skills include the ability to use (effectively and appropriately) statements to show empathy, concern, positive regard, and to give reassurance. Standard: The health service provider establishes and maintains a positive rapport with the client throughout the encounter. The behaviors discussed below can help the provider to achieve this goal. Guidelines: The following list of specific norms relate to the methods used in effective socio-emotional communication. This is illustrative, and is not intended t being exhaustive. These norms maybe adapted according to the local context. Framing of the encounter: The health service provider makes a statement which establishes a positive environment for the client to share his/her feelings, attitudes and beliefs so that the client feels that the health service provider is interested in his or her perspective. For example, the health service provider might say, “Good morning, Mrs. Gita, my name is Dr. Bushan, and I want you to tell me about anything that you think may be affecting your health.” 

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Attention: The health service provider focuses attention on the client and does not engage in other activities during the encounter. Constructive non-verbal behaviours: Behaviors, such as forward body lean, eye contact, smiling and touching, are appropriate and conducive to dialogue, when deemed culturally acceptable. Positive regard: The health service provider shows respect and positive regard for the client, irrespective of differences of age, social and educational status, race, gender, religion, etc. Empathy: The health service provider will elicit feelings from the client and reflect or restate those feelings to the client. This expression of empathy with the patient helps to establish rapport. Non-judgmental: The health service provider makes an effort to validate the way the client is feeling without judgment, so that the client will feel free to be frank and open.

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Concern: The health service provider shows that he/she cares about the client and the client’s problem. For example, he or she might use statements such as, “I’m worried about you,” or “I’m concerned that you are not taking care of yourself”. Reassurance: The health service provider encourages and reassures the client when appropriate while avoiding premature or unjustified reassurance.

15. Communication Skills Self- Assessment Exercise The following self-assessment exercise is designed to help you evaluate your own interpersonal communication skills and style, and provide you with helpful tips for becoming a good communicator - and team player! In each of the following, read items A, B, and C, then mark the one that best describes your communication style. (24 total) 1. A. When conversing with others, I usually do most of the talking. B. When conversing with others, I usually let the other person do most of the talking. C. When conversing with others, I try to equalize my participation in the conversation.

Best answer : c. Conversations should be a balanced two-way flow of dialogue. 2. A. When I first meet someone, I wait for the other person to make the introduction first. B. When I first meet someone, I introduce myself with a smile and offer a handshake. C. When I first meet someone, I hug the person.

Best answer : b. It’s good to initiate the introduction and introduce yourself with a handshake and smile. If shaking hands is difficult, a quick head nod is a good substitute. Initiating the introduction with a smile and handshake (or head nod) helps build rapport. 3. A. I usually “warm-up” new conversations with small talk. B. I usually avoid small talk and jump into more important matters. C. I usually avoid starting conversations.

Best answer : a. It’s good to initiate conversations with small talk. Topics to warm-up the conversation might include a chat about the weather, news of interest, or impressions about the current activity (if you’re at a meeting, staff party, or other gathering, for example) Examples of conversation starters might be: “It’s sure warm today, isn’t it?” “Did you hear about the big accident on the freeway? Traffic’s backed-up for miles.” “What did you think about the Blazers game last night?” “This is a nice party, isn’t it?” “Could I get you something to drink?” Training of Trainer

4. A. I make an effort to remember and use peoples’ names. B. I don’t pay attention to names as I tend to forget them. C. I only learn the names of important people.

Best answer : a. It’s good to call people by name whenever possible. It makes a good, lasting impression, and it makes the other person feel important and special. To help remember names, try these techniques: Repeat: After the person tells you his or her name, immediately use it several times in the conversation. “It’s nice to meet you, Bob.” “I agree with you, Bob.” “That was a great joke, Bob!”

Associate: Associate the person’s name to something unique and special. You might:  Associate the person’s name with a unique feature about the person. For example: “Anita has beautiful green eyes.” Think - “GG” - Green Ghanshyam Mohit tells funny jokes.” Think - “JJ” - Joking Smita 

Associate the name with a visual picture. For example: “Sandy” - visualize a sandy beach.

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Associate the name with a personal connection. For example: “Ramdev” - My uncle’s name is Ramdev. “Gita” - I had a turtle named Gita.

 Jot: Jot the person’s name down with an identifying description that will help jog your memory later. For example: “Meena” - tall; glasses; works in Accounting; has twin sister; runs marathons; new to Behrampur. 5. A. I frequently use courtesy words and phrases - “Please,” “Thank you,” “You’re welcome,” “I’m sorry” B. I occasionally use these courtesy words and phrases. C. I never use these courtesy words and phrases.

Best answer : a. Regular use of these courtesy words and phrases is important to show politeness and build rapport. 6. A. I tend to be serious and don’t smile often while conversing. B. I smile all the time while conversing. C. I smile at appropriate times while conversing.

Best answer: c. Smiling when greeting people and at appropriate times greatly helps build rapport. Training of Trainer

7. A. I make eye contact while conversing. B. I sometimes make eye contact while conversing. C. I never make eye contact while conversing.

Best answer: a. Making eye contact is important for building rapport. It gives the impression you’re interested and engaged in the conversation, and you have good self-confidence. Eye contact should include frequent breaks to avoid staring (this can make the other person uncomfortable). Break eye contact frequently - glance down to the side, then quickly make eye contact again. Glancing down to the side is important. If you instead glance to the side (as if looking out the window, for example) or look up, it gives the person the impression you’re distracted and not paying attention to what’s being said. This quickly breaks down rapport. 8. A. While conversing, I hold my head still at all times. B. While conversing, I nod my head at appropriate times. C. While conversing, I nod my head constantly.

Best answer : b. Occasionally nodding your head to indicate you agree or understand helps build rapport. Again, it shows you are interested and engaged in the conversation. 9. A. While conversing, I stand one-foot away from the person. B. While conversing, I stand two- to three-feet away from the person. C. While conversing, I stand five- to six-feet away from the person.

Best answer : b. Your arm’s length is the appropriate distance (between twoto three-feet). Standing closer than arm-length makes the other person feel uncomfortable (or feel threatened). Standing farther away breaks down rapport. 10. A. I often stand while talking to a person who is sitting. B. I often sit while talking to a person who is sitting. C. I often lean down while talking to a person who is sitting.

Best answer : b. Communicating at eye level helps build rapport. So, if the person is sitting and a chair is available, take a seat! There’s one exception - If you walk into your supervisor’s office or co-worker’s office, it’s best to ask the supervisor or co-worker if you can sit down first. Even better, wait for an invitation to sit. The person may not have time to talk at that moment. 11. A. To end a conversation, I often just leave. B. To end a conversation, I begin to look impatient hoping the person will get the hint. C. To end a conversation, I wrap up with a closing statement.

Best answer : c. It’s best to bring the conversation to an end by making a polite closing comment or gesture. Good closing (wrap-up) comments might be: “I’ve enjoyed talking with you.” “Let me give you my business card.” “Well, I need to go speak with....” “Do you know a person I can contact?” Training of Trainer

12. A. If a co-worker has put on weight, I say nothing about it. B. If a co-worker has put on weight, I tell the person that he or she has changed in appearance. C. If a co-worker has put on weight, I honestly tell the person that he or she looks fat.

Best answer: a. It’s best to say nothing. Never say anything that might hurt or offend the person. It’s called being tactful. It’s always best to give compliments only, and only say things that will make the person feel good. “I like your dress.” “That’s a nice shirt.” 13. A. When I’m listening to the speaker, I often cross my arms over my chest. B. When I’m listening to the speaker, I often lean back and turn my body away from the speaker. C. When I’m listening to the speaker, I often lean slightly forward and face my body toward the speaker.

Best answer : c. Leaning slightly forward and facing the speaker shows you’re interested, and it helps build rapport. Sitting with your arms crossed over your chest gives the message you are defensive. Leaning back with your body or turning your body away from the speaker gives the message that you are bored, disinterested, or feel in charge. Such body language breaks down rapport. 14. A. When I cross my leg, I cross my leg facing the speaker. B. When I cross my leg, I cross my leg away from the speaker. C. When I cross my leg, I bob my foot.

Best answer : a. Crossing your leg toward the speaker shows you’re interested, and it builds rapport. Crossing your leg away from the speaker gives the message that you are defensive, disinterested, or feel in charge. In essence, you are putting up a subtle barrier. And if you bob or swing your foot, you’re sending the message that you’re anxious or nervous! 15. A. While listening, I tend to be distracted by things going on around me. B. While listening, I listen for meaning and ask questions. C. While listening, I watch the person speak, but I don’t “hear” a word.

Best answer : b. If you’re a good listener, you keep mentally busy searching for meaning in the message, and you ask questions. This mental “search for meaning” helps keep you focused, attentive, and engaged. If you get easily distracted, try taking notes if the setting is appropriate. Note-taking helps draw and focus your attention as you must mentally “search for meaning” and listen for information in order to take notes. This might be helpful in meetings, for example. If you watch someone speak but you don’t “hear” a word, gauge if you are bored, tired, might have a gap between your speaking and listening rates, or are experiencing “emotional deafness.” We all experience emotional deafness on occasion, especially when we’re feeling overwhelmed, upset, or nervous. You hear people ask - “I’m sorry, what did you say?” or make the comment - “I have Training of Trainer

a lot on my mind right now. Could you repeat what you said?” If it’s a frequent problem, gauge the source and seek help if needed. 16. A. When someone talks about an unfortunate or sad experience, I don’t comment about it. B. When someone talks about an unfortunate or sad experience, I try to change the subject. C. When someone talks about an unfortunate or sad experience, I try to relate to the person’s feelings and show sensitivity to his or her misfortune.

Best answer : c. Showing empathy (sensitivity) to another person’s feelings helps build rapport. It’s called “reaching out to people.” Empathy can be shown by making comments, such as: “That must have been a scary (or upsetting) experience for you.” “I felt the same way when that happened to me.” “I know (understand) how you feel.” “I can imagine how you feel.” “I would feel that way too in your situation.” 17. A. When I discuss a topic, I tend to talk about and focus on positive (good) aspects. B. When I discuss a topic, I tend to talk about and focus on the negative (bad) aspects. C. When I discuss a topic, I tend to complain.

Best answer : a. Focusing on the positive (good) aspects draws people’s attention in a favourable way, and people enjoy the conversation more. People are generally more attracted to a person who has a “positive outlook on life.” And when it comes to work evaluations, positive-minded people generally do better. Consider the following examples: Positive: “The plan has some good ideas.” Negative: “The plan has some serious problems.” Complaint: “No one ever listens to my ideas.” Positive: “These changes might have some benefits.” Negative: “These changes would be awful.” Complaint: “I’m always having to relearn and re-do everything around here.” 18. A. When I have a negative opinion or comment, I just say it. B. When I have a negative opinion or comment, I lead in with a positive comment first. C. When I have a negative opinion or comment, I say nothing.

Best answer : b. It’s best to say something positive first, then express a negative opinion or comment in a tactful way. Consider these examples: Positive lead: “I like many aspects of your idea (positive lead), but it may not work well for this department.” (Tactfully stated) Training of Trainer

Interpretation: The idea won’t work. Positive lead: “You did a nice job setting the bread plates and glasses (positive lead), but the forks need to be placed to the left.” (Tactfully stated) Interpretation: The forks are in the wrong place. Positive lead (with empathy): “I know you worked a long time on this (positive lead), but it would look better retyped.” (tactfully stated) Interpretation: It needs to be retyped. 19. A. When I receive unfavorable feedback, I note where I need to improve. B. When I receive unfavorable feedback, I get angry and defensive. C. When I receive unfavorable feedback, I deny the problem, make excuses, or plead ignorance.

Best answer : a. When you receive feedback, it’s important to know what you do well, but it’s equally important to know where improvements can be made to increase your chances for success. Few people do everything well, and you’ve undoubtedly heard the saying - “No one is perfect.” Simply make note of “weak” areas (we all have them!) and make changes needed. Receiving honest feedback is truly “a gift.” It usually means someone cares and wishes to see you succeed. 20. A. When I give a person negative feedback, I focus on the person’s observable work or behavior and offer suggestions. B. When I give a person negative feedback, I focus on what I don’t like about the person. C. When I give a person negative feedback, I simply tell the person what to do right.

