1. 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
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

2. 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

3. 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”

4. 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

5. 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

6. 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

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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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?

18. 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

19. 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”

20. 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

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

22. 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

23. 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?

24. 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

25. 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

26. 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:
minutes
Preparation /Material Needed:
Handout #1: Common patient concerns

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

28. 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

29. 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

30. 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

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

32. 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”
You must attend all 5 sessions to receive CEU credit!
Please return completed evaluation forms by fax to:
Social Workers - NW #17 (415)
RNs - NW #18 (323)

33. 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)
Network #18: Cecilia Torres-Correa (323)