Introduction:

A sense of belonging within the National Health Service (NHS) workforce is imperative in establishing a safe and effective working environment, as outlined in the NHS People Plan (2020) [1], ‘The NHS must welcome all, with a culture of belonging and trust. We must understand, encourage and celebrate diversity in all its forms’ (p.24). It can be challenging to establish a sense of belonging within the NHS where large teams are working under high pressures in inconsistent shift patterns. Incorporating lived experiences, a simulation workshop was designed to enhance participants’ knowledge and understanding of how to foster workplace belonging when interacting with colleagues with protected characteristics.

Methods:

The workshop was delivered twice and opened with an introduction, explaining the use of simulation, how scenarios will run, the timetable and an ice breaker, establishing psychological safety. The workshop contained a diverse variety of simulated scenarios, using a range of simulation techniques, including, observed simulation, forum theatre and character monologues. The scenarios focused on working alongside colleagues with a range of protected characteristics, including those with caring responsibilities, age and faith.

The scenarios were followed by reflective debriefs, led by experienced facilitators, providing a psychologically safe space in which to explore the pre-set learning objectives, reflections, feelings and previous experiences.

Two separate communication frameworks were shared with participants in order to assist them in preparing for supportive conversations. These are: STEPS (Start, Time, Empathy, Provision of Support, Sense Check) [2] and CUS (Concerned, Uncomfortable, Safety) [3] and Clean Feedback [4].

Results:

Pre- and post-course rating scale evaluations were used following workshop delivery in April and May 2024, focussing on the individualised workshop learning outcomes, alongside free-text responses and were completed by a total of 9 participants. The feedback demonstrated an improvement in knowledge on the topics covered, with 46% of the participants expressing limited, neutral or no knowledge before the workshop and 99% expressing excellent or good knowledge after the workshop. Qualitative feedback highlighted the reflective value of the workshop, in addition to the authenticity of the scenarios, which were described as “real-life.”

Discussion:

The feedback supports the use of simulation training, containing embedded communication models in enhancing the ability of NHS employees to support colleagues with protected characteristics, in turn fostering a sense of belonging amongst the workforce. Specific feedback focussed on the value of ensuring that scenarios are authentic.

Ethics Statement:

As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

References

1. NHS England. WE ARE THE NHS: People Plan 2020/21 - Action for Us All [Internet]. NHS England. NHS England; 2020. Available from: https://www.england.nhs.uk/wp-content/uploads/2020/07/We-Are-The-NHS-Action-For-All-Of-Us-FINAL-March-21.pdf

2. Hamilton C, Thame A, Spencer J. A78 STEPS: Development of a communication skills framework for use in a broad range of simulation-based education. International Journal of Healthcare Simulation. 2023 Oct 31.

3. Agency for Healthcare Research and Quality. Tool: CUS | Agency for Healthcare Research and Quality [Internet]. www.ahrq.gov. 2023. Available from: https://www.ahrq.gov/teamstepps-program/curriculum/mutual/tools/cus.html

4. Doyle, N. (2008). Cleaning up the ‘F’ word in coaching – cleanlanguage.com. [online] Cleanlanguage.com. Available at: https://cleanlanguage.com/cleaning-up-the-f-word-in-coaching/. Accessed 8 April 2025.