Best answer : a. When you give negative feedback, you should focus on and communicate your observations of the person’s work or behavior, not focus on nor judge the person. Focus on performance, not personality (or personal traits). After sharing your observation about the person’s work or behavior, offer a suggestion in a tactful way. Consider these examples: Example 1: “The forms you completed were thoroughly done (positive lead), but I notice (observation) there are a few spelling errors (work feedback). Perhaps they can be corrected with correction fluid (suggestion).”   Important: Notice it says - “...there are a few spelling errors” instead of - “you made a few spelling errors.” Leave out “you” whenever possible. Example 2: “Your presentation covered the main points very well (positive lead), but I noticed (observation) contact information was left out (work feedback). I Training of Trainer

wonder if it might be good to include a contact name and phone number (suggestion).” Notice it says - “...contact information was left out” instead of - “you left out contact information.” It avoids using “you.” Example 3: “I like your ideas (positive lead), but it appears (observation) the delivery (communication style or behavior) weakens them. Perhaps they could be written down and handed out to everyone to review (suggestion). Notice it says - “...the delivery weakens them” instead of - “you weaken them.” It avoids using “you.” 21. A. When I give a person negative feedback, I do it around others so everyone can hear. B. When I give a person negative feedback, I do it in front of the supervisor C. When I give a person negative feedback, I talk with the person alone in a private place.

Best answer : c. It’s always best to meet the person privately and away from other people so others can’t hear. 22. A. When I disagree with a person, I listen first, ask questions for clarification, then disagree non-judgmentally. B. When I disagree with a person, I quickly point out the person is wrong and why. C. When I disagree with a person, I say little or nothing.

Best answer : a. It’s fine to disagree, but it’s important to  disagree agreeably. This means you should: Show respect for the other person’s ideas Listen attentively until the person is done Ask questions if needed Disagree non-judgmentally, and, if possible Offer an alternative solution Consider these examples: “I respect your view, John, (shows respect) but I think the problem is due to a lack of time (point of disagreement). One way to solve the problem might be to computerize repair reports (offered solution).” “I hear what you’re saying (shows respect), but it seems the staff would do better, not worse, with flextime schedules (point of disagreement). I would suggest we try it for six months (offered solution).” 23. A. When I’m in a group, I tend to frown a lot. B. When I’m in a group, I tend to smile and use humor at appropriate times C. When I’m in a group I tend to be serious.

Best answer : b. At appropriate times, it’s always good to smile. And when used at appropriate times and in appropriate ways, humor is beneficial for group Training of Trainer

dynamics. Humor helps “break the ice” when people first meet. Humor helps relieve stress and tension. A humorous observation and comment helps lower the heat when a heated discussion gets too “hot.” And most importantly, humor helps build team cohesiveness. If you observe people at a gathering, you’ll notice people naturally gravitate toward people considered “approachable.” Approachable people are the ones who smile; they are the ones who add humour  and lightness to conversations; and they are the ones who make fun of themselves in a selfdeprecating and humorous way. In any group setting, smiles attract, and humour bonds people together. Do you know a good joke?  Idea: If you’re like many people who have difficulty remembering humorous lines, puns, anecdotal stories, or jokes, consider creating a humour file. Clip and save humorous jokes, stories, and puns from the newspaper. Write down and save jokes and funny stories you hear. Your file will be a good resource to draw from for upcoming social events and gatherings. This last item has four choices (A, B, C or D). Which one best describes you? 24. A. I’m a “hands-on” person. I tend to: prefer hands-on experiences and activities; focus on tasks to be done; refrain from discussions; think in a logical and organized way; do things in an orderly way; have difficulty adjusting to change. B. I’m a “thinker.” I tend to: enjoy listening to a logical presentation of ideas; enjoy analyzing problems and finding systematic ways to solve problems; enjoy creating models based on theory and information; like structure and organization; act slowly in making decisions; show more interest in ideas than people.

C. I’m an “explorer.” I tend to: try things by trial and error; explore practical uses for ideas and theories; make decisions that provide quick solutions; decide quickly; take risks; enjoy change; rely more on people for information. D. I’m a “free thinker.” I tend to: base views and opinions on feelings; enjoy tossing around ideas (brainstorming); approach and view problems and experiences from different perspectives; rely on intuition, not logic, for making decisions; dislike structure.

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Best answer : The one that fits you! The four choices above describe and identify four communication (and learning  (and learning ) styles, and no one style is better than the other. other. This part of the exercise merely serves to illustrate how people can (and do) do) think, act, learn, and communicate differently. Each person in a group may have a different style. How well you are able to recognize, respect, and adjust to other people’ way of communicating and “doing things” is a key to success when working with a supervisor, group of people, or class instructor. For example, if you are a “free thinker” - you like to brainstorm ideas and do what “feels right” - you might find it frustrating working with (or learning from) a “thinker” - a person who focuses on and approaches tasks and ideas based on logic, reasoning, and organized structure. The “thinker” would be equally frustrated working with a person or group that loosely brainstorms ideas all afternoon. How successfully “opposites” work together largely depends on how willing and well each person is able to adjust to the other’s style. Flexibility and compromise are key.

16. Dealing with Complex Complex Feelings Feelings The problem with feelings is that feelings are not simple; they are very complex. You may be watching a person acting in a certain manner, showing a certain emotion, while inside he may be feeling something totally different. So how to find out what are his true feelings?

Dealing with Feelings Toolkit Let us now look at a toolkit for dealing with feelings of others.

a) Description of Feelings This is nothing other than the reporting of feelings. You are disclosing a feeling that is inside you to another person. You should do this only when it is required, and when it will contribute some value to the communication. Normally, you use this skill only with someone you know well and in situations where you can predict the reaction of the other person. In case someone commits a mistake, a typical unfeeling person will blame him using the word “You” and will also use hard words. But with description of feelings, you shift to “I” and “We,” and to words that are soft or neutral, thereby indirectly appearing to shift some of the blame on to yourself. Thus, this skill is a powerful trust-builder in relationships.

b) Reflection of feelings Sometimes we are not sure of what the other person is trying to say. Sometimes we get mixed messages from him because his message is not congruent. Sometimes, feelings run so high that we first have to tackle that problem before addressing the problem we should. All this occurs because persons are very indirect in expressing their feelings.

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In such circumstances, we have to guess what the other person is feeling. But our guess is merely a guess; it may be either right or wrong. We must check out our guess, our understanding, and this is called the reflection of feelings. We are trying to understand what the other person is feeling. Suppose the other person is angry or sad. The typical reflection of feelings would be: “I can understand that you might be feeling annoyed/upset about this.” What do we see about the above statement? First, it is a guess (might). Second, it is a close-ended statement; the other person can only give a yes-no answer, and not question back. Third, the statement is empathic; you are telling him that in his shoes you would have also felt such an emotion. Lastly, you are validating his emotion; you are saying that in such a situation it is ok for him to have such a feeling. You are also using soft/neutral words. Suppose you say: “You don’t have to be so angry/ sad.” This is not reflection because you are violating all the rules stated above. Suppose you say: “I understand just how you feel.” Again, this is not reflection, since you are showing sympathy, not empathy. Sympathy assumes that you are at a higher plane and the other person is at a lower level. You are also leaving room for a return question, which may not be polite. You should never say: “You should be really angry about this.” If the other person wasn’t angry before, he will now reconsider what his feelings should be!

c) Perception Checking Suppose some person says something or does something that appears strange to you. You do not know what were his intentions, or his motives, or why he reacted in this manner. When you try to find out what his intentions, motives or reactions were, then you are doing a perception check. It is a step higher than reflection, which deals only with feelings. But your perception check should be gentle and very polite. You should not cause offence, and the other person should not feel that you are cornering him or trapping him. Let us take an example. Six of you are doing a presentation. It does not matter who speaks when. To avoid confusion, the Project Leader has fixed an order of speaking. You are to speak third. Suddenly, after the second person finishes speaking, the sixth person starts speaking. He finishes his talk, and goes away from the room. Training of Trainer

You are surprised at his reaction. Why did he behave this way? What were his motives, his intentions? At that moment you are angry, and you feel that he wanted to draw attention to himself, and appear important. Later, when you meet him, you want to check your perception. So you ask him: “All of us were surprised when you spoke third. What happened?” He says: “I had some very urgent work in the lab to attend to. So I spoke earlier and left the meeting. Did it cause a problem?” Now, because he has explained the matter, your working relationship with him will continue to be good. But see the paradox. Your perception check was wrong, but it yielded positive results: Even though your perception was not not correct, the other person had the  chance to correct it, and remove any misunderstanding.  The other person was not aware till now now that he had done anything wrong. Your openness in checking has made him aware of his mistake. So, in future, he will be very careful.  The perception check clears up misunderstandings and wrong assumptions. Let us now have a small demonstration. I want three volunteers. (After they come, brief them in this way. The first person should silently pretend that he is typing a letter on a type-writer. He removes the letter, and hands it to the second person, who pretends to read it and sign it. Then he hands it to the third person, who pretends to fold it, put it in a cover, and lay it aside. Do this demo about three times. Then thank the volunteers and send them to their seats.) Now tell me, what were they doing? (Typical replies will be ‘typing letters, signing letters’ etc.) Consider again carefully, and tell me what they were doing. (More confused replies.) So, what were they exactly doing? (Keep it up till they are confused.) Shall I tell you what they were doing? Well, they were moving their hands! What did you do when you answered me? You assumed, or drew a conclusion, which was wrong. This is the last skill that we shall be considering in this session, and it is something that we have already touched upon during feedback. It is called

d) Behaviour Description It is a very powerful tool. It describes exactly what was said or what was done by the other person during any interaction. Since it is the total truth, the other person cannot deny it, and has to agree with and explain his behaviour. For example, you are giving a presentation. You see one of the participants close his eyes, and lean back in his chair for a few minutes. You think that perhaps he is tired. How do you do behaviour description and a perception check? Behaviour Description: “During my presentation, I noticed that you closed your eyes and leaned back in your chair for several minutes.” Perception Check: “I thought you might have been tired. Were you?” Training of Trainer

17. Exercise to practice toolkit: Situation 1: You are a Medical Officer talking to a newly diagnosed TB patient. You suspect him to be a TB suspect. The Patient does not believe he has TB. He agrees for an X-ray, but not for sputum examination.

Situation 2: Medical Officer is meeting with a patient diagnosed as having TB by a private doctor on the basis of an X-ray report. The patient wants free drugs without delay and sputum examination. The patient trust diagnosis of Private Practitioner.

Situation 3: A TB patient who is a daily wage-earner and does not want to come for directly observed treatment (DOT) because he does not want to miss work. He insisted on weekly supply of anti-TB drugs.

Situation 4: Doctor is meeting with a newly diagnosed sputum positive patient who is a truck driver and who says he will have difficulty in availing DOTS as he is travelling most of the time due to nature of his job.

Situation 5: MO-PHI is meeting with a newly diagnosed married woman who does not want her husband or family to know about her illness.

Situation 6: Medical Officer is meeting with the father of a woman who is to be married and he does not want the community to know that his daughter is suffering from TB.

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 Module 2

Team Work

1. Importance of Teams The need for teams and team working has never been greater. All of this call for a:  Combination of skills, experiences and judgements  Breaking down of barriers between departments within organisations  Closer customer relationships Teams, as opposed to individuals, have the potential to bring together the skills, experiences and disciplines required in these changing times. For professionals in the Axshya India project, healthy team work is essential to create quality conversations between patients and professionals, while also improving work relationships among team members. Typical results usually include stronger communication and motivated employees. That usually leads to happier and safer patients and colleagues.

2. Teams Vs. Groups Ask, do you think there is a difference between a ‘team’ and a ‘group’? Elicit responses. Despite greater emphasis on teams, very often there is confusion between what exactly a team is and what a group is. Furthermore, the word ‘team’ is used and applied in situations where the need for a team may not exist. 



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Whilst groups can achieve success, they may not be as effective as people working as a team People believe that groups will, in time, automatically become teams; sadly, this is not so, as you will read later Most of our time is spent in groups at work, at home and in our leisure time, as opposed to teams in the true sense of the word

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The differences between the two are subtle yet significant.

