Decreasing Dialysis Patient-Provider Conflict (DPC) Session #4 – Staff Training Modules 7-9 A Collaborative Presentation by Western Pacific Renal Network, LLC ESRD Network #17 Connie Lorenz, LMSW Patient Services Director 505 San Marin Dr., Bldg. A 300 Novato, CA 94945 Southern California Renal Disease Council, Inc. ESRD Network #18 Cecilia Torres-Correa, RN/BSN Patient Services Director 6255 Sunset Blvd., Ste. 2211 Los Angeles, CA 90028

Objectives Facilitate key educational strategies Encourage critical thinking Stimulate meaningful staff discussion Complete in a timely fashion Keep participants energized and interested Increase understanding & build communication skills Understand the root cause of the patient conflict

Continue to Communicate Module 7 “No relationship, whether personal or professional, is immune to conflict. One constant, though, is that most successful relationships include regular, ongoing communication”

Continue to Communicate Module 7 Purpose: To share and practice some basic communication skills that can help us listen to and communicate more effectively with our patients Time Required: 45 minutes Preparation /Material Needed: Case scenario cards List of benefits of good communication

Continue to Communicate Module 7 Teaching Concept Set a specific time frame to sit down with the patient Be open and ready to deal with the fact that not all conflict is easily resolved If it is evident that the conflict is continuing, consider an independent third party to help mediate

Continue to Communicate Module 7 Group Activities Group discussion on: Benefits of good communication Why do patients raise concerns? Communication Tips: Active listening Assertive statements Discussion on the importance of continuing to follow-up and communication Open discussion with questions

Continue to Communicate Module 7 Benefits of Good Communication More confidence in responding to patients Less time dealing with disruptions Increased patient/customer satisfaction

Continue to Communicate Module 7 “How do they think good communication would benefit our patients?” Improved dialysis environment Increased relaxation during treatment Less confusion about expectations

Continue to Communicate Module 7 Acknowledge staff challenges: We manage a high workload Sometimes there are staff shortages Patients can be demanding or difficult Patients can be disruptive or even abusive

Continue to Communicate Module 7 But we all know that: Good communication helps us identify reasonable patient requests Talking with patients calmly can avoid exacerbating the situation We can help identify problems early so that we can inform the appropriate staff

Continue to Communicate Module 7 Brainstorming on some reasons patients might raise concerns/complaints: They’re scared They want to know what to expect They’re frustrated, upset, or sad about their health or their personal life

Continue to Communicate Module 7 Patients may be dealing with: Mental health concerns, such as depression or anxiety Mood swings Cognitive impairments, such as dementia Alcohol/drug use and abuse Lack of support from family or other relationships Cultural differences or misunderstandings

Continue to Communicate Module 7 Communication Tips 1st Tip – Active listening Pay attention to what the patient is saying Look at the patient and use body language to show you’re following what is being said Tell the patient the feelings that you’re hearing them express

Continue to Communicate Module 7 Communication Tips 2nd Tip – Using Assertive Statements Focus on the behavior by being specific about what you need the patient to do Acknowledge the patient’s feelings Restate the behavior and desired outcome, from the patient’s point of view

Continue to Communicate Module 7 Communicating after the Conflict Communicate with your patients regularly Communication is both talking and listening Tell the patient if the conflict cannot be immediately addressed Not satisfying someone does not mean that your attempt to resolve the conflict has failed

Continue to Communicate Module 7 Negative Responses From Patient The professional’s first thoughts What was said or done after realizing the patient was still unhappy? Utilizing a neutral third party Good phrases to use when patients might have to accept solutions that they may never like

Continue to Communicate Module 7 Conclusion Effective resolution of a conflict requires follow-up communication. This allows you to monitor the progress being made and demonstrates to the patient your commitment to resolving the conflict. How's it working out?

Take Another Look Module 8 Purpose: Looking at conflict from a quality improvement standpoint Time Required: 30 minutes Preparation /Material Needed: Handout #1: CFC Requirements regarding complaints Handout #2: Individual facility’s grievance policy Handout #3: Reviewing the facility’s policy on grievances

Take Another Look Module 8 “Handling a conflict, like successfully performing dialysis related tasks, requires practice, understanding, education, and monitoring. Regardless of whether a conflict is minor or major, reviewing the steps used in addressing the conflict will be beneficial”

Take Another Look Module 8 Teaching Concepts Meet with other staff members Seek additional training Take a close look at the role you played in the conflict Evaluate and understand the root cause of the conflict

Take Another Look Module 8 Group Activities Understanding the grievance process Communicating after a conflict Wrap up and questions

Take Another Look Module 8 Understanding the Grievance Process Three Handouts: CFC requirements regarding complaints and/or grievances Two individual facility’s policy on grievances Questions about the facility’s policy on grievances

Take Another Look Module 8 Communicating After a Conflict As a patient: Would you feel comfortable raising a concern in this clinic? Why? Why not? Would you feel empowered by filing a complaint? If not, how would you feel? Who might not be feeling well, does the policy create a process for you to easily file and follow up on a complaint? Does the current complaint system provide a means by which you will be notified?

Take Another Look Module 8 Conclusion When Dealing With Conflict: Be willing to honestly examine the role we may have played Be open to feedback Recognize the strengths we have for handling conflict Always be willing to learn new skills

Take Another Look Module 8 Conclusion Continued Never stop trying to understand the causes of conflict Do not limit our conflict-intervention methods to one approach Be open to opportunities for learning that often arise from conflict

Common Patient Concerns Module 9 Purpose: To identify some of the most common concerns and solutions we’ve experienced in our dialysis unit Time Required: 30 - 45 minutes Preparation /Material Needed: Handout #1: Common patient concerns

Common Patient Concerns Module 9 Group Activities Common patient concerns What’s in your top 10? Wrap up

Common Patient Concerns Module 9 Most of the concerns we hear fit into one of four categories: Staff issues Treatment issues Food and diet issues Safety and policy issues

Common Patient Concerns Module 9 What’s in Your Patient’s Top Ten? Dialysis takes too long I want to get off the machine early Why can’t I drink a soda while I’m on the machine? I want more privacy It’s always cold in here

Common Patient Concerns Module 9 Conclusion We will sometimes have conflict with disruptive patients Asking for help early or reporting conflict to staff sooner rather than later will help the situation Help one another to provide support to the patients and help them manage their frustration

Additional Resources *DPC Tip Sheet #2 - Staff Training Modules *DPC Tip Sheet #1 - Administration www.esrdnet17.org www.esrdnet15.org * Developed by ESRD NW#15

CEU Requirements EVALUATION! “CEU Evaluation for DPC WebEx Session 4” Evaluation forms can be found on NW #17 or NW #18 websites under: “CEU Evaluation for DPC WebEx Session 4” www.esrdnet17.org www.esrdnetwork18.org You must attend all 5 sessions to receive CEU credit! Please return completed evaluation forms by fax to: Social Workers - NW #17 (415) 897-2422 RNs - NW #18 (323) 962-2891

Please feel free to contact us with questions Upcoming DPC WebEx WHEN: May 11, 2010 TIME: 9:00am - 10:00am SUBJECT: Quality Improvement Tools Please feel free to contact us with questions Network #17: Connie Lorenz (415) 897-2400 clorenz@nw17.esrd.net Network #18: Cecilia Torres-Correa (323) 962-2020 ctorres@nw18.esrd.net