Fig. 4

Trial design for Phase 1. Step 1: Participants (clinical staff members) are initially identified, informed and invited to take part in the training. Step 2: Participants give informed consent while baseline variables that can be measured independently are assessed. All participants in this phase receive the training so that there is no allocation to either treatment or control group but only to similar treatment groups. Step 3: Pre-tests². Step 4: Participants complete the communication training. Step 5: Post-tests³. Step 6: Follow-up after 3 months. Note: ¹ Baseline data includes baseline assessments of pAE prevalence and costs, adherence safety culture and job description. ² Pre-test assessment includes demographic data, competences, training-related outcomes and work satisfaction. ³ Post-test assessments include competences and training-related outcomes. ⁴ At three months post-intervention, job stress and satisfaction, competences, behavior change as training-related outcomes and adherence safety culture will be assessed.