In co-operative groups:  People trust each other  Feelings are expressed openly  Conflict is worked through   People support one another   Information is shared freely   Objectives are common to all

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In effective teams: People work together Feelings aren’t part of work Conflict is accommodated Trust and openness are measured Information is given on a ‘needs to know basis’ Goals/objectives are either personal or unclear

3. Elements of Team Work 

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Sharing information- this is the most important. If you do not share information, there will always be gaps in the answer. Listening and responding – Actively listening to other members, trying out their suggestions. Giving others the benefit of doubt – Not discarding any idea, but considering each one on merits. Providing support- If anyone was near the answer, you pointed out the shortcoming and helped him complete it. Recognizing and respecting the interests and achievements of others – you understood that each one had a different talent, and took the best that he had to offer.

Disadvantages of working in teams 1. Ego clashes 2. Conflicts 3. Disagreements 4. Stalemates 5. Politics 6. Non-cooperation 7. Lazy members, etc. And apart from this, some other generally observed disadvantages are: Since every member of the team is different, it is not possible to say what the total response of the team will be. Since every member of the team responds at his own speed, the total speed of response is normally found to be slow. When any critical task has been given to the team, it tends to become more inflexible, as every team member becomes more rigid in his thinking pattern. Every member of the team has to change his way of thinking, and approaching others. Thus, his personality may be stunted, and his creativity not of the best quality. But these disadvantages are very limited compared to the large number of advantages we have with teams and teamwork

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4. Stages of Team Formation Groups are formed and developed through several stages. They do not form overnight. No team starts out as a fully formed team. It does not even start out as a group. It is very interesting to find out what stages are gone through before a team, and a high performing team, is formed. Researchers Tuckman and Jensen identified five stages of development that all groups go through before performing as a fully mature and effective team. These five stages have been accepted and adopted by other researchers also. The five stages of team formation are:

NORMING Supporting

STORMING Selling

PERFORMING

Delegating

FORMING

Directing

ADJOURNING

Forming:  Formation of team happens & the team comes together  Members feel anxious and spend their time finding out about each other  Individual roles and responsibilities are unclear  Highly depending on the manager/leader  Equivalent Situational Leadership style: Directing Storming: Team members come up with ideas through debates on how to proceed with  the task about task priorities;   clarity on purpose of the task;  roles & responsibilities and  processes to follow    

Influence of ideas and power struggles may arise Compromises may be required to enable progress Team members may challenge the leader & leader coaches Equivalent Situational Leadership style: Selling

Norming:  Work as a team starts  Roles and responsibilities are clear and accepted Training of Trainer



 

Team begins to exhibit participative behavior & decision making happens by group agreement Commitment, trust and unity increases Equivalent Situational Leadership style: Supporting

Performing:  This stage is characterized by high levels of:  goal orientation,  interpersonal relations, independence, motivation,  knowledge and  competence in team members    

Team knows what, why & how of the task they are executing High level of respect in the communication between team members Team expects delegation of task instead of instruction/assistance

Adjourning:     

Happens when project completes Members moving out of the group after project goal achievement Everyone can move on to new things Achievement celebrated Members feel difficulty as they have developed close working relationships with other team members

Why is it necessary for us to understand these stages of team formation? By knowing these stages, we can understand the team performance at the different stages, and this helps us to cope with and adapt ourselves during the different stages in order to be more effective. More than that, if we know these stages, then we can reach out to other members of the group, inform them of the nuances, and help them settle into the culture of the team.

5. Effective Teams – Concept Think back on the activity that you have been part of: What were you asked to do? How did you go about it? Where were you successful and why? What difficulties did you come up against? How were these overcome? How was your team led?  What did the leader do well?  Where were they not so good?  If you were in charge, would you have done anything different? Each member is different from the others, and has his own program. But we have formed the team for only one result, not for multi-results. That one result, towards which everyone should be oriented, should be shining in the corporate sky like the Pole star or Northern star. This is the common goal or objective, and all should aim for it.

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But what sort of goals should we set? It is denoted by the acronym SMART. Adapted from Paul J. Meyer’s “Attitude Is Everything.”

Smart Goal

3. Look At Your Options 4. Action Plan 2. Determine the Barriers 5. Review Progress 1. Develop a Goal  6. Celebrate Success

Specific Measurable Attainable Realistic Time-bound

Specific - A specific goal has a much greater chance of being accomplished than a general goal. To set a specific goal you must answer the six “W” questions: Who: Who is involved?  What: What do I want to accomplish?  Where: Identify a location.   When: Establish a time frame.  Which: Identify requirements and constraints.  Why: Specific reasons, purpose or benefits of accomplishing the goal. Measurable - Establish concrete criteria for measuring progress toward the attainment of each goal you set. This measurement is in terms of quantity, quality or some other specifically measurable criteria. Remember, things that get measured tend to get done. To determine if your goal is measurable, ask questions such as......How much? How many? How will I know when it is accomplished? Attainable - When you identify goals that are most important to you, you begin to figure out ways you can make them come true. You develop the attitudes, abilities, skills, and financial capacity to reach them. You begin seeing previously overlooked opportunities to bring yourself closer to the achievement of your goals. You can attain most any goal you set when you plan your steps wisely and establish a time frame that allows you to carry out those steps. Goals that may have seemed far away and out of reach eventually move closer Training of Trainer

and become attainable, not because your goals shrink, but because you grow and expand to match them. When you list down your goals you build your selfimage. You see yourself as worthy of these goals, and develop the traits and personality that allow you to possess them.

Realistic - To be realistic, a goal must represent an objective toward which you are both willing and able to work. A goal can be both high and realistic; you are the only one who can decide just how high your goal should be. But be sure that every goal represents substantial progress. Your goal is probably realistic if you truly believe that it can be accomplished. Additional ways to know if your goal is realistic is to determine if you have accomplished anything similar in the past or ask yourself what conditions would have to exist to accomplish this goal. Time-bound - A goal is timebound when you can measure the accomplishment of it by a specific date in the future. That date is the finish line you are striving towards. It answers the question, ‘By when. ..” Leader: This is sometimes a controversial area. All the members of the team are extremely intelligent persons, so why make one of them a leader? Is it because he is more intelligent than any of them? Not so. The leader’s role is just another role in the team. He is the binder. He is the motivator for the introverts in the team. In cases of conflict, he is the arbiter. He is the bridge between the management and the team, carrying instructions and complaints from one to the other, and providing the direction as required. He is the first line of defence in any team. Proper leadership and structure provide focus and direction to the team. Roles and Responsibilities: After taking care of the proper team mix, we must see that each member of the team is very clear about what will be his role and responsibilities. By this, specialization will be protected. Nonidentification of clear roles and responsibilities will lead to duplication and grey areas and confusion. Members should not hide inside the team and indulge in social loafing. Communications: This is one of the most important characteristics. If the common goal is compared to a big jigsaw puzzle, then each member of the team has different pieces of the jigsaw puzzle with him. By communicating properly, all the pieces can be joined together to form a whole. If not, then the common goal cannot be achieved. If communications break down, then there is mistrust, low morale, and duplication of efforts. Therefore, effective communications is a must, through talking, phones, e-mails, letters, meetings etc. Trust: In an effective team, every member has complete trust in the other member. The team’s success is assured only if each member of the team succeeds, and this success is attained only through trust. Trust also means that respect is being shown. This is also one of the most important factors in an effective team. Training of Trainer

6. Importance of Trust & Communication in Team Work We have seen from the previous part of the session than communication and trust are considered to be the most important characteristics of an effective team. They are said to be the most essential building blocks of effective teams. There is no doubt that communication is an essential part of the team. As we said earlier, without communication there will be duplication, mistrust, and confusion; the jigsaw puzzle will not be complete. But what about trust? How important is it? Can we not do without trust? Cannot a team function and perform without trust? Let us consider a very paradoxical thing. We say that teams are better because persons get together, work together, and achieve a common goal. We also say that every member of the team is different from the other. Every member is an individual with his own ideas, thoughts and beliefs. Yet, we expect such people to get together, work together, and achieve a common goal. Theoretically, prima facie, does this not seem absurd and ridiculous? But what do we practically see? Diverse people do get together, form a team, and complete a task. How, and why does this happen? The reason is that we may be individuals, but that does not prevent us from respecting the abilities, the strengths and the contributions of the other persons, however different they may be from us. When we respect the other person, we get respect from him. This mutual respect gives rise to trust. When we trust the other person, we do not see his differences as a threat, but as a positive and constructive force. We do not view his difference as a challenge, but as a welcome change. But cannot a team function without trust? Maybe it can, but only for a short term. Trust is not only the cementing factor between relationships; it is the lifeblood of any relationship. If there is no trust, the relationships between the team members will corrode and disintegrate. Would you willingly have a relationship with someone whom you don’t trust? There are two ways in which trust can be demonstrated to the other person. These are the two important skills that you have learnt in the previous session. The first skill is that of Active Listening. What are you doing when you are actively listening to another person? You are paying him your full attention. So you are respecting what he says. This respect on your part makes him respect you in turn. This builds up trust for each other. The second skill is that of Feedback. If feedback is given effectively in the sandwich and 4-stage models, and if the changed action or behaviour is requested for properly, and the solution is worked out jointly, then there is excellent sharing and growth, and the team will be healthy and robust.

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7. Team Player Styles Many great achievements seem to be the product of the labor of a dedicated individual, such as Newton’s and Einstein’s physics, the music of Beethoven and Bach, Darwin’s theory of evolution, or Skinner’s theory of verbal behavior. Even though these past masters stood on ‘The Shoulders of Giants,’ they seem to have stood solitary, quite content with proceeding on their own. Many other great achievements seem to have come by due to the collaboration of individuals who often differed markedly in personality, such as the team of Thomas Edison and Nikola Tesla, who pioneered electrical and in particular alternating current engineering; John Lennon and Paul McCartney, who together transformed popular music into an art form. “A person cannot be perfect, but a team can be,” in the sense that a team might comprise personal attributes that no single person could ever contain. Personal attributes of several people making up a team might either complement each other, or have a synergetic effect. It seems, then, that the talents of the solitary thinker, who can wield great ideas, teamed up with the talents of the enthusiastic visionary who can turn ideas into reality, is a successful combination. These talents and personal characteristics are not common within a single individual, but can, of course, occur in a team of Individuals. For our purposes, a team is any number (greater than one) of individuals who share an expressed interest in work ing together in order to achieve a goal. A team, then, consists of individuals, and as individuals they have a number of properties or attributes which determine their efficacy as members of the team. Clearly, working in teams brings out the best in some people, if a suitable partner or set of partners can be found. Is it possible, though, to know or to predict with some nontrivial degree of accuracy just how beneficial a team is? Dr. Meredith Belbin, of the Industrial Training Research Unit at Cambridge has developed an understanding of how teams work, and how to make them work better. Belbin’s perception is that all members of a management team have a dual role. The first role, the functional one, is obvious: a manager belongs to the team because he is an accountant or production engineer or regional service manager or group marketing executive, or whatever. The second role, the team role, is much less obvious. Through extensive research at Henley Management College Belbin isolated and identified eight key roles as the ones available to team members. Over the years of his research, first at Henley and subsequently within the real business world extending from Britain to Australia, Dr. Belbin and his colleagues learned to recognize individuals who made a crucial difference to teams and to whose team types he gave descriptive names. The reason for these names is not always obvious, and the names themselves are sometimes a little misleading. When using them it is the descriptions, not their labels, which are important.

