Transcript Enhancing Patient-Staff Communication in Dialysis Units

Enhancing Patient-Staff Communication
in Dialysis Units
Evan Smith, LMSW, MBA
Patient Services Director
End-Stage Renal Disease Network of New York
Presentation Objectives
-Understanding the prevalence of communication related
conflict in dialysis units
-Describe the role of dialysis facility staff in promoting positive
communication
-Define Communication and understand techniques used to
facilitate positive communication
-Develop an understanding of best practices related to
communication on dialysis units
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Communication Related Grievances
- The Network performed a focused grievance audit for the 1st
quarter of 2014 to identify trends/ root causes of patient
grievances
-During this period, a total of (21) grievances were filed
-61% of all patient grievances was related to staff-patient
interactions
- Staff related issues were then analyzed further. Ineffective or
unprofessional communication was the root cause related to
nearly all staff related grievances received.
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Focused Grievance Audit Q1 2014:
Findings
9%
5%
Patient- Staff
Communication
Quality of Care
25%
Environment
61%
Policy /
Procedure
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Patient Grievance Quotes
-
“(staff member) called me a ________________”
-
“(staff member) always walks up without greeting me
or saying anything”
-
“(staff member) was giving me a bad look and rolled
their eyes”
-
“(staff member) always complains about personal
issues to me”
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Communication in ICH CAHPS
Question 10. In the last 3 months, how often did the dialysis
center staff listen carefully to you?
Question 11. In the last 3 months, how often did the dialysis
center staff explain things in a way that was easy for you to
understand?
Question 12. In the last 3 months, how often did the dialysis
center staff show respect for what you had to say?
Question 14. In the last 3 months, how often did you feel the
dialysis center staff really cared about you as a person?
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What is Communication?
Communication is the process of
transferring signals and messages
between a sender and a receiver through
various methods (written words,
nonverbal cues, spoken words). It is also
the mechanism we use to establish and
modify relationships
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Positive Communication
We promote positive communication to
create an atmosphere that is both
professional and comfortable for patients
and staff
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Overview of Communication Tips
-The five steps of active listening
-Non-verbal communication
-Managing your stress
-Emotional awareness
-Dealing with patient anger
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Communication Tips: Active Listening
“One of the best ways to persuade others is
with your ears—by listening to them”
~ Dean Rusk
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Communication Tips: Active Listening
Active Listening: 5 Easy Steps
Definition: Active listening is a communication technique which requires
the listener to feed back what they hear to the speaker, by way of restating what they have heard in their own words and confirm the
understanding of both parties
1) Pay attention
2) Show that your listening
3) Provide feedback
4) Defer judgment
5) Respond appropriately
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Communication Tips: Active Listening
1) Pay Attention

Give the speaker your undivided attention, and acknowledge the
message

Look at the speaker directly

Put aside distracting thoughts

Avoid being distracted by outside factors

"Listen" to the speaker's body language
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Communication Tips: Active Listening
2) Show You're Listening

Use your body language and gestures

You can nod to acknowledge understanding

Smile and use facial expressions

Note your posture and make sure it is open and non threatening

Prompt the speaker to continue with verbal comments like “yes” and
“uh huh”
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Communication Tips: Active Listening
3) Provide Feedback

As a listener, your role is to understand what is being said. This may
require you to reflect what is being said and ask questions

Reflect what has been said by paraphrasing. "What I'm hearing is,"
and "Sounds like you are saying," are great ways to reflect back

Ask questions to clarify certain points. "What do you mean when you
say." "Is this what you mean?"

Summarize the speaker's comments frequently.
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Communication Tips: Active Listening
4) Defer Judgment

Interrupting is counterproductive. It frustrates the speaker and limits
full understanding of the message

Allow the speaker to finish each point before asking questions

Don't initiate a counter argument
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Communication Tips: Active Listening
5) Respond Appropriately

Active listening is a model for respect and understanding. You are
gaining information and perspective. You add nothing by attacking
the speaker or otherwise putting him or her down

Be candid, open, and honest in your response

Assert your opinions respectfully
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Communication Tips: Active Listening
Avoid “Selective Listening”: the act of hearing
and interpreting only parts of a message that
seem relevant to you, while ignoring or
devaluing the rest. Often, selective listeners will
form arguments before they’ve heard the full
story
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Communication Tips: Nonverbal Communication
“The most important thing in communication is hearing
what isn't said””
-Peter F. Drucker
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Communication Tips: Nonverbal Communication
-When we communicate things that we care about, we do so
mainly using nonverbal signals
-Wordless communication, or body language, includes facial
expressions, body movement and gestures, eye contact,
posture, the tone of your voice, and even your muscle tension
and breathing.
-The way you look, listen, move, and react to another person
tells them more about how you’re feeling than words alone ever
can.
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Communication Tips: Nonverbal Communication
-When we communicate things that we care about, we do so
mainly using nonverbal signals
-Wordless communication, or body language, includes facial
expressions, body movement and gestures, eye contact,
posture, the tone of your voice, and even your muscle tension
and breathing.
-The way you look, listen, move, and react to another person
tells them more about how you’re feeling than words alone ever
can.
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Communication Tips: Managing Stress
“Adopting the right attitude can convert a negative stress
into a positive one”
-Hans Selye
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Communication Tips: Managing Stress
-Recognize when you are becoming stressed- Your body will let
you know, try to identify your personal signs of stress
-Take a moment to calm down- This is important, if you feel
overly stressed walk away for a moment and postpone the
conversation
-Be willing to compromise- sometimes if both parties meet a
middle ground stress can be reduced and a solution can be
reached
-Agree to disagree- if possible given the circumstances, or
propose to re-visit the issue at a later date
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Communication Tips: Empathy /
Emotional Awareness
“When you show empathy towards others, their defensive
energy goes down, and positive energy replaces it. That’s
when you can get more creative in problem solving”
-Stephen Covey
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Communication Tips: Empathy / Emotional
Awareness
-Understand and empathize with what is really troubling other
people
-Understand yourself, including what’s really troubling you and
what you really want
-Stay motivated to understand and empathize with the person
you’re interacting with, even if you don’t like them or their
message
-Build strong, trusting, and rewarding relationships, think
creatively, solve problems, and resolve conflicts
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Communication Tips: When a
Patient is Angry
“Never respond to an angry person with a fiery comeback,
even if he deserves it...Don't allow his anger to become
your anger.”
-Bohdi Sanders
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Communication Tips: When a Patient is Angry
When a Patient is Angry:
-Show respect and maintain professionalism
-Avoid a power struggle
-Remain calm in actions and the tone of your voice
-Remind the patient that you are there to help, ask them
how can we help?
”I want to help you”
“We can get through this issue”
“If you can _____I can see if I can_____”
-Attempt to re-direct the patient and de-escalate if
possible
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Network
Communication Tools
- The Network has just completed
the development of an educational
poster for dialysis patients
-The Dialysis Patient-Provider tool kit
is available to train staff on
communication and conflict
reduction
http://esrdncc.org/professionals/decr
easing-dialysis-patient-providerconflict/
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Questions?
For more information contact:
IPRO End Stage Renal Disease Network of New York
1979 Marcus Avenue
Lake Success, NY 11042
Phone: 516-209-5578
Toll-free: 800-238-3773 (Patients only)
Fax number: 516-326-8929
Email: [email protected]
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