Issues and answers for online facilitation and coaching

In March 2020 I provided my last session face to face and then moved to online delivery.  This got me thinking about how the issues and challenges of facilitating health professionals translate into the online environment.

Maintaining confidentiality

Action learning and coaching demand a safe confidential environment to be effective, especially in healthcare. Quite easy to achieve in a conventional face-to-face setting. Working with online video conferencing systems such as Zoom, or Microsoft teams requires more preparation. To establish confidential live online sessions, make sure that you:

• Password protect sessions to control access. 
• Use a waiting room so you can control who enters the session.
• Disable all recording facilities.
• Prevent people from changing their names during the session. 
• Assure participants that these mechanisms will be in place before every session. 
• Discourage participants from joining sessions in open environments; a person calling from a shared office can be distracting and breaches confidentiality. 

Minimising stress

On line sessions can be demanding for both facilitator and participants. Not all healthcare professionals will be accessing sessions from desktops or laptops. Many will have to use smartphones or tablet devices.  Accessing a session from these is not that easy.  

• Ask at the start of the session who is using what to access the session.  
• Check in at period intervals to make sure they are able to follow and engage the session appropriately. 
• Provide advance notice of break times and durations to help participants plan other activity around these times.
• Reduce the length of time between breaks.  

Reducing distractions

Check your own background, make it as simple as possible and try to use the same background each time, to create a feeling of continuity. 

Check your lighting to make sure your face is not in shadow or silhouetted against a window behind you.

If possible use headphones with a combined microphone, provides better sound quality and headphones reduce personal distractions. Also assures participants that conversations cannot be overheard so easily. 

Plan ahead if working from home, try to ensure that others in the home are aware of the session. Try to discourage noisy activity and reduce interruptions. 

Try different screen layouts, some platforms allow you to place participants in speaker views or gallery views.  Work out the best way of seeing the group so that you can maximise interaction. 

Coping with interruptions

Many healthcare professionals are in contact with their workplace most of the time at present. They will get calls on mobiles or be bleeped by work. I handle this interruption by asking them to indicate this to me and the group by whatever means works best – some gesticulate, some use icons on the platform others send a message via the platform.  If at a critical point in the session then take a break, if not, then continue and retain the pace of the session. Don’t ask them to explain or justify the need for the interruption on their return to the session. It seems best to continue and if necessary provide a quick summary of the points missed. 

Some participants will have children, pets, deliveries and home maintenance interrupt at some point. Enable the session to keep going, if facilitating a group then its easier to manage, if one to one coaching then try to ensure the session is planned to be non interrupted ahead of time if at all possible.   If not, then use the mute button, stop the video and wait until they are ready to return to the session. I use a short re-cap session when they return to ensure they can re-focus and re-engage with the session.  If really necessary then stop the session and plan to start at another time. 

Broadband speeds can have a detrimental impact on sessions.  With action learning and coaching it is sometimes easier to ask a person to switch to audio only, use a phone or landline. 

Keeping track of time 

Find a solution to keeping to time. Time is a valuable commodity.  I have a phone on with a clock displayed in front of my screen. I also have an outline of the session timings to help. This is starting time, activity, breaks and finish time, a lesson plan of sorts. 

Using prompts and artefacts

My style of facilitation and coaching relies at times on using metaphors, pictures and artefacts to stimulate thought and engage both the left and right sides of the brain.

The picture of the mugs represents a session when a participant used mugs to represent aspects of themselves and their work. Moving the cups around helped them understand about their relationships with aspects of their lives. Think of readily available props that can be used.  Screen sharing is an excellent device for this in an online session with the advantage that you can use video easily. I place any visual resources I’m intending to use on my computer ‘desktop’ ahead of the session and then share at the appropriate time. Learning how to switch seamlessly makes it easier.

Building rapport is critical for action learning and coaching.  As part of sessions I sometimes ask people to share an object or picture with the group that is meaningful for them.  Sometimes I ask for this in advance to give them time to choose an object and to think about its significance. At other times I ask them to go and find an object that conveys a feeling at a particular point in time.  This gives them a screen break and gets them moving.

A session I am planning for the future will involve me sending some materials in the post. They will then be asked to construct an individual artefact live on line at the same time as the others in the group.  The construction will them be used to explore aspects of their work through a facilitated dialogue. This is similar to a session I use in a classroom and I have no idea how it will work or be received! The point for me is be creative and keep trying different things.

One of the key learning points for me is to realise how resilient the people are that I work with. They have adopted this new way of working with enthusiasm. They remain committed to supporting their colleagues and overcoming the obstacles that this situation could have generated.

Getting feedback

A great way to improve is to get feedback, using online approaches you have access to the usual myriad of evaluation approaches with the use of on screen icons, such as smiley faces, thumbs up or clapping hands. Maybe think about adding some specific ‘on line’ questions, such as:

• Did the technology help or hinder? What technological improvements would you suggest?
• If you had to leave the session for a period of time, did you feel included when you returned? If not what could have been improved?
• Was the background of the facilitator distracting? If so, in what way?

About Mike Cook

I have been engaged in healthcare for over 40 years, as a clinician, academic and at strategy level. I am a qualified coach and a Socratic Dialogue participant. Since 2011 I have been working with the National Institute for Health Research (NIHR) at the East of England Applied Research Centre (ARC).  I work with senior clinical staff that have been awarded fellowships to investigate an aspect of their clinical work.  More details can be found here https://arc-eoe.nihr.ac.uk/training-development. My role is as an action learning facilitator. During this time I have developed an approach that I have called Action Dialogues. Over a year I facilitate a small set of about 12 people to support their project work. I have always provided this in a face-to-face setting and was comfortable with my approach.  In March I provided my last session face to face and then moved to on line delivery.  I am not new to online teaching having developed several post grad programmes using online materials.  However this was a whole new challenge that got me thinking about how to facilitate a group of health professionals that were facing unprecedented demands on their time and expertise. As part of my own learning and development for facilitating these sessions I was fortunate to hear about the Jumping on line Webinars being delivered by the University of London Centre for Online and Distance Education and joined the session entitled Sustaining Quality Learning. The ideas of on-line communities resonated with me and I liked the ideas presented by Simon Rolfe.