Healthcare in Lebanon

Participants during a role play, Tyre, December 2014Between December 2014 and April 2015, International Alert helped train 110 healthcare workers in Lebanon in an effort to improve the conflict-sensitivity of aid in the country.

The four-day training course was designed to improve their understanding of conflict and hone their skills in dealing with tensions and stress in the workplace, learning how to be more sensitive to the needs of their patients and handle the increased workload in the wake of the Syria crisis.

Five groups of 20–30 participants attended the course from health clinics across the country, including Beirut, Mount Lebanon, Tyre, Akkar, Tripoli and Beqaa. 75% of participants were female.

Many health clinics offer services to Syrian refugees alongside their regular Lebanese patients, resulting in increased workloads and pressure. 69% of the staff who registered for the training in December reported that they were completing their tasks with difficulty. Compared to two years earlier, 54% said that there were more problems at work and 57% felt more stressed.

The main causes for problems at work were harassment by patients (40%), friction between centre staff and patients (22%) and frictions among patients (21%). Over half of the respondents (51%) felt that these problems were more frequent in comparison to two years earlier.

The aim of the training was therefore to improve healthcare staff’s understanding of conflict and enhance their communication skills in order to develop creative options for dealing with conflict and stress.

The first day of the training focused on understanding conflict, and recognising the positive aspects conflict can have, if addressed without violence. Participants were introduced to several tools for analysing conflict and used examples from their practice to describe conflicts and their causes.

Using role play, participants acted out conflict situations from the clinic’s waiting room (pictured above). The exercise allowed participants to step into the shoes of patients, and recognise how different behaviours can escalate or help calm down a tense situation. Participants also learned about and discussed the main conflict styles: controlling, compromising, problem-solving, accommodating and avoiding.

The second day of the course was about practicing communication skills. Participants did active listening exercises, discussed the difference in perceptions and the use of ‘I-messages’ (assertions about the feelings, beliefs, values etc. of the person speaking), and worked in groups to improve teamwork and cooperation.

Participants at a training in South Lebanon province“A patient was enquiring and the receptionist was not very friendly with him,” a participant from South Lebanon province recounted of one incident. “The patient then raised his voice and started shouting and verbally attacking the receptionist. Using the conflict iceberg method, his behaviour only represented the visible 10% of the iceberg. He had been waiting for a while to see the doctor, was probably in a bad psychological state, had a crying baby in his arms and might have other pressures to deal with. This invisible 90% of the iceberg is what we have to keep in mind to understand patients and react responsibly.”

The third training day was dedicated to understanding the stress at the individual and social level. Participants discussed different approaches to transferring negative stress into positive energy, and practiced relaxation techniques. Participants were interested in further training on time management, which they felt would help reduce their stress at work.

Follow-up sessions were then held for all five groups in March and early April this year. Participants were invited to reflect on their practices and assess their communication and conflict management skills since the training.

Most participants noted they had improved their active listening and effective communication. “I listen more to others in order to understand the problem,” said one participant from Beirut. “Through active listening I started accepting criticism.” A health worker from Beqaa reflected: “Before the training I had problems with my teammates. After the training, I changed the way I communicate with everybody.”

65% of participants rated the course as excellent and 33% assed it as very good, while three out of four found it extremely interesting (76%) and an additional 22% considered it very interesting.

Participants also assessed the extent to which their skills improved as a result of the training (on a scale of 1–5), with 90% marking a high level of improvement in six core skills (see below). Respondents reported the most marked improvement in teamwork and general communications skills.

Graph showing the skills participants improved as a result of the training

The five courses took place as part of Alert’s work on conflict-sensitive aid, under the EU-funded project on conflict reduction through improved healthcare services, led by the Lebanese Ministry of Public Health and implemented by UNHCR, WHO, UNICEF and Alert. Find out more about the project here.