1. The Florida ESRD Network Frontline Floor Staff Workshop “Together Performing at a Higher Standard”

2. The Florida ESRD Network Agenda Your Role in the Patient Experience: How to build professional relationships with patients while maintaining boundaries Customer service and effective communications skills Interactive communication scenarios Staff–to-Staff teambuilding communication Vascular Access – The Patient Chronicles: Common physical, emotional, and psychological challenges patients face when migrating from a catheter to a permanent vascular access (VA) Engaging patients in discussions regarding VA and infection control VA Assessment – What complications look like, what staff will see with stenosis 11/19/20142

3. The Florida ESRD Network Why Have a Frontline Staff Workshop? Quality care starts and ends with you Your jobs require building good working relationships, working in a team-oriented environment, and providing outstanding clinical care You build meaningful and sometimes personal relationships with the patients because you have the most one-on-one time with them Patient and facility feedback There is always room for improvement 11/19/20143

4. CUSTOMER SERVICE VIDEO We’re all Friends 11/19/20144

5. THE PATIENT PERSPECTIVE Joe Karan, Network 7 Patient Subject Matter Expert 11/19/20145

6. LET’S TALK ABOUT CUSTOMER SERVICE AND PROFESSIONALISM Dorothy Craft, RN, CDN 11/19/20146

7. The Florida ESRD Network What the 2008 ESRD Conditions for Coverage Require 494.60 Physical Environment Building/furnishings/equipment – must be safe and functional All equipment operated according to manufacturer’s guidelines Patient care environnent sufficient to prevent cross contamination and accommodate emergency equipment Comfortable temperature Accommodations for patient privacy 11/19/20147

8. The Florida ESRD Network 2008 ESRD Conditions for Coverage 494.70: Patients’ Rights Informed within the first six treatments Informed regarding:  Right to participate in care  Advance directives  Treatment modalities  Facility policies regarding patient care and isolation  How to file a grievance  The facility’s discharge and transfer policies including involuntary discharges 11/19/20148

9. The Florida ESRD Network Patient’s Rights Information that is easy to understand Care that is respectful Involved in decisions about care Privacy and confidentiality Make a complaint and receive a response Clear information about facility policies including discharge and transfer policies 11/19/20149

10. The Florida ESRD Network The Patient Experience of Care In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems Survey (ICH CAHPS) Not a Consumer Satisfaction Survey Administered once in 2014 and semiannually in 2015 and subsequent years Results reported to CMS as part of the Quality Incentive Program (QIP) 11/19/201410

11. The Florida ESRD Network ICH CAHPS In the last 3 months, how often did you feel the dialysis center staff really cared about you as a person? In the last 3 months, how often did dialysis center staff make you as comfortable as possible during dialysis? In the last 3 months, did you feel comfortable asking the dialysis center staff everything you wanted about dialysis care? 11/19/201411

12. The Florida ESRD Network ICH CAHPS In the last 3 months, how often did dialysis center staff insert your needles with as little pain as possible? In the last 3 months, how often did dialysis center staff check you as closely as you wanted while you were on the dialysis machine? In the last 3 months, how often did dialysis center staff behave in a professional manner? 11/19/201412

13. The Florida ESRD Network Empathy The ability to identify with and understand another’s situation, feelings, and motives Put yourself in the patient’s shoes 11/19/201413

14. The Florida ESRD Network Who Would You Prefer Caring for You? 11/19/201414 Source: 5-Diamond Patient Safety Program, “Professionalism in the Dialysis Setting.” www.5diamondpatientsafety.org.www.5diamondpatientsafety.org

15. The Florida ESRD Network Professionalism Describes a certain type of behavior in the workplace Is based on our values and understanding of our professional roles Is evidenced in our behavior and judged through:  Our image  Our communication  Our competence  Our demeanor 11/19/201415

16. The Florida ESRD Network From the Patient’s Perspective A professional is: Trustworthy Competent Empathetic Respectful Caring Culturally aware 11/19/201416

17. The Florida ESRD Network Becoming Personally Involved Sharing that shifts focus from the patient to the staff member Disclosing personal problems/employee concerns Losing the ability to respond objectively Giving/receiving gifts Showing favoritism 11/19/201417