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Here are the eight Belbin team types:

Creators

Leaders

Implementers

Completers

Plant

Co-ordinator

Team Worker

Monitor Evaluator

Resource Investigator

Shaper

Team Implementer

Completer Finisher

The question arises: do these team roles really exist? Belbin’s Team Roles are presented in two books and in the manual of the INTERPLACE computer program. Even though it is a much used instrument for personality assessment and team building, there exist no publicly available records or scientific reports to actually demonstrate its validity. In an assessment of the Belbin TeamRole Self-Perception Inventory (BTRSPI), Furnham goes as far as to state that ‘the measure is neither theoretically nor empirically derived.’ In a reply Belbin counters that the BTRSPI is a historical antecedent of INTERPLACE, a system which is supposedly far more robust than the BTRSPI. However, no publicly available examination of the psychometric properties of that instrument exists, either. A handful of authors have tried to validate Belbin’s Team Roles. These attempts at validation are all entirely empirical. They all give the impression that the validity of Belbin’s Team Role is not particularly impressive. Rolf Marvin Boe Lindgren of the University of Oslo, Finland, has suggested the Big 5 method of determining Team Styles. According to him, all the styles come under one or the other of the five main personality dimensions. Based on this system, eight styles emerge which are a mixture of the personality dimensions. Rolf Lindgren of the University of Oslo has in his thesis “R. Meredith Belbin’s Team Roles Viewed From the Perspective of The Big 5- A Content Validation” argued that every member of a team has only one Team Role, that of a team member. On the other hand, their personalities are composed of various traits, all of which come under one or other of 5 major personality dimensions. For easy memory, we can call them as the 5 E’s, and what they comprise of is mentioned below: 1. EXTROVERT: Aggressive, assertive, daring, flamboyant, frank, open, funloving. 2. EMPATHIC: Accommodating, acquiescent, compassionate, cordial, kind, mild, gentle, and sincere. 3. EFFICIENT: Careful, exacting, fastidious, fussy, tidy, hardworking, meticulous, neat, orderly. 4. ELITE: Un-envious, calm. 5. ELDRITCH: Artistic, complex, creative, imaginative, philosophical. Based on the above, Lindgren has suggested 8 team styles with the following traits possessed by each one of the styles:

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The Builder: adaptable, caring, avoids conflict, observant, co-operative, diplomatic, over-sensitive, indecisive during crisis, full of team spirit. The Visualizer : broad in outlook, calm & confident, conscious of priorities, consultative, empire-building, laid-back, encouraging of others, manipulative, less creative, more practical. The Analyst: analytic, impartial, logical, realistic, shrewd, critical, sceptical, slow moving cannot motivate others. The Controller: accurate, conscientious, frightened of failure, good at following through, perfectionist, reluctant to delegate, persistent, fussy. The Organizer: disciplined, effective, loyal, practical, resistant to change, well organized, inflexible, un-adventurous. The Guide: challenging, competitive, hard-driving, outspoken, provocative, tough, aggressive, impatient, paranoid. The Networker: easily bored, enterprising, inquisitive, opportunistic, persuasive, outgoing, erratic, and impulsive. The Innovator: Creative, forgetful, imaginative, innovative, knowledgeable, original, unorthodox, up-in-the-clouds, intellectual, disregards practical details or protocol.

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 Module 3

Conflict Resolution

Introduction Persons working with TB patients often have little training in interpersonal skills. They may have high IQs but lack emotional intelligence. Temper outbursts and loud profanity directed at any unfortunate person who happens to be near at hand—are no longer tolerated. Patients and their families have the right to be treated with respect, and they know it. The care provider presents an insidious cost to any practice or health care organization. He or she increases the stress in the work environment and the accompanying loss of efficiency. Morale and team spirit suffer, which results in an increased turnover of staff and a dysfunctional team. Once this stage is reached, various negative factors begin to interplay. Communication is poor, and staff and patients withhold information because of fear of an outburst. The information withheld may be vital for patient well-being. The TB official can lose staff support and may become isolated. Once this dysfunctional behavior pattern is recognized, an intervention should be made. This action is necessary not only for patient safety but also because lack of action could be interpreted as negligent or as condoning a hostile work environment. When a confrontation is necessary, a team approach should be used, and if possible, a member of the team should be a close acquaintance of the individual, setting up a “good cop–bad cop” scenario. If only one person is involved, the person involved may view the intervention as a personal confrontation instead of a peer-related issue. Specific incidents should be documented, and the focus should be on behavior, not personality. Empathy should be expressed but change must be demanded, with a delineation of the consequences if behavior is not improved. The communication should be direct and clear, with the subject not given an opportunity to respond until the end of the dissertation. In this manner, a potential indignant response is often overwhelmed by the data and the presence of peers, and the person involved in the conflict will respond positively to the guidance given or help offered. The goal is to correct the situation and allow the highly trained TB specialist to perform to an optimal degree. Those participating in the confrontation should look for the good in any situation. In this way, the good can be built on, and a positive outcome becomes more likely. Training of Trainer

1. Understanding Conflict What is conflict? Conflict is a natural disagreement resulting from individuals or groups that differ in attitudes, beliefs, values or needs. It can also originate from past rivalries and personality differences. Other causes of conflict include trying to negotiate before the timing is right or before needed information is available.

The ingredients of conflict: Needs - Needs are things that are essential to our well-being. Conflicts arise when we ignore others’ needs, our own needs or the group’s needs. Be careful not to confuse needs with desires (things we would like, but are not essential). Perceptions  - People interpret reality differently. They perceive differences in the severity, causes and consequences of problems. Misperceptions or differing perceptions may come from: self-perceptions, others’ perceptions, differing perceptions of situations and perceptions of threat. Power  - How people define and use power is an important influence on the number and types of conflicts that occur. This also influences how conflict is managed. Conflicts can arise when people try to make others change their actions or to gain an unfair advantage. Values - Values are beliefs or principles we consider to be very important. Serious conflicts arise when people hold incompatible values or when values are not clear. Conflicts also arise when one party refuses to accept the fact that the other party holds something as a value rather than a preference. Feelings and emotions  - Many people let their feelings and emotions become a major influence over how they deal with conflict. Conflicts can also occur because people ignore their own or others’ feelings and emotions. Other conflicts occur when feelings and emotions differ over a particular issue. Conflict is not always negative. In fact, it can be healthy when effectively managed. Healthy conflict can lead to... Growth and innovation New ways of thinking Additional management options If the conflict is understood, it can be effectively managed by reaching a consensus that meets both the individual’s and society’s needs. This results in mutual benefits and strengthens the relationship. The goal is for all to “win” by having at least some of their needs met.

How public and private conflicts differ. Most of us have experience with conflict management and negotiation in private disputes (with a salesman, among family members or with your employer). Public conflicts, like those that can occur during watershed management efforts and other environmental issues often are rooted in trying to balance environmental protection and economic growth and jobs. Keep in mind, Training of Trainer

however, that effective watershed management can result in both economic and environmental benefits. Some complicating factors include:

Distribution of costs and benefits.  Those who benefit may not be the same as those who pay the costs. Perceptions of problems.  People tend to blame others for causing the problem.  Speed of clean-up or other actions.  Some will want changes to take place more quickly than others.

2. Conflict Styles a) The Five Conflict Styles Thomas/Killman, 1972 with further descriptions and analysis by Bonnie Burrell, 2001 Avoidance (lose-lose)

Accommodation Competition (lose-win) (win-lose)

Compromise (negotiated lose-lose)

Collaboration (win-win)

When the issue When the is of little issue is more importance important to the other person than it is to you

When the issue is not important enough to negotiate at length

When the issue is moderately important but not enough for a stalemate

When the issue is too important for a compromise

To cool down and gain perspective

When you discover you are wrong

When you are convinced that your position is right and necessary

When opponents are strongly committed to mutually exclusive goals

To merge insights with someone who has a different perspective on the problem

When the costs of confrontation outweigh the benefits

When the longterm cost of winning may not be worth the short-term gain

When there is not enough time to seek a win-win outcome

To achieve quick, temporary solutions to complex problems

To come up with creative and unique solutions to problems

To build up credits for later conflicts

When the other person is not willing to seed a win-win outcome

As a backup mode when collaboration doesn’t work

To develop a relationship by showing commitment to the concerns of both parties

To let others learn by making their own mistakes

To protect yourself against a person who takes advantage of noncompetitive people

When a long-term relationship between you and the other person is important

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Self-Assessment Your Method of Conflict Resolution Think of a relationship with someone with whom you interact regularly and with whom you engage in conflict (for example, a parent, sibling, roommate, close friend, spouse, partner, or lover). How do you usually respond to your conflict with this person? In each pair below, circle the A or B statement that is most characteristic of your behaviour. In some cases, neither answer may be very typical of your behaviour. If this happens, select the response that you would be more likely  to use. 1. A. There are times when I let the other person take responsibility for solving the problem. B. Rather than negotiate the things on which we disagree, I try to stress those things upon which we both agree. 2. A. I try to find a compromise solution. B. I attempt to deal with all of the other person’s and my concerns. 3. A. I am usually firm in pursuing my goals. B. I might try to soothe the other’s feelings and preserve our relationship. 4. A. I try to find a compromise solution. B. I sometimes sacrifice my own wishes for the wishes of the other person. 5. A. I consistently seek the other’s help in working out a solution. B. I don’t worry about my own concerns if satisfying them means damaging the relationship. 6. A. I try to avoid creating unpleasantness for myself. B. I try to win my position. 7. A. I try to postpone the issue until I have had some time to think it over. B. I give up some points in exchange for others. 8. A. I am usually firm in pursuing my goals. B. I attempt to get all concerns and issues immediately out in the open. 9. A. I feel that differences are not always worth worrying about. B. I try to integrate my concerns with the other person’s concerns. 10. A. I am firm in pursuing my goals. B. I try to find a compromise solution. 11. A. I attempt to get all concerns and issues immediately out in the open. B. I might try to soothe the other’s feelings and preserve our relationship. 12. A. I sometimes avoid taking positions that would create controversy. B. I will let the other person have some of what she or he wants if she or he lets me have some of what I want.

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13. A. I propose a middle ground. B. I press to get my points made. 14. A. I tell the other person my ideas and ask for his or hers. B. I try to show the other person the logic and benefit of my position. 15. A. I might try to soothe the other’s feelings and preserve our relationship. B. I try to do what is necessary to avoid tensions.

SCORING: For question 1, circle the A and B below according to your answer: for question 2, circle the A or B below according to your answer. Repeat the process for all 15 questions.

CT

Cl

C

1. B

2. 3.

AC

A

B

A

A

B A

4.

B

A

5. 6.

A

B

A A

7. 8.

A

B

9. 10.

B

A

A B

A

11.

B

12. 13.

B

14.

B

A

A A

15.

B

Number of As and Bs circled in column CT (CompeT ition)__________ Number of As and Bs circled in column CL (CoLlaboration)__________ Number of As and Bs circled in column C (Compromise)__________ Number of As and Bs circled in column A (Avoidance)__________ Number of As and Bs circled in column AC (ACcmmodation)__________ How do your five scores compare? Which is your highest, your most-likely method of conflict resolution, and which is your lowest, your least-likely method?

b) The “Interest-Based Relational Approach” The second theory is commonly referred to as the “Interest-Based Relational (IBR) Approach”. This conflict resolution strategy respects individual differences while helping people avoid becoming too entrenched in a fixed position. In resolving conflict using this approach, you follow these rules:  Make sure that good relationships are the first priority:  As far as possible, make sure that you treat the other calmly and that you try to build mutual respect. Do your best to be courteous to one-another and remain constructive under pressure;  Keep people and problems separate:  Recognize that in many cases the other person is not just “being difficult” – real and valid differences can lie behind conflictive positions. By separating the problem from the person, real issues can be debated without damaging working relationships;  Pay attention to the interests that are being presented: By listening carefully you’ll most-likely understand why the person is adopting his or her position;  Listen first; talk second: To solve a problem effectively you have to understand where the other person is coming from before defending your own position;  Set out the “Facts”: Agree and establish the objective, observable elements that will have an impact on the decision; and  Explore options together: Be open to the idea that a third position may exist, and that you can get to this idea jointly. By following these rules, you can often keep contentious discussions positive and constructive. This helps to prevent the antagonism and dislike which sooften causes conflict to spin out of control.

Using the Tool: A Conflict Resolution Process Based on these approaches, a starting point for dealing with conflict is to identify the overriding conflict style employed by yourself, your team or your organization. Over time, people’s conflict management styles tend to mesh, and a “right” way to solve conflict emerges. It’s good to recognize when this style can be used effectively, however make sure that people understand that different styles may suit different situations. Look at the circumstances, and think about the style that may be appropriate. Then use the process below to resolve the conflict:

Step One: Set the Scene If appropriate to the situation, agree the rules of the IBR Approach (or at least consider using the approach yourself.) Make sure that people understand that the conflict may be a mutual problem, which may be best resolved through discussion and negotiation rather than through raw aggression.

