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Decreasing DialysisPatient-Provider Conflict (DPC)
Session #4 – Staff Training Modules 7-9
A Collaborative Presentationby
Western Pacific Renal Network, LLCESRD Network #17Connie Lorenz, LMSWPatient Services Director505 San Marin Dr., Bldg. A 300Novato, CA 94945
Southern California Renal Disease Council, Inc. ESRD Network #18Cecilia Torres-Correa, RN/BSNPatient Services Director 6255 Sunset Blvd., Ste. 2211Los 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 No relationship, whether personal or professional, is immune to conflict. One professional, is immune to conflict. One constant, though, is that most successful constant, though, is that most successful relationships include regular, ongoing relationships include regular, ongoing communication”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 communicationWhy 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? How's it working out?
Take Another Look Module 8
Purpose:● Looking at conflict from a quality improvement
standpointTime Required:30 minutesPreparation /Material Needed:Handout #1: CFC Requirements regarding
complaintsHandout #2: Individual facility’s grievance
policyHandout #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 ConflictAs 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 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
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 9Conclusion
● 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 RequirementsEVALUATION!
Evaluation forms can be found on NW #17 or NW #18 websites under:
“CEU Evaluation for DPC WebEx Session 4”
www.esrdnet17.orgwww.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
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
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