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Communication Frameworks: Designing Performance-related Materials for ESP - by Ros Wright

‘It is important to remember that the overall objective of Business English [and ESP] courses is to improve performance.’ (1994)

Ellis and Johnson’s observation is as relevent today as it was 20 years ago. Areas they suggest will lead to enhanced learner performance are the development of confidence and fluency, use of communication strategies, delivery of speech, and greater cultural awareness. Using examples from medical English, this article presents ideas for designing performance-related ESP materials for your learners whatever their profession.

Communication frameworks are often used in training to enhance spoken performance, especially in the caring professions and customer service, but also in team building and conflict resolution. Such frameworks are high-frequency near-authentic tasks that prove an engaging and effective method with immediate relevance to the workplace. From a language perspective, frameworks can help professionals develop confidence and fluency and provide guidance, especially at lower levels. They are also surprisingly easy to adapt to the teaching of English language.

The SBAR is a framework used to ensure safe and effective communication between colleagues in a healthcare setting, either during handover – often together with the patient – or over the phone. In the initial stage of this example from Schroeder (2011), a nurse might first inform her colleague of his/her patient’s current Situation (‘Tina, Ms. J is here to have rehab after her right knee replacement.’) before giving essential Background information specific to the patient’s history, e.g. the patient’s diagnosis, history of previous procedures, even her family situation (‘Ms. J had a right knee replacement on 3 June by Dr. Smith. She has a history of hypertension, diabetes, and arthritis. She lives with her husband who’s retired and able to care for her at home when discharged.’). Assessment of the patient then follows (‘Blood glucose levels have been stable, vital signs are within normal limits. Her pain has been reported as a 7 on a 0-to-10 scale.’), which leads finally to either a Recommendation (‘Ms. J is scheduled for discharge this Friday and will need to speak to the discharge planner today.’) or a request (‘I’m still concerned about Ms. J’s mobility. Can you arrange for the physio to visit her before her discharge?’).

The functions and communication strategies employed in SBAR (questioning, making polite requests, signposting, clarifying, summarising, documenting) provide a sound basis around which to develop a series of spoken and written communication tasks. The framework acts as a vehicle to present relevant grammar structures in an authentic context with the emphasis on outcome as opposed to accuracy. In Schroeder’s scenario this might include simple present, simple past and the passive. The SBAR provides the opportunity to develop not only the full range of lexical input required of healthcare professionals, from medical terminology to colloquialisms and euphemisms, but also the means to move back and forth between medical and layperson’s language.

By maximising the use of authentic video clips, ESP writers strive to bring the workplace into the classroom. Putting the SBAR into practice, therefore, a couple of well-chosen clips will allow learners to ‘shadow’ other healthcare professionals as they work through the SBAR framework. Learners can analyse practitioners modelling key techniques and study both the visual (gesture, facial expression) and auditory (intonation, pronunciation) features of the language. Such clips also offer the necessary non-verbal, environmental and physical clues to help learners understand usage and register as well as interpret and respond appropriately to cues from their patients and colleagues.

When dealing with the cultural aspect of communication, ESP writers should go beyond the anecdotal and actively encourage learners to consider culture in its broadest sense (national, local, professional). Authentic video clips offer a means to demonstrate these aspects and the impact on interactions with patients and colleagues. They can also provide a more in-depth insight into the target culture if necessary. To develop cultural competency, materials need to provide a forum to discuss differences and thus avoid potential clashes in the workplace.

The value of role-play should never be underestimated; not least because it replicates methodology employed in medical communications training, allowing medical students to ‘try out different approaches without having to worry about upsetting a real patient’ (McKillop, 2010).  From a linguistic perspective, role-play requires learners to use opening gambits, incorporate turn-taking strategies and seek clarification, etc. This essential rehearsal stage develops fluency and delivery, and helps reduce the stress learners might associate with spoken communication, which for the SBAR might include speaking over the phone or participating in meetings. What is important, however, is to design scenarios that actually develop learner performance.

A traditional role-play scenario based on Schroeder’s example (idem) might look like this:

Student A: You are a nurse. Your patient has a temperature of 38°C. Contact the on-call doctor and ask for advice. Use the SBAR framework.

Student B: You are the on-call doctor. You receive a call from a nurse on your team about a patient. Advise him/her to continue monitoring the patient’s vital signs for a further 60 minutes.