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If you are involved in the conflict, emphasize the fact that you are presenting your perception of the problem. Use active listening skills to ensure you hear and understand other’s positions and perceptions. •  Restate •  Paraphrase •  Summarize And make sure that when you talk, you’re using an adult, assertive approach rather than a submissive or aggressive style.

Step Two: Gather Information Here you are trying to get to the underlying interests, needs, and concerns. Ask for the other person’s viewpoint and confirm that you respect his or her opinion and need his or her cooperation to solve the problem. Try to understand his or her motivations and goals, and see how your actions may be affecting these. Also, try to understand the conflict in objective terms: Is it affecting work performance? Damaging the delivery to the client? Disrupting team work? Hampering decision-making? Or so on. Be sure to focus on work issues and leave personalities out of the discussion. • • • • •

Listen with empathy and see the conflict from the other person’s point of view Identify issues clearly and concisely Use “I” statements Remain flexible Clarify feelings

Step Three: Agree the Problem This sounds like an obvious step, but often different underlying needs, interests and goals can cause people to perceive problems very differently. You’ll need to agree the problems that you are trying to solve before you’ll find a mutually acceptable solution. Sometimes different people will see different but interlocking problems - if you can’t reach a common perception of the problem, then at the very least, you need to understand what the other person sees as the problem.

Step Four: Brainstorm Possible Solutions If everyone is going to feel satisfied with the resolution, it will help if everyone has had fair input in generating solutions. Brainstorm possible solutions, and be open to all ideas, including ones you never considered before. Step Five: Negotiate a Solution By this stage, the conflict may be resolved: Both sides may better understand the position of the other, and a mutually satisfactory solution may be clear to all.

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However you may also have uncovered real differences between your positions. This is where a technique like win-win negotiation can be useful to find a solution that, at least to some extent, satisfies everyone. There are three guiding principles here: Be Calm, Be Patient, Have Respect…

3. Negotiation Skills Negotiation is an important skill for coming to an agreement when conflicts develop at home, at work and when dealing with issues like those related to watershed management. When negotiating... Separate people from the problem. When negotiating, remember you’re dealing with people who have their own unique needs, emotions and perceptions. Some conflicts are based on differences in thinking and perceptions. These conflicts may exist mainly in peoples’ minds. It helps for each party to put themselves into the other’s shoes so they can understand each other’s point of view. Identify and openly discuss differences in perceptions, being careful not to place blame. In addition, recognize and understand the other side’s emotions as well as your own.

Interest vs. Position People often confuse interests with positions. An interest may be reducing litter in roadside ditches. There are many possible ways of addressing this interest. One might be the position of mandatory recycling. Another position might be a deposit on bottles and cans. Still another could be organizing a clean-up day. Focus on interests, not positions Focusing on interests, rather than positions, makes it possible to come up with better agreements. Even when people stand on opposite positions, they usually have a few shared interests. It takes time and effort to identify interests. Groups may not even be clear about their own interests. It helps to write down each group’s interests as they are discovered. It helps to ask why others take the positions or make the decisions they do. Partners will have multiple interests. Interests involving important human needs (such as security, economic well-being, a sense of belonging, recognition and control over one’s life) are difficult to negotiate.

Develop optional solutions When developing optional solutions that meet the interests of all sides, try to meet as many of each side’s interests as possible. Start by inviting all sides to brainstorm ideas (before reaching a decision). Some obstacles to developing innovative options are: Judging and rejecting prematurely Searching for a single best answer Putting limits on scope or vision Considering only your own interests Training of Trainer

To overcome these obstacles, view the situation through the eyes of different partners. Focus on shared interests to make the process smoother for all involved. Look for meaningful opportunities, not simple solutions.

Developing objective criteria. When developing criteria for selecting or combining possible alternatives, revisit the conflicting interests. These can’t be ignored or “wished” away. Instead discuss them as you begin developing criteria for judging alternatives. Also keep in mind principles such as fairness, efficiency and scientific merit. Strive for criteria that are legitimate, practical and unbiased. You may also find it helps to explore the criteria used in making past decisions and discuss criteria with your partners or outside experts.

4. Case Study for Conflict Resolution State A is holding a quarterly review meeting of RNTCP. It has high burden of TB. Due to social, religious and cultural traditions, health facilities are accessed differently. The meeting is being convened to assess the status of the tuberculosis control services in various districts and to determine the resource requirements of the districts pertaining to different components of the program on the basis of inputs from the districts. Review meeting is chaired by Health Secretary. Other Officials participating in the meeting are Director Health Services, NRHM Director, representatives from medical colleges and stakeholders from public and privates sectors. The core issues discussed are: Review of technical parameters of the RNTCP like case detection rate, cure rate, default rate, death rate, etc. are within the acceptable range, and when not within range, identify causes for this and take the necessary corrective action(s). Monitoring the financial management of District TB Control Societies like expenditure tracking. Review of participation of NGOs and private sector organizations at the State level and facilitate the same at the District level. Oversee the implementation of any other initiative/activity undertaken by RNTCP. The performance of a district X in state has been consistently below average in all the parameters of the RNTCP. The given district has all the required infrastructure and human resource to meet the requirements of population. As a program manger of an organization you are operating TB related services. The performance of your organization is largely dependent on the RNTCP service delivery by the govt. health staff. It is being observed that diagnostic and treatment protocol of RNTCP is not followed resulting in low case detection rate, low treatment success rate and high default rate. It is happening in spite of all the administrative, technical and logistic support to the district. It has been brought to the notice of District TB Officer who is unable to deliver without the support of district administration. A debrief of the salient findings should be given to the highest available district officer(s) Training of Trainer

CDMO/District Magistrate, but it has not yielded any positive outcome. In addition, it appears that some evaluations have been done in a somewhat routine and mechanical manner which has made little difference to the quality of the program in the district. Evaluation has shown results not consistent with the reported data or has found many problems with the implementation of the program. Overall, therefore, the evaluation exercise is proving to be somewhat ineffective, and is in urgent need of reform. You have been invited as Civil Society Member at state level meeting to review the performance of the districts. Each one has a “pain point” so the meeting is a potential landmine of conflicts waiting to explode. Discuss….

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 Module 4

 Time Management

1. Importance and need for Time Management Time management is an essential skill for health care professionals. Time is money as the saying goes, and maximizing both is a key element of success. To manage time well, it is important to be organized. Time management is an important skill for a health care professional. Without these skills, health care professionals can seem overwhelmed, sloppy and uncaring. Patients may also tend to doubt the knowledge base and medical skills of these individuals.

Being on Time for Appointments In this fast-paced world, everyone is pressed for time. Timeliness is an asset and patients respect physicians, dentists, nurses and other health are professionals who make timeliness a priority. Waiting an hour or more after the set appointment time to be seen by a health care professional is not only annoying, but stressful. All too often, patients put off necessary health care visits because they know it can take several hours for their 15-minute appointment to actually transpire. On the other hand, patients do appreciate their health care professionals who spend quality time explaining and answering their questions.

Providing Quality Patient Care Health care professionals who can organize and manage their time well, will bring to their practice an amazing ability to provide quality care for their patients. To do this they have to first be organized, and second mindful of time and how much time it should take to accomplish a task.

Prioritizing and Re-Prioritizing in Patient Care In addition to organizational skills, the health care professional needs to be able to prioritize. For instance, in a crisis, the most critical patient gets seen first. In everyday routine care, there may not be a crisis to deal with, but even the most mundane tasks must be prioritized. As the day or situation progresses, re-prioritizing may be necessary to keep things moving in an orderly and timely fashion. Understanding how to do this is another essential skill health care professionals must learn. Training of Trainer

Flexibility is yet another skill, or perhaps even characteristic, that is important for health care professionals to possess. Expecting the unexpected and being able to flex with the need is a must more times than most nurses, doctors and other health care professionals would care to think about, but it’s a reality in the day to day life for these professionals. No two days are ever exactly alike, and there is no way to predict how a day will turn out. This makes health care an exciting profession, but it also adds to the intensity and stress levels. The individual who is disorganized and has no concept of how to manage time, will quickly become overwhelmed and extremely stressed. This can greatly affect their ability to provide accurate as well as quality care. At the heart of time management is an important shift in focus: Concentrate on results, not on being busy Many people spend their days in a frenzy of activity, but achieve very little, because they’re not concentrating their effort on the things that matter the most.

2. Objectives By the end of this module, the participants will be able to: • Understand and appreciate the need and importance of time management • Use prioritization tools and techniques • Identify personal time wasters.

1. Activity - Daily Time Map The first step of effective time management is identifying how you are using your time. Make a list of the activities that you spend time on. Identify how much time the activities consume. Take note of activities you are keeping up with versus activities you are falling behind on. Make a list of all activities in micro detail from the time you got up till the time you went to sleep. Ask yourself: “What one thing could you do in your personal and professional life that, if you did on a regular basis, would make a tremendous positive difference in your life?

2. Goal Setting Most of us to not think about goals very much. We just seem to respond or react to pressures from other people or events. Once in a way we do see someone doing this very meticulously; then we are surprised; at times some of us are also cynical to think that they are wasting their time in this useless pursuit. If we do Training of Trainer

not know where to reach and what we have to achieve there, our days may not make too much sense. If we want to control our own time and life then we must decide what our goals will be. Having a goal will also help us manage time better. In the earlier chapter, we have seen how to set SMART Goals.

3. Time Management Tools and Techniques a) The Pareto Principle – The 80-20 Rule We need to be clear about two fundamental points: • Should we spend 80% of the time and effort to get 20% results or should we spend our valuable time on 20% of the tasks to get 80% results? • Which are these 20% tasks which will give us 80% results? The Pareto Principle, names after an Italian economist-sociologist of the late nineteenth and early twentieth century, states that the significant items in a give group normally constitute a relatively small portion of the total items in the group. Sometimes it is referred to as the concept of the ‘Vital Few’ and the ‘Trivial Many’ or the 80-20 Rule. In Pareto’s case it meant 20 percent of the people owned 80 percent of the wealth. In Juran’s initial work he identified 20 percent of the defects causing 80 percent of the problems. Project Managers know that 20 percent of the work (the first 10 percent and the last 10 percent) consume 80 percent of your time and resources. You can apply the 80/20 Rule to almost anything, from the science of management to the physical world. You know 20 percent of your stock takes up 80 percent of your warehouse space and that 80 percent of your stock comes from 20 percent of your suppliers. Also 80 percent of your sales will come from 20 percent of your sales staff. 20 percent of your staff will cause 80 percent of your problems, but another 20 percent of your staff will provide 80 percent of your production. It works both ways. The value of the Pareto Principle is that it reminds you to focus on the 20 percent that matters. Of the things you do during your day, only 20 percent really matter. Those 20 percent produce 80 percent of your results. Identify and focus on those things. When the fire drills of the day begin to sap your time, remind yourself of the 20 percent you need to focus on. If something in the schedule has to slip, if something isn’t going to get done, make sure it’s not part of that 20 percent. So whenever you are faced with the difficult task of choosing from among a number of alternatives, keep the Pareto Principle in mind by asking ourselves “which items are the really significant ones?” we can avoid getting sidetracked on secondary activities.

