D ecreasing D ialysis P atient- P rovider C onflict ( DPC )

1. Decreasing DialysisPatient-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

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 LookModule 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: • 30 - 45 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 www.esrdnet17.org www.esrdnet15.org * Developed by ESRD NW#15

32. CEU Requirements EVALUATION! 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

33. 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