Transcript What your clinical staff won`t tell you - but you need to know!

What your clinical staff won't tell you
- But you need to know!
Presented by:
Ginger R. Bandeen, LCSW, CHC
Session Overview
Communication challenges
I.
A.
B.
What makes communication difficult?
What makes communication essential?
Communication skills and techniques
II.
A.
B.
C.
Formal tools
Cultivating a reputation
Clinical skills to borrow
Communication Challenges
Primary Differences
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Style – distinct methods
of communicating
Goals – the purpose of
the conversation
Language – word
choice, jargon
Content – what are
people willing to share?
Underlying Dynamics
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Emotions – fear, anger,
pride
Social setting – stigma,
groupthink
Culture – values,
diversity
Other – cognitive
dissonance, defenses
Underlying Dynamics
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Beneath the surface of interactions:
 Clinical staff may have huge, fragile egos.
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Staff see themselves as experts.
Staff often experience feelings of incompetence.
Defense mechanisms help staff survive in a climate
of certain uncertainty.
Underlying Dynamics
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What people may not tell you…
 In many clinical decisions, the jury is still out.
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Treatment decisions are not ‘right’ and ‘wrong’
Options are limited by the ‘system’
Choices can feel like the lesser of two evils
Underlying Dynamics
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Many clinical staff feel isolated, asking themselves:
 How can we balance conflicting professional
responsibilities?
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to our clients/patients
to our values
to our employer
to our profession
to our community
Underlying Dynamics
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From the perspective of many clinical staff:
 The tail (compliance) is wagging the dog
(services).
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Staff and clients develop skills in maneuvering
through systems and ‘bending’ the rules.
These skills are sometimes then used in our own
systems.
With this in mind, it’s no wonder!
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Clinical staff are often hesitant to come forward.
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Staff evaluate the potential risks & benefits:
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Personal factors: the staff person, family, friends
Organizational factors: the agency, the staff person’s
clients, other clients, and the community
Some factors are beyond our control.
Compliance and Communication

How does quality communication impact the
elements of Compliance and Ethics Programs?
1)
Standards and Procedures
2)
Oversight
3)
Education and Training
4)
Auditing and Monitoring
5)
Reporting
6)
Enforcement and Discipline
7)
Response and Prevention
8)
Commitment to Ethics
9)
Evaluating Effectiveness
How can we tip the scales in favor of
open communication?
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Organizational factors
 Non-retaliation
policy/practices
 Open and supportive culture
 Compliance, ethics, and the mission
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Interpersonal factors
 Relationships
 Reputation
Organizational Culture
All organizational culture is local.
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Direct supervisors define organizational culture.
One unethical or demoralizing supervisor can
cancel out positive messages everywhere else.
Retaliation can take many forms.
Formal Feedback Tools
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What are some methods for gathering feedback if
all else fails?
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Online Surveys
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Example: Compliance and Ethics Survey
Give information
Use multiple-choice &open-ended questions.
Focus Groups
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Use clear parameters
Be prepared for what you’ll hear.
Cultivating Your Reputation
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Build credibility by being someone who:
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Is willing to seek out knowledge
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Learn about dilemmas faced by clinical staff.
Acknowledge gaps in understanding.
Avoid assumptions.
Has shared values
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Demonstrate commitment to the organization.
Connect ethics and compliance to the organization’s mission.
Cultivating Your Reputation
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Build trust by being someone who:
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Models transparency
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Acknowledge flaws in the program, and yourself.
Recognize when your values conflict with your role.
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Offers mutual respect
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Give people the tools to do
their job, and the benefit of the
doubt.
Interpersonal Factors
Compliance
Officers can
improve
relationships
by borrowing
the tools and
communication
techniques
used by
clinical staff
to encourage
open,
authentic
conversations.
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Clinical skills can enhance
communication at all levels:
 One-on-one
interviews
 Group meetings and trainings
 Presentations
 Investigations
 Disciplinary meetings
Compliance vs. Counseling
Similarities
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Purposeful
Mindful
Built on mutual respect
Expectations of
confidentiality
Ethical responsibilities to
be non-directive
Differences
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Expectations of
objectivity
Scope of the
conversation
The “client” is not just the
individual, but also the
agency as a whole
Clinical skills you can borrow

Clinical skills Compliance Officers can use to
increase the effectiveness of communication:
 Reflective
listening
 Observing the here-and-now
 Respecting boundaries
 Selective self-disclosure
 Thinking about systems
 Mindfulness
 Building human connections
Practice Reflective Listening
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Don’t reflect words back verbatim!
 Use
nonverbal and contextual clues to understand the
meaning behind statements.
 Offer interpretations carefully.
 Check
to clarify
 Avoid emotionally-charged words
 Practice
mirroring
 Observe
and mimic style, word choice, etc.
Use the ‘Here-and-Now’
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Consider pointing out:
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Connect observations to content.
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Posture, behavior, expression
Long silences
Half-answers
Unspoken statements
Word choice
Values, intentions, and fears
Use caution and tread lightly.
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Offer the opportunity, but never force the issue.
What could be unspoken?
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People lead complicated lives.
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Clinical staff are affected by:
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Personal goals
Unresolved family issues
Financial stressors
Work can provide people with:
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A salary that supports our life
A sense of purpose
An escape/rest from home
Positive reinforcement
Respect Boundaries
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Begin by explaining:
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Meta-communication = “talk about talking”
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Your role, goals, and the process
Limitations of confidentiality/anonymity
Other constraints (time, etc.)
Discuss the pros and cons of being open
Find a connection to the organization’s values & mission
Selective Self-Disclosure
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Use generalizations to describe common
feelings/barriers:
 “A
lot of people feel …”
 “Some people I talk to say …”
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Cautions – watch out for these pitfalls:
 Diverting
the conversation to you
 Leading the person to feel un-heard.
Analyze Systems
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Family Systems
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‘Family of origin’ roles
Team roles outlive individuals
Interdependence
Person-in-Environment
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Multiple systems interact
Observe group dynamics
Practicing Mindfulness
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Consider environmental factors
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Location, management, and décor in your office.
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Counselors carefully consider furniture arrangement, soundproofing, etc.
Consider tools to reduce interruptions (sign on the door, donot-disturb on your phone) and make expectations known
• Minimize power differences and
maximize comfort.
Practicing Mindfulness
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Prepare for one-on-one and group meetings
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Set aside time to process and re-group, rather than
moving from one person to the next.
Connect to your personal values and mission.
Practicing Mindfulness
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During your meeting
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Balance attention to:
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Being in the moment
The purpose and long-term goal
Content and process.
Take on a stance of “not-knowing”
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Be authentically curious.
Practicing Mindfulness
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End your meeting with a ‘wrap-up’
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Give the person time to re-collect themselves
Use chit-chat to transition back
Verify that everyone leaves with clear expectations
The most important factor
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Seek out the ‘spark’ of humanity in relationships
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Find connections that will help you see through barriers.
Identify common values, ideals, or our shared humanity.
– Speak and act with
‘unconditional positive
regard’
– Approach difficult
situations with respect for
each person’s humanity.
Questions/Comments
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For more information, please feel free to contact:
Ginger R. Bandeen, LCSW, CHC
Quality Improvement Manager/Compliance Officer
Columbia Community Mental Health
P. O. Box 1234, St. Helens, OR 97051
(503) 397-5211, x254
[email protected]