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b) Time Prioritisation: Planning the Day – Things to do List

Can Do

Should Do

•  These are unimportant tasks; need to be attempted only if necessary and if there is time; not otherwise

• Equally important as MUST DO tasks, but come in the second position • All these tasks also need to be completed by the end of the day to the extent possible

Must Do • No. 1 priority tasks • All highest priority tasks which have to be completed by the end of the day to get maximum results for the day

c) Time Management Matrix from Stephen Covey’s book “First Things First”

   t   n   a    t   r   o   p   m    I

   t   n   a    t   r   o   p   m    I    t   o    N

•  • • • •

• • • • •

Urgent

Not Urgent

I (MANAGE)

II (FOCUS)

Crisis Medical emergencies Pressing problems Deadline-driven projects Last-minute preparations for scheduled activities

•  •  • •  •  •

Preparation/planning Prevention Values clarification Exercise Relationship-building True recreation/relaxation

Quadrant of Necessity

Quadrant of Quality & Personal Leadership

III (AVOID)

IV (AVOID)

Interruptions, some calls Some mail & reports Some meetings Many “pressing” matters Many popular activities

Quadrant of Deception

• • • • • •

Trivia, busywork Junk mail Some phone messages/email  Time wasters Escape activities Viewing mindless TV shows

Quadrant of Waste

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4. Getting Organised a) Organise your workplace “Out of sight, out of mind.” The reverse of that is true too. When it’s in sight, it’s in mind and we cannot help but be distracted. Studies have shown that a person working with a messy desk will spend, on average, one and a half hours per day either being distracted by things in their view or looking for things. That’s seven and a half hours per week. Keep the clutter before you at a minimum and you will have a more accurate focus on what you need to do to increase your daily productivity

b) Dealing with interruptions • When you’re interrupted, ask yourself what’s more important: the interruption or what you’re working on? • Keep a ‘To Do’ list to re-focus on what you should be doing • Try to keep interruptions short - ‘What do you want, why, when, etc?’ • Keep a log of who/what interrupts you; a pattern may emerge • Be assertive; learn to deal with ‘Have you got a minute?’ • Invent a deadline • Continue to look busy  stand up to interruptions  remove the chair in front of your desk reduce eye contact  collect your papers, check your watch  • • •

Go to them - this way you can leave any time Learn to say ‘no’ Plan a quiet hour

c) Dealing with paper  Do you have a cluttered desk? On average people spend 45 minutes every day looking for lost papers or documents ‘Cluttered desk = cluttered mind’ Cluttered desks aren’t conducive to clear and creative thinking, so • clear your desk of everything not related to what you’re currently working on • resist the temptation to leave your current work on your desk • once you’ve finished a task, put all the papers relating to it away in a drawer or file • always leave a tidy/clean desk when you go home at night • adopt a system of dealing with paperwork (read on) • group papers together and put them in files Start by clearing your desk of all unwanted items. Handle it only once; read it/decide what you want to do with it

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Apply ‘GUTS’ technique Give it away Use it T hrow it away Send it Have a waste bin within easy range. Finally, when it doubt - throw it out!

d) Filing Systems Set up working files to include: • projects you are working on • routine jobs you perform daily, weekly, monthly • information required for meetings with key customers/staff  • information needed at your fingertips (names, addresses, phone numbers, etc) For long-term pending or follow-through items, set up a ‘tickler’ file; a separate file represents each day of the month, behind are 11 folders for the months that follow. As a rule of thumb, if you come across a piece of paper and you: • can’t remember the last time you used it, and • don’t know when you’ll need it next - BIN IT!

Conclusion In conclusion, we hope that you have enjoyed this journey through the world of soft skills --and soaked in the concepts of Effective Communication, Teamwork, Conflict Resolution and Time Management. The quiver of Facilitation techniques shall help you in turn to disseminate these skills to wider audience. It is hoped that you shall apply these skills in your personal and professional life, which will help you become more productive in your chosen field of Healthcare. We, at Axshya India, fervently hope that, as a result of this Soft Skills intervention, you are able to effectively contribute to the overall objectives of TB eradication and saving lives, which is at the heart of this laudable initiative.

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 SEC T I    O  N  C 

Facilitation Skills

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SESSION PLAN FOR FACILITATION SKILLS Role of Soft Skills Trainer – Crux of the Soft Skills Training 1. Introduction A. Main Objectives of Training B. Principles of Adult Learning 2. Preparing to Train A. Training Needs Analysis B. Research C. Training Objectives D. Session Plans E. The 5 W’S F. Structure - 3Ts G. Course Timing H. Determining the training location I. Preparing the Learning Environment 3. 4. 5. 6.

Training Delivery Facilitation Skills & Techniques Training Aids – Audio Visual Support Training Evaluation

References & Bibliography Learning Summary SMART Action Point

 Module I

Role of Soft Skills Trainer – Crux of the Soft Skills Training

The role of soft skills trainer is to provide role models for learning soft skills by presenting himself personally. There is no argument in the vital nature of soft skills in an employee’s effectiveness in an organization. It is an established fact. Increasingly, companies aren’t just assessing their current staff and future recruits on their business skills. They are now assessing them on a whole host of soft skill competencies around how well they relate and communicate to others. In the most progressive companies, managers are looking for people’s ability to communicate clearly and openly, and to listen and respond empathetically. Many significant business researchers have identified social skills (read soft skills) as the singular factor in differentiating star performers from mediocre performers. For example, a recent study by Johnson and Burden (2003) found employers expected younger people to be less likely to have work experience and therefore they ‘tend to focus upon ‘softer skills’ and behavioural attitudes in the recruitment process, with a less prominent role played by qualifications’. Employers report that technical and occupational skills can be taught on-the-job if the recruit has the right soft skills, such as motivation and willingness to learn (Dench  et al., 1998). Kodz and her colleagues (1998) also find that employers use soft skills as an indicator of peoples’ ability to learn occupational skills. Further research will only confirm the importance of soft skills training to future managers in increasing productivity, fostering innovation, ability to be a team player, persuasion of organizational agendas, sensitivity to workplace diversity and successful negotiation of conflicts. Beyond this we have specialist needs such as language learning, presentation skills, coaching and a host of other organisational needs that all require a high degree of competence in soft skills .

It’s the soft stuff that’s hard Now, that the “Why” of the soft skills has been firmly established, we have to focus on the “How”. How we can effectively impart these vital skills is the challenge looming large before the B-Schools and corporate world.

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As we all understand the emphasis in our schools and universities is not on soft skills or ‘skills’ in general. Our academic curriculum tends to ignore these important life skills. The concentration in these early years of our learning has been solely gaining knowledge and not acquiring skills. It is therefore left to employers to improve performance in these areas. Daniel Goleman in the influential best seller “Working with Emotional intelligence” argues forcefully for the ‘hard case of soft skills’. But, in practice, there is nothing soft about soft skills. And it is evident from industry estimates - millions of Rupees and dollars are spent on soft skills training across the world.

1. Introduction A. Main Objectives of Training  

Change Mindset Change Behaviour

Why is Training Necessary?  To cope with changes – advanced technology and the dynamic business environment of today and tomorrow  To bridge the gap from where they are to where they should be  To help people overcome fears of redundancy and obsolescence  To promote self esteem and self confidence; to make them feel better about themselves  To inculcate professionalism on the job by improving their knowledge, skills and applications To standardise behaviour, systems and procedures within the organisation  To bring about behavioural changes which will benefit them and the  organisations  To benchmark and accelerate excellence at work  To achieve all round growth and development and improve the overall quality of work life and personal life

B. Principles of Adult Learning   

Learning is basically a change in attitude or behaviour There are nine principles of adult learning which promotes effective learning Trainers need to bear them in mind while preparing and presenting training sessions

a) Recency  Points learnt last are remembered best  Actions: frequent reviews and summaries b) Appropriateness  All training activities should be appropriate to the training needs  Actions: linking of activities to the needs  Connect familiar or known information to the new information

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c) Motivation  Participants must want to learn, be ready to learn and have reason to learn  Actions: connect benefits of learning new information; draw out what they already know and connect new information  Material and contents meaningful   Arouse curiosity and creativity; stroking d) Active Learning  Participants learn more when they are actively involved in the process  Actions: include activities, exercises, demonstrations and practice Give many experiences  Use questions and quizzes  e) Multiple Sense Learning  Learning is far more effective when participants use more than one of their five senses  Actions: not only telling; show them; most important, make them do it f) Exercise  What is repeated is remembered best  Actions: practice, questions, frequent summaries, questions and recall   Tests and homework  Review, reinforcement and consolidation of what has been learnt, before proceeding further g) Primacy What they learn first are learnt best  Actions: create good first impressions  Include key points in the beginning and then expand gradually   Help them to get things right first time h) Two way Communication  Not only trainer to participants; more important, participants to trainer  Actions: communicate with the participants; NOT at them  Encourage participation and interaction i)Feedback  Both need information from each other  Actions: ask for regular feedback  Give prompt and regular feedback Positives first; negatives last  These principles of learning relate to training and education. They are used in all areas, whether in a classroom setting or on the job. They can be used with children, adolescents as well as adults. Effective facilitation should utilise as many of these principles as possible. When you plan a session, look though the draft to ensure that you have used these principles.

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2. Preparing to Train A. Training Needs Analysis Training Needs Analysis will highlight the subject matter needing to be covered during the training program. The knowledge gained by the participants will help to increase their level of ability and allow them to perform their tasks at an acceptable level. Training needs analysis will evaluate current competencies against targeted competencies and training delivered will aim to bridge that gap.

B. Research Why is research necessary? The participants must be given correct and up-to-date information in each presentation they attend. The best way for the trainer to find out if the information is correct and up-to-date is to spend some time researching the relevant facts. Also, the participants rightly expect the trainer to know thoroughly the topics being presented. Would you sit and listen attentively to a trainer who did not appear to know the subject? This means that the trainer must carry out study before entering the training room. You are not expected to be a walking encyclopaedia or an authority on every subject you will be presenting. But you must know more about the subject that you will be presenting to the participants. If you find that you are asked a question relevant to the topic and you don’t know the answer to it, tell the group that you don’t know but that you will find out and report back to them later. Trainers must learn how to confine their research to a useable quantity.

C. Training Objectives The objective setting is one of the most important areas of focus. Without clearly stated objectives the trainer and the trainee may have absolutely no idea of where they are heading. If they don’t know where they are heading, how can they know when they have reached their target? Very simply, an objective or a number of objectives gives us our target or learning goals. All training objectives are normally designed and written after the training needs analysis has been completed, a training need has been identified and the decision to go ahead with the program has been made.

D. Session Plans What is a session plan? A session plan is a set of notes in logical order for the instructor to follow to ensure that the objectives set for the training program are met. A session plan also includes other relevant information such as the training aids required; references used and identified problem areas.

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Session plans are useful tools for trainers in any field. They ensure that the instructor heads towards the objectives of the session. They also enable the trainer to check in advance that the sequencing of the lesson is correct, the content relevant and the training methods suitable. The session plan is also a checklist for the resources required.

Why use session plans? Why use a roadmap when going on a driving holiday? A session plan is very similar to a road map in that it shows us a starting point, a finishing point and all the places we need to pass or explore along the way. It gives a logical list of information to be covered in a session, appropriate sequence and timing for the session.

E. The 5 W’S The success of a seminar, course or instructional module depends on a great number of variables. Before preparing yourself to train, you must answer 5 questions specifically – The 5 W’s!

WHY? WHAT? WHO?

Ask why you are training at all. What are the trainees’ objectives?

WHEN?

Ask whether the timing of the course is good for you and for them. Period of year? Weekdays/weekends? Morning? Afternoon? Evening?

WHERE?

Ask about and prepare for environment. Building? Room? Layout? Seating patterns? Interruptions? Temperature? Noise?

What should trainees think or do at the end of the course? Ask what you can put over in the available time. At what intellectual level will you pitch your teaching? What audio visual aids will you need? Analyse the trainee group: Age? Nationality? Level? Language abilities? Prior experience? Expectations? Mind set?

F. Structure - 3Ts Tell Them What You Are Going To Tell Them! Always start with a learning ‘hook’ or attention-getter Bang Establish the gap between participants’ present skills/knowledge Gap and those to be acquired during the course Understand Check that participants understand the existence and size of skills/knowledge gap Establish the need for participants to close the skills/  Need knowledge gap Ask/Answer  (Ask and answer questions to check participants’ individual needs encourage those with smaller gap/need to help with ‘teaching’) Outline course coverage, stressing results to be achieved Route (during the course and after the course) in closing skills/  knowledge gap

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Tell Them! Explain

Explain each new skill/learning in digestible chunks using appropriate Visual, Hearing and Feeling support

Demonstrate Demonstrate skills and/or show how knowledge applies to them Allow participants to exercise each new skill or to feedback Exercise their understanding of new knowledge Show participants how well they have learned and correct any Guide/ inadequacies correct Tell Them What You Have Told Them! Review all learning points at end of each module (or Recap beginning of next); use audio-visual aids support Agree on an action plan for the transfer of new skills or Action Plan knowledge to real life Agree on any follow-up or refresher Follow-up Always finish with a succinct and provocative encapsulation of Bang the learning experience

G. Course Timing Downtime - In a training day of 9 hours (9.00 am – 5.00 pm) always plan for down time as follows: 

Latecomers, settling, housekeeping

= 10 min

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Coffee/Tea breaks planned 15

= 20 + 20 = 40 min (even if you have minute breaks!)

