1. Quality and Outcomes Framework
Assessor Training
Personal Skills for Interviewing, Listening and Giving Feedback
Module S1

2. Aims of the Module To be able to: Listen well
Ask questions effectively
Give feedback
Handle difficult situations
Module S1 Personal Skills in interviewing, listening and giving feedback
Aims of module
To understand how to…
Listen well
Ask questions effectively
Give feedback
Handle difficult situations
Your success or failure in carrying out these visits will depend in large part on how you communicate with the practice team. Get it right, and even if they do not like your conclusions they will nevertheless agree you have done it fairly. Get it wrong and you will leave behind an angry and de-motivated practice.

3. Two Key Points
It is a privilege to visit a contractor – it is their domain and their organisation and you are a guest.
You will never know as much about what goes on as the contractor’s team does.

4. Active Listening Words – listen to particular emphasis and repetition
Facial expression – does it fit with the words?
Body movement – relaxed or jumpy?
Beware of your own behaviour; it may encourage people or shut them up
Active Listening
Listening to what people tell you is far more than simply hearing the words. Pay attention to how they say them and whether particular words are emphasised or repeated. “We don’t usually do that,” suggests there are times when they do.
Facial expressions indicate when someone says “Yes” they mean “No”. If someone says they feel confident that the appropriate procedure is in place but look worried or anxious, you need to enquire further.
Body movements will suggest to you whether someone is relaxed about what they are telling you or whether you are probing a difficult area.
Finally be aware of your own behaviour in either encouraging people or shutting them up. Maintaining good eye contact and indicating you are paying attention and interested will encourage people to talk. On the other hand there are behaviours that tend to switch people off or at the least mean that we may get the wrong information. These are sometimes referred to as roadblocks. Here are some:
· Interrupting before someone has finished their sentence
· Expressing indifference or superiority
· Persuading with logic, arguing, or lecturing
· Moralising, preaching, or telling people what to do
· Disagreeing, judging, criticising, or blaming
· Agreeing, approving, or praising too much
· Shaming, ridiculing, or labelling
· Interpreting or analysing
· Reassuring, sympathising or consoling

5. Effective questioning
Open – “How is it going?”
Probing – “What do you mean by that?”
Reflective – “You say ‘difficult’?”
Closed – “ Have you got a complaints protocol?”
Don’t ask cued questions – “You’ve no problem with that, have you?”
Use triangulation – put the same question to more than one person separately
Effective Questioning
Your ability to ask the right questions will determine the other success or failure of the visit. It is very easy to get the wrong impression or information if the questioning is inept.
It is generally best to start with open questions. These often start with such words as “What?”, “Where?”, “How?”
Examples of open-ended questions:
·How did you find your induction programme?
·Which areas of your work would you say require more attention?
·How do you feel about the data you have collected?
·In what ways would you say you have developed in the last 3 months?
You will then need to follow these up with some kind of probing questions. Here you are after specific information that will be needed to ensure your report is accurate.
Examples of clarifying probing questions:
·What do you mean?
·Why do you think that was so?
·I’m not quite sure I understand what you are saying. Will you please explain that to me again?
·Can you give me more details on what you think were the reasons?
You will also need to use reflective questions from time to time. This involves simply repeating back to someone what he or she has said and is another technique for obtaining accurate information.

6. Effective feedback
Start with what you regard as the contractor’s strengths (they all have them!)
List the developments needed
Be specific, so that people understand what you mean and why you are saying it – “The reason you are doing this well is because…”
Feedback
The purpose of feedback is not simply to praise the practice team where they have done well and to tell them you believe they should make change. It is also about motivating them to make those changes and to be more insightful about themselves.
Although the detailed feedback will be in the report it is bad practice to leave without saying anything. After all you have been intruding into many areas of the practice work and will inevitably have caused some disruption and taken up people’s time. Furthermore the team will be anxious to know what you think after all this.
We suggest you agree amongst the team members what the highlights were and where you think improvements should be made so that you can put these to the team at the end of the visit. Needless to say these must tally with what appears in the report.
Start with the strengths and then go to suggestions for improvement. Doing it this way round means you get off to a good start. It needs to be done in enough detail so that people understand what you mean. That way the team knows that it is genuine and that you have pinpointed exactly what the issues are. Saying something like “You are pretty good” does not mean much and may appear as patronising. On the other hand saying something like “What we particularly liked was the way you…”. Equally “This is no good,” means little; say instead “It would be more effective if you did this…”

7. Giving difficult feedback
Begin positively and establish empathy
Have the facts/evidence available
Point out any resistance you encounter
Review detail of specific items
Keep the responsibility with the contractor
Allow ‘time out’ if needed
Giving difficult feedback
There will be times when feedback is difficult especially if the practice team disagrees with your findings.
Here are some tips on how to handle these situations:
Always ensure that you underline what is going well and indicate support for what the practice is trying to do. The more supportive you are the more practice will be able to cope with disappointments. Be positive and supportive throughout the feedback.
Have the facts and evidence. It is no good stating that something is not satisfactory if you don’t have the facts available. It is very difficult to argue with facts but if you have been sloppy about your information gathering you will be in a difficult situation.
Spot when people are simply trying to block the discussion. A favourite one of doctors is “You haven’t got adequate evidence”. If that one fails they may move on to “What right have you got to say this?”. Another one is “You don’t understand what you are talking about”. Instead of trying to argue with all these statements and questions, it is better to say, “It seems that every time I mention this you try to block me. Is there a reason for that?”
It may be helpful to review specific items. You may be able to produce a particular record or register as an example of something that isn’t right.
Get them to accept responsibility for what is going on. Ask them what they would do if they saw this in another practice.
Finally, if it would help, let them mull it over.

8. You will have succeeded if:
The contractor feels motivated at the end
You have established good relationships
Even if the contractor does not like the results, they compliment you on the way you have carried out the visit