18. The Florida ESRD Network Other Pitfalls Flirtation Inappropriate dress/language Ordering/parenting Having the last word Threatening termination 11/19/201418

19. The Florida ESRD Network What if I am Not Sure if I am Being Professional? Ask yourself these questions: Would this be allowed in another medical setting? How does this activity assist the patient in care of his or her ESRD? Can this be documented in the medical record? Are you willing to do this for all patients? 11/19/201419

20. The Florida ESRD Network Proper Professional Behavior Encouraging patient self ‐ determination Providing informed consent Competence Not taking unfair advantage of any relationship Avoiding dual relationships Respecting privacy/confidentiality Empowering patients rather than creating dependency Not taking things personally 11/19/201420

21. The Florida ESRD Network How do We Not Take Things Personally? Know yourself: What pushes your buttons? Recognize your limits: What is your tolerance level? Anticipate situations and have a plan: Positive outlets and coping skills. Understand that our response can either escalate or deescalate the situation. 11/19/201421

22. The Florida ESRD Network Patient Engagement Maintaining professionalism, boundaries, and showing respect for patients’ care builds trust Having trust in staff leads patients to engage more in their care Together this leads to better outcomes for patient and facility Utilizing new patient orientation, plan of care meetings, and patient education to engage patients 11/19/201422

23. The Florida ESRD Network Customer Service Think about your own experiences. What would your patients say about your facility’s customer service? Does staff at your facility welcome and engage every patient the same way? Are concerns addressed quickly? Is the customer always right? 11/19/201423

24. The Florida ESRD Network Conflict Resolution Conflicts or complaints are rarely isolated incidents. All staff can look for indicators that the patient is unhappy. Try to take personal feelings out of the equation.  This is not about you! Address complaints immediately.  Do not wait until the “right moment.”  Things tend to escalate the longer they go without resolution. 11/19/201424

25. The Florida ESRD Network Conflict Resolution Try to determine the “real” cause of the conflict:  Is there a problem that effects multiple patients or only one?  Is there a win/win solution? With a little effort most issues can be resolved:  Scheduling  Medication  Attitudes  Access skills 11/19/201425

26. COMMUNICATION SCENARIOS Staff-to-Patient 11/19/201426

27. The Florida ESRD Network For Our Discussion After reading the scenarios that follow we will discuss the questions below. What rule of professionalism or code of conduct was broken? What boundaries (if any) were crossed? What should have happened? If you were the staff member in this scenario, how would you have handled it? 11/19/201427

28. The Florida ESRD Network I’m Going Through a Terrible Divorce! A patient told the facility manager that he refused to have a certain technician cannulate him because the technician has been talking, non-stop, about a terrible divorce and custody battle that she is going through. He describes her in a constant state of impatience and anger. He refuses to let her work with him because he is afraid that she won’t concentrate on his arm. He’s afraid that she will ultimately cause him pain because she is not focused on her job or her patients. 11/19/201428

29. The Florida ESRD Network For Our Discussion What rule of professionalism or code of conduct was broken? What boundaries (if any) were crossed? What should have happened? If you were the staff member in this scenario, how would you have handled it? 11/19/201429

30. The Florida ESRD Network It’s a big deal to me! A dialysis patient often sees technicians at the dialysis facility move from one patient to another without washing their hands or changing gloves. One morning the patient’s machine started beeping and a technician walked over from another patient area and hit a button on his machine to reset the alarm without changing his/her gloves. The patient stated to the technician “You did not wash your hands or change your gloves before you touched my machine!” The technician stated back to the patient, “Don’t worry about it, I know what I am doing, it’s not that big of a deal.” 11/19/201430

31. The Florida ESRD Network For Our Discussion What rule of professionalism or code of conduct was broken? What boundaries (if any) were crossed? What should have happened? If you were the staff member in this scenario, how would you have handled it? 11/19/201431