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Lunch and ‘re-settling’ after lunch

= 75 min (even if you have planned 1 hour!)

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Stretch breaks, breaking into syndicates and other miscellaneous down time

= 25 min

Total

= 2 hrs 30 min

Timing Tips  Always keep a clock or watch on your desk - but don’t rely on looking at the watch on your wrist  Use a chronometer or good kitchen timer for timing break-out sessions, separate modules, etc  Always allow time for discussion - build it in to your course plan

H. Determining the training location i. Number of participants The number of participants generally determines the training location. A decision on the location should be the trainer’s first priority. Don’t try to squeeze a few more participants into an already crowded venue, cut the number down or find another location. Similarly, a large room for just a few people can also create a barrier to learning.

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ii. Size of the training room The size of the training room will generally depend on two factors: what the room is being used for and the number of people it has to accommodate. If the room is being used in a classroom setting (a chair with arm tables), allow about 2 to 2.5 square meters per person. If the room is being used in a conference setting (chairs and full tables) allow about 2.5 to 3.5 square meters per person. Then add a bit for yourself and your equipment. An alternative is to use a room that is a size you and the group feel comfortable with.

iii. Lighting The lighting in the room must be arranged to provide for both the trainer’s and trainees’ requirements. They also need enough light to be able to take notes if they require. iv. Background noise Noise in the background during training can be very destructive to the learning atmosphere. Most trainers would like to have a totally soundproof room without any windows but unfortunately this type of room is rare. What we can do, though, is choose a training location far away from work area to exclude work noises such as machines and telephones. v. Access Access is something that most trainers now take for granted, but we do need to consider how the participants will get to the venue. Public transport/ own transport, etc. Also consider access for the disabled such as ramps. vi. Facilities Are tea and coffee making facilities available for morning and afternoon breaks? Do we have access to telephones? Do we know where all the toilets are located? Do we know where the fire exits are? All of this information must be passed on to the participants at the beginning of the course. vii. Acoustics The acoustic qualities of the location should assist the leader in keeping control of the group. The trainer’s voice should be the dominant noise in the room; background noise should be minimal. The noise from background conversation and projectors should be absorbed by the room and not be in competition with the speaker. viii. Power outlets Power outlets must be checked for availability and location. Check the power outlets in advance. Don’t assume that they all work – check them first! ix. Availability of training aids Training aids must be checked to see that the ones you want to use are available. Check that they are all on top working condition. And do it yourself, don’t take anyone’s word for it. Spare parts your may need must be located and you will need to know how to fit them. Get familiar with the buttons on all the equipments to switch on/off, standby, blank, etc.

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x. Public address system A public address system may be advisable in a large conference room. It could be a portable type or a built-in system. If you have a group of more than 25 for a day or more use a sound system to support you, especially if you are not sure that you will be audible to the last person in the room. xi. Storage areas Storage areas could be needed for excess equipment, student handouts, training aids not in use, spare parts, training models and many other items.

I. Preparing the Learning Environment The Ideal Environment Checklist  Good audio visual equipment  Appropriate seating patterns  Comfortable chairs Good writing surface for each participant  Thermostatically controlled temperature  Independently controlled ventilation (air conditioning or windows)  Good supply of coffee/light lunches   Adequately sound-proofed room, with 5 square metres space per participant  Natural daylight (windows with blinds/curtains)  Central electrical commands (lights, audio visual, etc)

i. Seating Patterns 1. ‘U’ shape Advantages   Businesslike  Trainer can walk into ‘U’  Generally good participant visibility Standard, therefore non-threatening  Disadvantages  Somewhat formal; needs ice-breaking  Some participants masked by audio visual equipment  Front participants constantly at 60-90˚ (neck ache)  Rear participants are far from screen/flip chart

2. ‘V’ shape Advantages  Best pattern for visibility/neck ache  Optimum trainer/participant contact  Less formal and intimidating than ‘U’ Disadvantages  Space requirements (only small groups)

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3. Herring Bone Advantages  Space effective for large numbers  All participants at good angle to screen/flip chart, etc  Trainer can walk down ‘spine’ Disadvantages  Several participants ‘masked’ by others  Reminiscent of school   Encourages dysfunctional groupings Rear participants far from screen/flip chart, etc  Relatively poor participant/trainer contact 

4. ‘Bistro’ Advantages Ideal for ‘teambuilding’ sessions and small group workshops  Informal: encourages maximum trainee participation/identification  Original: encourages open-mindedness  Trainer can ‘circulate’  Disadvantages  Some participants have poor visibility or may be constantly at an angle to screen/flip chart  May foster lack of attention and encourage side conversations  Encourages splinter group identification

5. Circle Advantages  Ideal for sensitivity training sessions  Encourages maximum participant involvement  Excellent trainer/participant contact  Minimum side conversations; no informal group formation Disadvantages  Difficult to find tables which can be set up in a circle  Some participants have poor visibility/neck ache  Without suitable tables participants may feel unnecessarily ‘exposed’

6. Amphitheatre Advantages  If room is well designed, excellent visibility and acoustics  Very space-effective  Good for lecture-type presentations Disadvantages Very poor trainer/participant contact   Difficult to set up unless room is designed with permanent seating  Back rows must be elevated  Very university-like Training of Trainer

Seating Patterns Psychology Research shows that distance reduces participation - trainees in back rows are less likely to participate than those in front. Any kind of ‘row’ reduces interaction: it is difficult for those in the back row to hear front row contributions and for those in the front row to twist round to interact with people behind Changes in seating patterns from one session to another can be psychologically upsetting for participants. At repetitive sessions participants will invariably sit in the same place. Angry or cynical participants will attempt to move away from a group seating pattern.

Setting up The Room

ii. Media Varying the Media As a general rule the learning environment should provide a change of pace/  medium/subject/blood circulatory pattern every 10 minutes to avoid ‘auto shutoff’. The professional trainer will, therefore, plan seminar coverage so that new audio-visual interventions, and new topics, come at fairly regular 10 minute intervals. S/he will also plan for regular discussion periods, small group work or ‘stretch breaks’ to fight the descending learning curve. Lastly, voice control (pitch, volume, modulation) can help change the pace of a seminar.

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3. Training Delivery A. Names and Faces When faced with a room full of new trainees you will need to remember their names:  Listen to name  Spell it in your head  Repeat name as often as possible during training event  Look for an outstanding facial feature  Exaggerate the feature   Associate This will ensure you can address (and impress) them during coffee break, lunch, etc.

B. Icebreakers Trainers always start with an Icebreaker Why? As the name suggests, an ice breaker session is designed to “break the ice” at an event or meeting. The technique is often used when people who do not usually work together, or may not know each other at all, meet for a specific, common purpose. Consider using an ice breaker when:  Participants come from different backgrounds.  People need to bond quickly so as to work towards a common goal.  Your team is newly formed.  The topics you are discussing are new or unfamiliar to many people involved.  As facilitator you need to get to know participants and have them know you better. So what’s the “Ice”? When designing your ice breaker, think about the “ice” that needs to be broken. If you are bringing together like-minded people, the “ice” may simply reflect the fact that people have not yet met. If you are bringing together people of different grades and levels in your organization for an open discussion, the “ice” may come from the difference in status between participants. If you are bringing together people of different backgrounds, cultures and outlooks for work within your community, then the “ice” may come from people’s perceptions of each other. You’ll need to handle these differences sensitively. Only focus on what’s important to your event. (Remember, you want to break some ice for your event, not uncover the whole iceberg, or bring about world peace!)

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A good icebreaker should be:

Foolproof  Amusing Bridged Unique Lively Optimistic Uncomplicated Short

has been tested and works! trainees should enjoy it linked to the course subject (if possible) trainees should not have done it before has movement, exchange and chatter is positive and non-threatening is easy to explain and organise lasts between 5 and 10 minutes

C. Enthusiasm You Got to Believe!  If you’re not enthusiastic about your subject, how can you expect the trainees to be!!  Consciously use your eyes and eyebrows to communicate enthusiasm  Always keep a sparkle in your voice  Fight boredom of repetitive sessions by introducing new anecdotes, examples, etc, or by changing lesson structure

D. Using your voice         

Speak louder than usual; throw your voice to back of room Don’t swallow words Beware of verbal ‘tics’ Vary tone and pitch; be dramatic, confidential and/or triumphant Watch tonic accents; check difficult words; beware of malapropisms Over emphasise Accentuate syllables Repeat key phrases with different vocal emphasis Use delivery speed to manipulate the audience; fast delivery to excite and stimulate; slow delivery to emphasise, awe, dramatise and control 

E. Challenges for a facilitator Ask the groups to reflect on the discussions in the previous session. Is it harder to be a facilitator or a teacher? Hopefully they will say it is much harder to be a facilitator! Some of the challenges are as follows: i. Taking control  ii. Difficult questions iii. Managing conflict iv. Handling dominant people v. Working with shy people.

i. Taking Control One of the greatest difficulties facilitators can face is the temptation to take control of a discussion or change process. This is often out of a genuine desire to help the group move forwards. If we are used to a top-down teaching style, and have not had the chance to observe good facilitators at work, it can be very difficult to change our approach to sharing ideas. One way to encourage the group to take responsibility for their own learning and Training of Trainer

progress is by asking the group to write some ground rules for participation so that each person feels free to share their ideas. Such rules might include not interrupting, respecting different views and agreeing on a maximum number of points that each person can make to any one discussion. If the group writes them, they will have shared ownership and a shared responsibility to ensure that they are respected. The group could also write their own learning objectives, and measure their progress against them over time. Some of the ways that might help the facilitator in empowering others are as follows: Be patient.  Listen to others and show that their opinions are valued.  Be open to learning from the group so that information sharing is  multidirectional.  Encourage the group to discover solutions for themselves and to take responsibility for their own learning and progress.

ii. Difficult Questions Dealing with people’s questions can be difficult. Facilitators may often feel that they need to have all the answers. They may lack confidence in their own ability to deal with questions on a particular subject. Some of the ways of dealing with difficult questions are as follows:  Prepare for group discussions by reading through the discussion material and becoming familiar with the concepts and language. Anticipate people’s questions where possible and think of possible responses.  Do not be afraid to say that you do not know the answer to a question!  Instead say you will get back to the group with more information.

iii. Managing Conflict Sometimes people will have strong and conflicting ideas on a subject. Poor relationships within the group will also affect the way the group works together as a whole. A facilitator needs to be sensitive to possible differences and tensions and encourage people to work through these, keeping their common goals and interests in mind. If the conflict is not related to the topic being discussed, a good facilitator needs to ask people to put this to one side. Conflicts can be managed effectively by: Acknowledge the conflict.  Try to establish the cause of the conflict.  If it is related to the topic in question, help lead the participants to a place  of agreement, encouraging mutual respect.  If it is unrelated to the topic, and only involves several group members, encourage them to resolve this disagreement later, outside of the group setting.

iv. Handling Dominant People Sometimes there is one person who dominates the discuss ion, confident that they have all the right answers. A good facilitator needs to make sure that others have the opportunity to speak. They could invite them by name, or Training of Trainer

split the group into smaller groups, or introduce a quota system, in which each person is given three stones or bits of paper, and they have to give one up every time they speak. When they ha ve no more, they cannot speak again! For handling difficult people the following tactics can be used:  Give them responsibility within the group.  Reinforce alternative behaviour.  Place with other similar types or in the same group as the facilitator.  Limit the number of times each person can speak, so that each member is treated equally.

v. Working with Shy People Sometimes people may be very shy or afraid to express their views in a group. A facilitator can either put people into smaller groups or ask people to discuss questions first in pairs. They can also use other practical activities such as mapping, ranking, seasonal cale ndars, timelines to help people express their views. The most effective way of encouraging people who are shy is to refer back to and use their ideas, so they know they are important and of value. To work with shy people it is important to:  Encourage them individually, within and outside of the group.  Establish reasons for their silence.  Give notice of the topic before the discussion, so that they have time to prepare. Give them responsibility for note-taking and feedback.  Place them in a supportive group.  Give them time.   Use role-play to build up confidence and skills.

