Handling disgruntled patients and conflict resolution

Overview

Staff conflict

Disgruntled patients

Complaints

Abusive or violent patients

Drug seekers

Staff conflict Prevent

Restore Isolate

Manage

Lead by example from the top down• stamp out poor role modelling• focus on team building• communication skills• ongoing coaching and effective performance reviews

Robust recruitment process to avoid importing the problem• recruitment for attitude, train for skills• consider person specification pertinent to the role and the team fit• effective pre employment checks• personality and/or psychometric (cognitive) testing – particularly for senior

positions• effective induction

Prevent

General responsibilities listed in employment agreements• your responsibilities as well as theirs• serious misconduct definition• procedure for resolution of employment relationship problems

Position description • details the tasks, the expected standards and outcomes for the role

Code of conduct • developed in conjunction with the practice team and applies to the whole

team

Clear, legally compliant documentation

• Environmental - adequate working space- equipment- training needs - realistic time frames

• Bullying in the workplace• Behavioural or attitudinal • Stress – work or personal• Staff not knowing the boundaries

Isolate and identify any causal factors

Incompatibility

InvestigateLook for solutionsThird party mediation and counsellingAct in a fair and reasonable manner• meet legal complianceMutual termination – comes with risk GET ADVICE FIRST

Performance improvement plan

Drawn up in conjunction with the employee to:•identify the behaviours you are unhappy with•define what is expected•agree to pathway and timeframe to achieve expectations •include what you need to do – any training, support or equipment needs

Review and update progress at prescribed intervals•annotate with date and initials of both parties

Proceed to disciplinary process if expectations not met•seek advice first•advise insurer if you have employee disputes cover

ManageBe familiar with and expect accountability to terms in: •employment agreement •position description•practice policies and guidelines – including code of conduct

Comply with principle of fairness and reasonableness

Regular and timely observation•“You handled that well”•“That seemed like a difficult situation, let’s talk about it”•“That is not appropriate, let’s go and have a coffee...”•“Things don’t seem happy here, please tell me what the problem is”

Conflict of interest: staff as patients

Managing business needs versus employment relationship issues

• e.g. request for medical certificate for extended sick leave due to stress in the workplace

Familiarity• potential clinical safety issues

Document, document, DOCUMENT!

You may well need to depend on these notes in the future.

Restoring the team

Acknowledge a difficult time has passed

Celebrate moving forward

Review and model expected behaviours •the ideal team working environment

Keep your finger on the pulse •avoid slippage

Disgruntled patients

Sometimes you can spot them coming a mile away.

What is driving the patient’s behaviour?

Frustration

Emotionally or stress driven

Unmet expectations

Poor self control

Outright bad behaviour

The aggrieved patient

Triggered by outcome of certificates and reports for• work capacity

• insurance

• ACC

• government departments and other agencies

• employers

See:

www.mcnz.org.nz for their statement Medical certification

www.workandincome.govt.nz Completing the Work Capacity Medical Certificate

Or contact MPS phone 0800 225 5677 or email querydoc@mps.org.nz

Prepare = ability to respond appropriately

1. Self awareness• identifying and controlling our own behaviours and responses• understanding the reactions we get

2. Staff training• how you want them to react

2. Know how to diffuse• speak calmly and clearly• treat with respect

Avoiding patient frustration

Phone system

Reception interaction

Appointment availability

Waiting times

Waiting room

Privacy

Don’t put up with abusive or threatening behaviour

Look after your own safety first and don’t hesitate to call the police if necessary

Ignore personal insults – do not retaliate

Call for help from the practice team if necessary

Get to the bottom of the problem

Listen and take accurate notes– document, document, document!

Investigate

Has the patient inadvertently caused the issue?

Tell them what you need to doe.g. follow complaints protocol and explain what that entails

The Code of Health and Disability Services Consumers’ Rights states patients have the right to:

1.Be treated with respect2.Freedom from discrimination, coercion, harassment, and exploitation3.Dignity and independence4.Services of an appropriate standard5.Effective communication6.Be fully informed7.Make an informed choice and give informed consent8.Support9.In respect of teaching or research10.Complain

Who is at fault?

Don’t be too proud to say “I am sorry we could have done that better”

“Let me take your contact details so we can...”

Ask them what they would like to see happen

Body language awareness

You can’t always put it right!

Sometimes all the patient wants is an apology

An apology is not an admission of guilt or liability – but saying sorry can help a lot

Complaints procedure

Staff need to:• be familiar with your policy, feel comfortable about receiving

complaints and know who to hand them on to

Patients need to:• feel comfortable about complaining and have easy access to the

process

Privacy Act requires you to:• have at least one privacy officer• ensure staff are aware of and up to date with privacy obligations• acknowledge receipt of complaints within 5 working days• respond within 10 working days

Ending patient relationshipProcess• verbal or written notice with reason for termination and opportunity to

respond– CANNOT be on basis of health need, anticipated health need or

discrimination• PHO or provider must help find suitable new provider• keep an auditable trail • recommendation to seek advice before proceeding

Resources:NZMC statement Ending a doctor-patient relationship www.mcnz.org.nzMoH Enrolment Requirements for Primary Health Organisations – version 2.3,

enrolment parameter 8 www.moh.govt.nzMPS 0800 225 5677, email querydoc@mps.org.nz

Finally – write it up as a significant event

Debrief – are there any:• lessons learned?• policy changes to make?• staff training needs identified?

Or did you earn a pat on the back confirming that the practice is well prepared with good policies and training in place?

Armed robbery

Survival is the number one rule

• Remain calm and exercise self-control• Don’t play the hero or resist – you may put other

people at unnecessary risk• Co-operate and listen carefully and do what you are

told without question• Don’t make sudden movements, talk to, or stare at

the offender• If the offender has a firearm, consider it loaded

Once the offender has left

• Dial 111 and ask for police• Render first aid to any victims• Preserve the scene for evidential purposes

– don’t touch anything the offender may have touched– isolate area/s used by the offender and ask witnesses to stay until police

have arrived

• Without staring, note the offender’s description – physical features, clothing, distinguishing characteristics, weapon/s, actions

• If safe, note the direction the offenders go following the robbery– vehicle type, colour, make, number plates

• Don’t chase the offenders

Drug seekers – determining if legitimateTreat them like any other new patient, ask for: • full name• address• date of birth• phone contact details• details of previous GP to request transfer of records

Ask for proof of identification • passport• drivers licence • some kind of card that confirms their identity

Seek help from the experts:

Medicines Control Office www.moh.govt.nz/moh.nsf/indexmh/medicinescontrolNorthern (09) 580 9088Central (04) 496 2000Southern (03) 474 8074

MPS 0800 225 5677 querydoc@mps.org.nz

MCNZ statement Good prescribing practice www.mcnz.org.nz/portals/0/news/Good%20prescribing%20practice.pdf

Work shop

Questions?

Chris Wills – business advisorBusiness Advisory ServicesMedical Assurance Society

Telephone 0800 800 MAS (627)E-mail business@medicals.co.nz