32. The Florida ESRD Network There, There Sweet Baby… A retired colonel stated to the facility manager that a new technician was being very disrespectful. When asked what the technician had done to be disrespectful, he stated, “She calls me hon, honey, sweetie pie, and cutie. She even called me a baby because I complained about how bad I was feeling. I’m a Colonel in the United States Army! I served in two wars! She should be calling me Colonel Jones, Mr. Jones or Sir!” 11/19/201432

33. The Florida ESRD Network For Our Discussion What rule of professionalism or code of conduct was broken? What boundaries (if any) were crossed? What should have happened? If you were the staff member in this scenario, how would you have handled it? 11/19/201433

34. The Florida ESRD Network Stop Telling Me What to Do! A dialysis facility dietitian has been trying to explain to a patient the importance of monitoring potassium. The patient begins yelling at the dietitian, “I’ve given up everything I love! Tomatoes, strawberries, and bananas. I don’t have any potassium in me. I’m sick and tired of being harassed by you. You’re one to talk! Look at you, Miss Fatty Pants! Who are you to tell me how to diet?” The dietitian then yells at the patient, “If you don’t shut up right now, you’ll never be able to come back here!” 11/19/201434

35. The Florida ESRD Network For Our Discussion What rule of professionalism or code of conduct was broken? What boundaries (if any) were crossed? What should have happened? If you were the staff member in this scenario, how would you have handled it? 11/19/201435

36. The Florida ESRD Network I’m the Only Caregiver for You, Babe! A patient refuses to allow any technician, except for his absolute favorite, to cannulate him. It was discovered that the technician had told the patient, “I’m the best technician here and the only one you need. I’ll take the best care of you and make sure nothing bad happens to you while you are on the unit.” Now this technician has moved to another dialysis unit across town. The patient is furious and scared. He’s demanding to know, “Where has my girlfriend gone?” 11/19/201436

37. The Florida ESRD Network For Our Discussion What rule of professionalism or code of conduct was broken? What boundaries (if any) were crossed? What should have happened? If you were the staff member in this scenario, how would you have handled it? 11/19/201437

38. COMMUNICATION STRATEGIES FOR TEAM BUILDING Staff-to-Staff 11/19/201438

39. The Florida ESRD Network The Sustainable Circle of Success! 11/19/201439 Happy Patients Happy Staff Happy Facility

40. The Florida ESRD Network Communication Scenarios 11/19/201440

41. The Florida ESRD Network Failure is Not an Option! What is the most important reason to support and assist other staff? 11/19/201441

42. The Florida ESRD Network Teachable Moments Give immediate assistance when possible. Provide examples within a non-parental, non-judgmental, “What I’ve learned,” or “What helped me,” framework. Use the opportunity to reinforce both staff and patient teaching, so that everyone learns at the same time. 11/19/201442

43. The Florida ESRD Network Why Be Mean? Why do people bully others? 11/19/201443

44. The Florida ESRD Network Teachable Moments Reduce criticism and inspire confidence. Mentor using a “walk through” technique. Allow for questions, feedback, and learning curves. 11/19/201444

45. The Florida ESRD Network R-E-S-P-E-C-T The Rebound Effect 11/19/201445

46. The Florida ESRD Network Teachable Moments How important are you? What really happens when you discourage communication? The “day after” conversation 11/19/201446

47. The Florida ESRD Network Take It Away Two final thoughts as we close this portion of the workshop: It is so awesome; you get to do this every day. Your words have the power to change things. 11/19/201447

48. BREAK 11/19/201448

49. VASCULAR ACCESS – THE PATIENT CHRONICLES Christina Beale, RN, CNN Lifeline Vascular Access 11/19/201449

50. The Florida ESRD Network Network Contacts Helen Rose, MSW,LCSW HRose@nw7.esrd.net Beverly Whittet, RN,CDN BWhittet@nw7.esrd.net Mary Fenderson, RN, CNN,MSHSA MFenderson@nw7.esrd.net Phone: 813-383-1530 Fax: 813-354-1514 www.fmqai.com 11/19/201450 This material was prepared by ESRD Network 7, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy nor imply endorsement by the U.S. Government. FL-ESRD-Aim1-11142014-01

51. PROGRAM EVALUATION 11/19/201451