NHS partnership

Case Study:
Compassionate Conversations for Difficult Situations

A Collaboration with NHS England

NHS partnership

Helping NHS Colleagues to handle difficult situations with compassion

A concerning reality for healthcare professionals is the level of violence, abuse, and threatening behaviour they must deal with regularly. With negative experiences on the rise, there was a clear need for a training intervention bespoke to the realities of working in the NHS to support staff in their everyday roles. With staff wellbeing at the intervention's core, increasing staff confidence and competence for dealing with these negative experiences were training priorities.


Starting in January 2022, this training programme has achieved a 95% satisfaction score to date, with 93% of participants telling us they would recommend it to their colleagues. More than that, participants experienced an average increase of 25% in their confidence in handling difficult conversations with compassion before and after their training.


So how was this confidence boost achieved?


For more than 2400 participants from Primary and Secondary Care throughout England, training sessions included getting involved in extensive discussions about patient interaction, skills practice sessions, and knowledge-sharing exercises relating to the skills needed to better handle difficult conversations with compassion.

escalla designed training materials and skills practice exercises for relevance to the real-life roles of participants', with 95% of participants telling us materials were clear and easy to understand.

Facilitated by knowledgeable escalla trainers with many years of training expertise, participants told us they felt safe, supported, and engaged with the materials in their training sessions. In addition, 95% of participants told us that the course met the learning aims and objectives, clearly supported by this open, active and communicative training environment.

Finally, and most importantly, participants told us they had an increased understanding of compassion fatigue and their own wellbeing and felt better equipped to support valued colleagues with wellbeing concerns.

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Compassionate Conversations for Difficult Situations: Full Case Study

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The Challenge

Recent survey activity undertaken by the British Medical Association and the 2021 NHS Staff Survey reported concerning levels of threatening behaviour, violence or verbal abuse to doctors, nursing staff, receptionists, and healthcare assistants. It is also suggested that these instances of negative behaviour have been increasing since the COVID-19 pandemic.

This concerning data indicated a continuing need for initiatives to help ensure staff feel as though they have the skills and techniques needed to handle these increasingly difficult situations with compassion and look after their own wellbeing. NHS England commissioned escalla to design, develop and deliver a training initiative that would meet this need.

Following an extensive consultation period with staff across the NHS and the National Health and Wellbeing Team at NHS E&I, escalla designed a comprehensive training initiative intended to positively contribute to the creation and maintenance of a compassionate and inclusive culture between colleagues and with patients. This initiative, aimed at supporting patient-facing primary and secondary care staff across NHS England, trained more than 2400 individuals in diverse topics such as levels of listening, emotional intelligence, and compassion fatigue.

Meeting the Challenge

Each training session, tailored to the distinct operational requirements of the NHS in timing and format of delivery, was designed to equip participants with the practical skills and confidence to handle challenging conversations with compassion.

Practicality and the relevance of training materials to a participant’s everyday role were at the centre of the Compassionate Conversations training, informing training content and the delivery methods used. A core component of this training initiative was skills practice, with several exercises in each training session dedicated to participants increasing their competence and confidence in handling difficult conversations with compassion.

Skills practice sessions were tailored to the situations and challenges shared with escalla by NHS staff in the consultation period of the process. Facilitated by expert trainers from escalla, in-event activities allowed participants to explore different responses, skills and tactics that would help them in their daily working lives. When asked to rate how useful these activities were, more than 93% of participants were satisfied or very satisfied that the skills and tactics discussed would be useful to them when they returned to work.

Participant wellbeing was another focus of this initiative. Training materials were designed to support participants in looking after their own wellbeing, the wellbeing of their colleagues, and in developing a broader understanding of the support available to them. After attending the training, participants reported an average confidence level of 8.7 out of 10 in understanding their own mental health and wellbeing after their session. They also reported a slightly higher score of 8.8 out of 10 in knowing how to better support their colleagues with mental health or wellbeing concerns.

escalla’s Internal Capability

Despite a short lead time between contact award and initiative launch, escalla mobilised a team of highly experienced facilitators with a wealth of relevant experience to support the country-wide programme roll-out within three months.

A large majority of participants (96%) told us that they were satisfied or very satisfied with the knowledge and expertise of their facilitators, further stating that the communication and engagement from facilitators was very good or excellent (96%).

Facilitators with expert technical knowledge in on-line learning were also available to participants during their training session, support that further enhanced participation across the initiative.


A comprehensive programme of evaluation was embedded within this initiative, incorporating qualitative reflection and quantitative assessment from training participants contemporaneously. This embedded measurement ensured the frequent and repeated measurement of training effectiveness, learning outcome achievement, and participant satisfaction. In feedback from more than 2000 participants, 95% told us that their training experience had been very good or excellent. This far exceeded the contractual key performance indicator provided by NHS England in advance of initiative launch, which was a participant satisfaction rating of greater than 70%.

This initiative was positively received and highly successful based on feedback data from more than 2000 training participants. Not only did more than 93% of respondents tell us that they would recommend this training to their colleagues, suggesting a high value of session content, there was a 24.7% increase in confidence for participants in handling difficult situations with compassion after attending their training session. Six weeks after the training, some participants also provided follow-up assessments of their confidence. This increase was seen to be lasting for participants, with 87% of participants telling us that they agreed or strongly agreed that they felt more confident in handling difficult conversations with compassion. This was a clear demonstration that the initiative met the learning outcomes and that participants left the training feeling more competent, confident, and better supported at work