Enhancing Care for Older People - Health Service Executive

3.6 Example of an activity to introduce the process of
High Challenge/High Support (HC/HS)
This is an example of an activity session to introduce the process of challenge and support in
practice. This session can be incorporated into a PD group meeting, or in a ward or practice
area. It is important to allow 1-1½ hours to carry out this activity. Within this example, the
healthcare team is referred to as the PD group but this can be adapted to include a smaller
cohort (more than two). Using HC/HS in the change process is a skill which is built up over
time as the PD facilitator will become more experienced, knowledgeable and confident.
This is an example of what the activity will look like with suggested timings:
1 Introduce the activity and its purpose to your group. Introduce the HC/HS grid
and generate discussion around each of the sections through role playing, taking
examples from their workplace or a situation that one of the group members may have
experienced. At the beginning of this exercise, schedule time for a group discussion at
the end to evaluate this type of process and the facilitation skills needed.
2 15-20 minutes – In small groups of 2/3 ask the participants to describe what challenge
and support means to them. The discussion should also centre on the positive and
negative points about each of the areas. The aim is to establish a summary description
of both challenge and support.
3 15 minutes – Ask the groups to discuss what happens when:
There is too much challenge and not enough support.
There is too much support and not enough challenge.
Ask them how they feel their individual department or larger organisation deals with
challenge and support.
4 10 minutes – Introduce the challenge and support grid and talk through the four
sections. Use real situations to demonstrate each of the sections. Encourage the group
members to participate and suggest they offer some real life examples or situations
they have come across to demonstrate this process. The group can then act this out in
role play.
5 45 minutes – Role Play. The facilitator of the group can lead this by role playing HC/
HS. Involve the group as much as possible, ensuring participants have an opportunity
to discuss and critique the role play. This can be the foundation for participants or
individuals to begin the process of HC/HS. It can be a very challenging experience and
support is required at facilitator level. The importance of having terms of engagement
is reiterated at this point and it is crucial to schedule time to debrief the role that you
are playing.
HC/HS is integral to PD work and will be revisited and reviewed at all stages of the PD
process of implementing change and enhancing care effectively. Throughout HC/HS, the
integral component is person-centeredness which involves supporting others and therefore
expanding learning.
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