Forum theatre is proving a useful tool to help independent practitioners improve their communication skills. Actor Richard Matthews shows how
Doctors who are effective communicators will always have a head start in independent practice: from winning the confidence of patients and colleagues, to asserting themselves with colleagues when required.
At the same time, poor communication is such a common factor in complaints and workplace disputes that practice owners are effectively sabotaging their business if they do not prioritise interpersonal skills when recruiting or promoting front-line staff.
But it is not just about hiring smooth talkers.
Even the most articulate employees can struggle in a confrontation with an angry or distressed patient, perhaps because the other person’s reaction is unexpected.
And, occasionally, practitioners’ body language and tone of voice let them down.
In short, it is one thing to know the principles of effective communication but applying them in real-life situations can be more challenging.
The best communication training therefore includes opportunities for participants to put what they have learned to the test. Traditionally, this has been done through role-play exercises.
This approach has much to recommend it – it is quite straightforward, quick to organise and participants can receive useful feedback from their peers. But it does have some drawbacks.
Role-plays can make people feel cripplingly self-conscious and they rarely feel realistic to observers because those taking part know each other and are familiar to the audience. This means the learning points can be missed.
But here I want to look at another interactive training technique which engages participants through their imagination.
Unlike role-plays, forum theatre brings scenarios to life by using professional actors to perform, challenge audiences and facilitate audience participation.
From conducting an employee’s performance review to giving bad news to a patient, the technique can be used to explore, in a more credible way, a range of sensitive situations that might arise in independent practice.
Forum theatre is not new. It emerged in the 70s and 80s from the work of renowned Brazilian theatre director, Augusto Boal. Boal was a political figure who sought to break down social barriers by encouraging audiences to get actively involved with his productions.
In a 1997 article about his work, Boal explained his philosophy: ‘We aren’t content, any of us, to be just actors and spectators … We also want to write our own scripts for every scene we are involved in. We are in charge of the wardrobe… We are also the directors who stage our own actions.’
And he recalled how he and his colleagues devised Forum Theatre in Peru as part of a literacy programme: ‘It was here we first came up with a play in which the main character didn’t know what he was supposed to do or else made wrong or unsuitable decisions. So I asked the audience what they would have done instead.’
Forum theatre has caught on as a way to engage new audiences with the dramatic arts, but the interactive format has also become popular with businesses as a learning and development tool for staff. Indeed, type the words ‘forum theatre’ and ‘business’ into Google’s search engine and you will get over 40m results.
The next act
In recent years, the healthcare sector has also begun to appreciate the potential of forum theatre. Notably, the technique has been used on a number of occasions by the GMC, both as an educational tool for healthcare professionals and to spark debate.
In 2008, for example, the GMC collaborated with the Royal National Theatre, Alzheimer’s Society and other patient groups in a series of forum theatre events around the country. These were intended to generate discussion with patients in the early stages of dementia, and with carers and doctors about how best to reach treatment decisions. This process was used to inform the GMC’s 2008 Consent Guidance.
The council’s Learning Disabilities website currently features a specially commissioned play about a patient with Down’s syndrome, and the problems that she faces when trying to access appropriate healthcare.
This play was performed in a UK tour of forum theatre events during 2010 to an invited audience of doctors, people with learning disabilities and their carers. Each performance was followed by a discussion exploring how a change in the doctor’s behaviour could affect the outcome, and audience members were encouraged to step onto the stage.
And, in 2013, the GMC commissioned a forum theatre element to its Welcome to UK Practice Pilots, an induction programme for doctors new to UK practice about the ethical and professional standards they were expected to meet.
In this instance, the plays about dementia and domestic violence covered ‘the themes of team-work, communication, consent, respect for patients and ensuring equal access to care’.
Forum theatre techniques are also being used to train the doctors and healthcare professionals of tomorrow.
For example, a presentation on the use of forum theatre at Southampton University was included in an Educating for Excellent Care Workshop organised by the Council of Deans of Health in 2014, which showcased examples of innovation in health higher education.
My company, Pitch to Perfection, has been providing forum theatre training for corporate clients for the last two-and-a-half years, alongside my acting work.
In the last year, we have been working with Dr Mike Roddis (right), of MJ Roddis Associates, to deliver sessions in healthcare settings, usually as part of a more extensive professional development course.
The process usually works like this:
Verbal briefing – Mike and I discuss the type of organisation and its communication needs.
Draft scenario and script – I work up a short scenario in collaboration with Mike and review this with the client. In most cases, there will be a script for the actors to work with, but sometimes the session is wholly improvised.
The most important requirement is that the scene will be familiar to practice employees; for example, explaining to a patient that a procedure has not gone to plan.
Casting – To keep costs to a minimum, the cast is very small. I tend to use actors that I know well and have some experience of the process because they need to be able to adjust to performing in different environments and relate to people in different professions.
It is also important the actors can listen, involve the audience and respond to suggestions – this is not the place for ‘method-actor’ debates about character motivation.
Staging – The simplicity of forum theatre is part of its attraction. Very little preparation is required; the action takes place at clients’ workplaces and the actors do not need a real stage – just a table and chairs, at most. The audience can be as small as four or as large as the space allows. The most important thing is their willingness to get involved.
Performance(s) – Before the action begins, I will set the scene for the audience and explain that their role is to watch what happens and think about what the lead character does well in terms of his/her communication and the mistakes he or she makes. The scene is played once so everyone can form an opinion about what happens and why.
Audience participation – Once the scene has been performed, we encourage the audience to get involved, point out mistakes and suggest ways the outcome might be improved with a different approach, sometimes working in groups to devise the alternative dialogue for a critical moment.
Some audience members are prepared to take on the role of the protagonist themselves to demonstrate how it should be done.
An important element of audience participation is analysing what the character says, as well as non-verbal communication such as the way the character makes their entrance, facial expressions, tone of voice and other nuances.
It is also essential that the actors in the scene are asked how they have been made to feel, both the original version of the scene, and in the subsequent versions changed by the audience (see below).
This helps raise the audience’s awareness of the effect that different approaches to communication can have.
Encore – These suggestions are used when the scenes are replayed to see how a change of approach can influence the outcome and which is most effective.
We might replay the scene two or three times, depending on the level of participation. By the end of the session – which typically lasts up to 1.5 hours – the audience and actors have usually reached a consensus about the most appropriate and effective way to communicate in that scenario.
Feedback – As with any training, we always ask people to complete evaluation forms following forum theatre sessions. To date, I’ve been delighted by the enthusiastic response from participants.
The use of professional actors and realistic situations is key to the potential of forum theatre as a useful and cost-effective training technique in independent healthcare.
As its creator intended, it is a process which breaks down barriers and promotes better understanding.
Forum theatre draws the audience in and helps them focus on the unfolding drama and their response to it – rather than worrying whether they are making a fool of themselves in front of their boss. But it also means participants can be challenged by people with a different perspective, rather than fall back on lazy assumptions; for example, a patient is being difficult or unreasonable if they do not accept what the doctor is telling them.
Today’s independent practitioners appreciate the importance of communication within a successful practice. Forum theatre is a very powerful tool to demonstrate what this means in reality.
Richard Matthews worked in the corporate world before becoming a professional actor and forum theatre practitioner. His company, Pitch to Perfection, provides forum theatre sessions for MJ Roddis Associates