This traditional format: question-answer-suggestion-response, tends to be transactional rather than interactional and invariably results in a successful outcome. In short, it does little to truly develop learner performance. A more effective scenario can be achieved by creating more rounded personalities for the role-play characters. Aside from the patient details, the following information might also be included:

Nurse Smith: It is 20 minutes before the end of your shift and you realise Ms J. has developed a fever with a temperature of 38.2°C. You decide to contact the on-call doctor, Dr Davies. You sometimes find Dr Davies difficult to work with – s/he speaks quickly over the phone and you feel a little intimidated by him/her.

Dr Davies: This is your final shift before going on holiday and you are trying to finish all outstanding paperwork before you leave. This has been a busy shift and you have not had chance to sleep. You tend to be a little sharp when you speak over the phone, but you try to control it.

You receive a call from Nurse Smith about his/her patient. Advise him/her to continue monitoring the patient’s vital signs for a further 60 minutes.

Indeed, you might first want to include a traditional role-play scenario in your materials to allow learners to focus on accuracy and to practice the basic stages of the framework. This can then be followed by a more developed scenario to hone the effectiveness of their communication skills using the SBAR.

Experts in medical communications, Maguire and Pitceathly note that ‘If doctors are to acquire skills […], they must have an opportunity to practise and to receive feedback about performance.’ (2002) Asking a third party observer to provide constructive peer feedback on language issues and the effective use of SBAR will help learners monitor their progress. Adding an observer to the role-play mix is a technique commonly used in medical communications training that can easily be incorporated into ESP materials. A simple feedback form will help guide ‘observers’ through a task. Here is a sample Observer evaluation sheet for a handover scenario in the presence of the patient.

 Observe and evaluate the doctor’s ability to:

Rating: 1 limited, 2 room for improvement, 3 effective 1 2 3
a Describe the patient’s current situation      
b Provide essential background information about the patient      
c Give an assessment of the patient      
d Offer a recommendation / Make a request      
e Include the patient in the discussion      
e Employ language for clarification      
f Use appropriate intonation and tone of voice      

A follow-up reflection stage will help the ‘doctor’ think about his/her own performance:

Answer the questions.

a. What went well?

b. What could have gone better?

While the ‘patient’ evaluates the communication skills of the ‘doctor’ from his/her perspective:

Complete the statements.

a. The doctor made me / didn’t make me entirely feel at ease because _____________________

b. I would recommend this doctor to family and friends because __________________________

Finally, asking learners to replay the scenario, taking on board the feedback from their peers (and the trainer), will help consolidate their newly acquired skills.

The SBAR is one of many communication frameworks in healthcare, some of which are now present in the business field. Indeed, one can easily imagine using SBAR to facilitate communication in a number of business situations. One such example is SPIKES (Baile et al, 2000). The SPIKES model was originally developed to break bad news to cancer patients. First, doctors Set the scene, then determine the patient’s Perception of their condition. Next they obtain the patient’s Invitation before delivering the preferred amount Knowledge, while providing Empathy. Finally, they Summarise the information for the patient before laying out a Strategy for the future. In the business world SPIKES is used in Human Resources to announce redundancies or refuse employee requests. Professional councils and accreditation bodies (e.g. Institute for Customer Service) can prove useful sources of similar communication frameworks as can discipline-specific reference books.  So whether you are designing materials for call centre employees, high-powered negotiators or social carers, it is quite likely a communication framework (or two) exists to form the basic structure of your next set of ESP materials, which in turn will go a long way to enhancing the performance of your learners.



Baile, W. F. et al. (2000) SPIKES – A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer. The Oncologist (5). p.302-311.

Ellis, M. and C. Johnson (1994) Teaching Business English, Oxford University Press

Maguire, P. and C. Pitceathly. (2002). Key Communication Skills and How to Acquire Them. British Medical Journal 325, 697-700.

McKillop, J. in Lever, M. (17.06.2010) Medical drama: Playing sick to teach doctors. BBC News. http://www.bbc.com/news/10267228

Schroeder, M.J., MSN, Looking to improve your bedside report? Try SBAR



Author’s Bio:
Ros specialises in medical English. Her titles include Good Practice (Cambridge, 2008) and more recently, English for Medical Professionals, a course preparing doctors to work in the NHS. Ros is currently General Secretary of EALTHY – an association for English teachers working with healthcare professionals. Her own website, www.englishformedicine.net aims to be a one-stop-shop for teachers of medical English.

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