4. Facilitation Skills & Techniques A. Lecture      

Talking to or talking at the group Audience is passive Trainer needs to be aware of the participants at all times Voice is important, both in level and tone Participants do not contribute to the learning experience Absence of two-way communication

B. Modified Lecture 

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

 

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Similar to a lecture except that the lecturer encourages some group participation Person delivery the lecture often relies on the participant’s experiences to generate some form of discussion It is stated in the beginning that group discussion and participation is welcome Questions should also be encouraged It is an efficient method of instruction and is commonly used in training programmes.

C. Demonstration Why Demonstrate?  To show participants how to perform the skill/ technique  To instil confidence in participants  To build credibilit credibilityy for the suggested skill/ technique  To “walk the talk” Tips for Demonstrating Before the course:  Plan for demonstration during the preparation Script the demonstration  Enact the demonstration – yourself/ with other faculty member member  Just before the demonstration:  Ensure you have all participants attention  Ensure there is no no immediate break after the demonstration  Try and and make it interesting – weave it as a story; provide a benefit of applicability While Demonstrating:  Make sure you are audible  Make sure you are visible to all participants  Be sincere and put in 100% - it helps helps build authenticity  Keep it crisp After Demonstration: Check for audience comprehension  If necessary, do it again   Debrief demonstration demonstration and and draw parallels to the context in discussion  Ensure that you always keep demonstrating the skill/ technique for the rest of the course

D. Group Discussion Here are 4 ways to keep a group discussion going: Building Build on incomplete answers by adding adding own comments and asking  for agreement or disagreement  Boosting Support timid participants’ contributions, boost their confidence and ask for extra comment  Blocking Interrupt dominant/talkative/ dominant/talkative/aggressive aggressive participants by asking what others think  Bantering Establish non-threatening atmosphere by engaging in friendly repartee with outgoing participants

E. Simulations Sometimes used for team-building exercises. They are not u nlike role-plays but they are more complex in their structure and require more participant input. Simulations are the trainer’s mock-up of the real thing. They can range from a simple paper mock-up of utensils or furniture, to exact replicas of the inside of a motor vehicle or aircraft, run by sophisticated computers.

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The cost of these simulators varies v aries and they require a lot of trainer preparation time. The use of a simulation allows the participant to try new behaviours without endangering the real product or suffering terrible consequences if something goes wrong.

F. Role-plays Why Role-Play? A role-play is similar to a simulation except that it doesn’t use any props. Normally the only items required for a role-play are a script or an idea and one or more participants. The situations acted out by the participants are usually related to real-life situations appropriate to their workplace. After the roleplayers have been identified, they act out the parts as they would normally or perhaps try new behaviours shown to them during training. After the scenario has been played out, the participants and facilitators carry out a critique (debrief) of the role-play. They identify good and bad points, include suggestions for other behaviours and suggest other possibilities. Advantages of Role-plays  A non-threatening way of exploring sensitive issues  Allows people to practice alternative ways of thinking and behaving  Reinforces ideas ideas in a way that is memorable and non-threatening  A widely accepted form of communication in many cultures and societies  Entertaining and and enjoyabl enjoyablee for those acting and those watching  Engages the audience on an emotional emotional as well as an intellectual level   The audience does not need a high level of literacy  Humour can break down barriers Aspects of a Good Role-Play Short and to the point  Confident participants   Participants speak clearly  Uses the local language  Relevant to local culture  Relevant to the audience – rural/urban, using local names and place names  Can be funny  Sensitive to the political situation.

G. Games 

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Games can be simple (joining the does in the shortest time, time, virtual volleyball). Games are normally competitive. An activity, illustration or exercise that can support the point that the trainer is trying to get across to the trainees Brief, not complicated, non-threatening to the participants Contains a learning point, is predictable in its results and is generally generally adaptable to a wide variety of situations A games does not not always appear to have direct relevance to the topic

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Participants may may not not see the relevance until the experience is discussed later If this discussion does not not take place the trainee may may never see the connection between the game and the subject matter and the whole exercise is wasted

H. Videos/ films I. The Quiz In training courses where facts must be learned it is essential to ‘exercise’ participants’ new knowledge. Written tests are fine but remind people of their school days. A well-devised quiz will appeal and test at the same time. Suggestions  Break group into quiz teams to provoke competition  Invent different categories of questions (like TV game shows)  Keep scores on imaginatively designed board (whiteboard/ (whiteboard/pin pin wall)  Don’t forget the prizes!

 J. Brainstorming A technique for obtaining ideas from a group. Here’s how:  Ask for/provoke ideas; if necessary necessary wait 45 seconds before giving own  Write all ideas on a flip chart (number them for for future reference) don’t don’t evaluate until end  Use brainstorming discussion techniques to encourage participants to trigger ideas  Summarise and/or regroup ideas; help group to choose best

K. Lighthouse Technique Sweep the audience with your eyes, staying only 2-3 seconds on each person - unless in dialogue. This will give each participant the impression that you are speaking to him/her personally and ensure attention, in the same way as the lighthouse keeps you awake by its regular sweeping flash of light. Above all, avoid looking at one (friendly-looking) member of the audience or at a fixed (non-threatening) point on the wall or floor.

L. Teaching Tempo Two factors will govern the tempo of your material coverage and discussion periods: The participants’ level of knowledge and general intelligence low = slow  high = fast  Your own teaching style  snappy/authoritarian/directiv snappy/authorit arian/directivee = fast  relaxed, informal, facilitativ facilitativee = slow

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How to change tempo  Slower - Use more cases, examples, anecdotes; speak slower; ask open questions  Faster - Speak faster; use more directive tone; cut down discussions; ask closed questions

M. Body Language of the Facilitator  Postures & Gestures

How do you use hand gestures? Sitting position? Stance?

Eye Contact  Orientation Proximity  Looks/Appearance Expressions of Emotion

How’s your ‘Lighthouse’? How do you position yourself in class? How close do you sit/stand to participants? Are looks/appearance/dress important? Are you using facial expressions to express emotion?

i. Postures and Hand Gestures (Hands)

STEEPLING HAND CLASP Self Confidence (Intellectual Arrogance)

HAND CLASP Anxious, controlled

ii. Postures and Hand Gestures (Hands)

‘L’ CHIN REST NOSE TOUCH Critical  Doubt iii. Postures and Gestures (Sitting)

ARMS UP Reserved, defensive Training of Trainer

MOUTH BLOCK  Resisting evaluation speech

ARM/LEG CROSS Closed, unconvinced

LEAN BACK  LEAN FORWARD Confident Ready! iv. Postures and Gestures (Standing)

THUMBS OUT In charge! Dominant

ARMS OUT  Open, sincere,onciliatory

LINT-PICKING Disapproval 

FIG LE AF Self-control, tense

TABLE LEAN Authoritative, involved

LEAN ON Unthreatened, casual belongingness

Quick Tips 1. Don’t keep your eyes on your notes 2. Never read anything except quotations 3. If you’re not nervous there’s something wrong 4. Exaggerate body movements and verbal emphasis 5. Perform (don’t act); perform = ‘fournir’ (to supply) and ‘per’ (for) 6. Pause often - silence is much longer for you than for the audience 7. Use humour; a laugh is worth a thousand frowns! 8. Be enthusiastic; if you’re not, why should they be? 9. Don’t try and win the Nobel prize for technical accuracy 10. KISS - Keep It Simple, Stupid! Training of Trainer

5. Training Aids – Audio Visual Support The human brain stores information in VHF - as visual, hearing or feeling data. Each trainee has a preferred channel for remembering data. In an on-going classroom experiment on trainee recall, 52% of participants say that their memory favours visual information; while only 7% prefer words/lectures and sounds. An astonishing 41% say they remember feelings, tastes, and smells and tactile experiences best. In order to ‘tune in’ to the maximum number of trainees’ wavelengths, professional trainers use a wide range of transmitters!

V Flip chart  Pin board  Whiteboard  OHP  Slide projector props and Accessories  Video clips  Word pictures  Imaging H Music (instant access CD’s or Minidiscs for changes of mood/illustrations) Sound effects  Audio gimmicks  M Music (emotion/mood setting)  Handouts  Verbal descriptions

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Anecdotes

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Metaphors

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Feelings stay longer than facts!

A. Flip Charting Techniques i. Pre-prepared Flip Charts

Invisible Outline Lightly pencil in headings in advance. When unsure of space, Drawing, Handwriting, etc.

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Corner Crib Use the top corner to pencil in your notes each chart. Write small and no one will notice!

Pre_prepared Prepare key charts in advance

Parables

ii. Graphics

ATTRACTIVE  Give each flip a title  Use bullet points (like the ones on this page)  Use at least 2 dark colours BIG & BOLD Use thick markers (bring your own!)  Should be legible from 10 meters!  CAPITAL KEYWORDS  Never write sentences!

Whenever possible use cartoons or drawings to personalise and add interest to your headings.

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iii. Standing

Every time you turn your back on the audience your voice and their attention disappear. Since you can’t write and face the audience at the same time (unless you are a contortionist!) you should:  Write (a few words/seconds)  Turn and Talk  Write (a few words/seconds) Turn and Talk 

B. The Whiteboard Writing & Sticking Write on!    

Replaces blackboard Great for brainstorming Change colour often Only use appropriate whiteboard pens

Stick up! 

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Use 3M ‘post-it’ stickers to create group-work summaries (key phrases only); stick on whiteboard Move stickers into columns or categories; use pens to draw bubbles around salient groupings or to make links between stickers

MURPHY’S LAW

‘If something can go wrong - it will!’ O’Connor’s corollary: ‘Murphy was an optimist!’ The only way to beat Murphy is to be a professional and use the 3 P’s:  Preparation  Preparation  Preparation

6. Training Evaluation Training evaluation is the process of finding out whether all the money, time and effort put into designing and delivering training courses or other learning experiences was worth it. The definition of  worth it depends on your objectives.

Kirkpatrick’s Four Levels In the 1950s, Donald Kirkpatrick first suggested that we should evaluate training by measuring four levels of impact: 1. Reaction – with end-of-course evaluation forms we can find out how participants reacted to the training. 2. Learning – we can pre- and post-test participants to measure their learning during the training. 3. Behaviour – three to six months after the training we can follow up with questionnaires to participants and their bosses to find out if they have really changed the way they do things as a result of the training. 4. Results – although difficult to prove, we can look for evidence that the training has caused an improvement in the organisation’s results.

Conclusion These are facilitation tips and techniques which we believe shall aid the Trainer in the art and science of Facilitation. Knowledge of these concepts and techniques, and rigorous practice and application, will help hone the skills and make you an effective Trainer.

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References & Bibliography 1. Improving Interpersonal Communication between Health Care Providers and Clients – Quality Assurance Project – Bethesda, USA. 2. Leadership & Strategic Management for TB Managers – World Health Organisation, Regional Office South-East Asia   http://www.searo.who.int/LinkFiles/Training_Materials_LSM-6.pdf 3. Interpersonal Communication Manual for Trainers of Health Service Providers – Ministry of Child and Health & Child Welfare (Health Education Unit) – Ministry of Health, Zimbabwe, GTZ 4. Basis Training for Trainers – Gary Kroehnert 5. Interplay – Adler, Rosenfeld, Proctor 6.

http://www.scribd.com/doc/16510232/the-soft-skills-trainer-role-model1corrected

7. Improving Interpersonal Skills in RNTCP Training, Central TB Division, Directorate General of Health Services, Ministry of Health and Family Welfare, Delhi 8. Baylor University Medical Centre Proceedings, Dallas, Texas   http://www/ncbi.n/m.nih.gov/pmc/articles/PMC1291328/ 9. The Communicator’s Pocketbook – Sean Misteil  10. The Time Management Pocketbook – Ian Fleming 11. Team working Pocketbook - Ian Fleming 12. Trainer’s Pocketbook – John Townsend

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Learning Summary

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SMART Action Point

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