Transcript Communication Training and Impact on Patient

Decreasing Patient Complaints &
Improving Satisfaction in a
Correctional Environment
ARTHUR BREWER, MD, CCHP, CLINICAL ASSISTANT
PROFESSOR, DEPARTMENT OF FAMILY MEDICINE,
ROBERT WOOD JOHNSON MEDICAL SCHOOL
STATEWIDE MEDICAL DIRECTOR
MECHELE MORRIS, PHD
DIRECTOR OF TRAINING
UNIVERSITY CORRECTIONAL HEALTHCARE
OF
THE UNIVERSITY OF MEDICINE & DENTISTRY OF NEW
JERSEY
OBJECTIVES
PARTICIPANTS WILL:
UNDERSTAND THE RELATIONSHIP BETWEEN GRIEVANCES &
LITIGATION
BE ABLE TO DISCUSS THE IMPORTANT ASPECTS OF AN INMATE
GRIEVANCE PROCESS
BE ABLE TO IDENTIFY VARIOUS TRAINING METHODS
PROVIDED TO MEDICAL STAFF
LEARN THE BENEFITS IMPROVED COMMUNICATIONS
TRAINING HAS ON GRIEVANCES
PATIENT COMPLAINTS
 Allows patients to provide feedback
 Provides helpful information to health
organizations about:
Systems
that may need improvement
Staff
Areas
with the potential for liability
Patient Complaints & Malpractice Risk
 Unsolicited patient complaints are positively associated
with physicians’ risk management experiences.
 Risk appears to be related to patients’ dissatisfaction with
their physicians’ ability to:
 Establish
 Provide
rapport
access
 Communicate
effectively
SOURCE: JAMA, JUNE 12, 2002
Malpractice Risk by Specialty
 7.4% of all physicians had a malpractice claim
 Range

19.1% in Neurosurgery to 2.6% in Psychiatry

5.2 % Family Practice

8 % Internal Medicine
Source: NEJM Aug 18, 2011
Physician Patient Communication
 Routine MD – Patient communication differs in primary
care MDs with malpractice claims versus those without
malpractice claims
 Orienting to the process
 Use of humor
 Facilitation
 Active Listening
Source: JAMA Feb 19, 1997
Why Patients Sue
 Deserting the patient (32%)
 Devaluing the patient &/or family views (29%)
 Deliver information poorly (26%)
 Failing to understand patient &/or family perspective
(13%)
Source: Arch Intern Med June 27 1994
Inmate Grievance Process
 Standardized
 Patient Representative at each facility
 Complaints received centrally & distributed
 Response timelines enforced
 Analysis & monitoring ongoing
 Results used for training & process evaluation
Top Medical Grievances
 Co pay
 Relationship between patient & practitioner*
 Medication issues
*Practitioners cite the relationship with
some patients to be their biggest
challenge
Relationship Between Patient & Provider
 Staff conduct
 Dissatisfaction with provider
 Delay in treatment (perception)
 Failure to treat (perception)
Relationship Between Patient & Provider
Common thread for these complaints is
inadequate communication
 Perceived lack of focus on issues of concern to
patient
 Patient not fully understanding
 Patient doesn’t feel engaged
 Mutual trust & shared decisions are challenging at
best
INTERVENTION
 Introduction of staff training
 Invitation to submit details of difficult patient
encounters
 Site visits/training with medical staff
 General meeting with role play video
 Online training options including CME
BATHE TECHNIQUE
Brief Psychotherapeutic
Patient-Centered Technique
fitted into a 15 minute appointment
 Background
 Affect
 Trouble
 Handling
 Empathy
MD Anderson Online CME
Interpersonal Communication And Relationship Enhancement
I*CARE
 I*CARE Program


Designed to improve communication among patients, their families & their
clinical team
Provide information on “how-to's” of patient-doctor communication (breaking
bad news, non-verbal communication skills, medical errors, end of life & more)
 Basic Strategies
o Learn four useful communication strategies
 Non-Verbal Communication
 Review techniques for effectively using non-verbal communication
 Discover how paying attention to non-verbal behavior in clinical encounters
can help with the messages you send to others
 Managing Difficult Communication
 Disbelief/Denial
 Serious Illness/Sensitive Discussions
 Crossroads
ONSITE TRAINING
STAFF PRESENT DIFFICULT CASES
 What was difficult about the case?
 Why was it difficult?
RESPONSE
 Peers offer feedback & share their experiences with
the same patient
REPEATED RESULT
 Staff often take difficult interactions personally
EFFECTIVE ENGAGEMENT








Introduce patient to the service relationship
Explain our role
Try to find common ground to build on
Non-threatening
Respect, accept, support
Active listening
Help patient make informed choices
Is consistent with repeated, predictable patterns
of interaction when you meet and incorporate the
things above
CULTURAL ADAPTATION
Personality Disorder: “…enduring pattern of inner
experience & behavior that deviates markedly
from expectations of the individual’s
culture.” DSM IV
 Suspiciousness, hostility, social withdrawal & self
centeredness
 Adaptive & expected patterns of behavior
 Looking out for self & distrust of others are necessary
to survive
Would I want to work with me?
Monitor Your Behavior
 Posture
 Tone
 Eye contact or lack thereof
 Are you listening/paying attention
 Are you focused on now or later
Taking Crap With Dignity & Style
No matter what you do, you’re still going
to get crap!
 Acknowledge crap is being flung at you
 Consider your options
 Resist,
dismiss, defend
 Give the insults & negativity no power
 Try giving into the crap
WHY ME?
Are you utilizing all the skills available ?
 Mental
Health
 Nursing
 Correctional
 Colleagues
staff
Tips You Can Actually Use
 Paraphrasing
 Anticipate resistance but focus on the here & now
 Avoid telling patient what to do…present options
 Learn to let them say what they want
 Give respect even when it’s not deserved
 Practice patience
 Humor
Medical Grievances Data
Year Request
for
services
Unfair
Treatment
Communication
Med
Issues
DOC
Issues
Total
MD/NP
2011
882
784
846
688
251
3510
2012
1015
679
586
492
138
2910
13%
reduction
30%
reduction
28%
45%
17%
reduction
reduction reduction
THE BOTTOM LINE
Treatment in corrections takes
many forms;
but most important is
basic human respect
&
concern!
REFERENCES
Stuart MR, Lieberman JA: The Fifteen Minute Hour: Therapeutic Talk in
Primary Care. UK, Radcliff Publishing, 2008.
Thompson GJ, Jenkins JB: Verbal Judo, The Gentle Art of Persuasion.
NY, Harper Collins, 2004.
Rotter M, Way B, Steinbacher M, et al: Personality disorders in prison:
aren’t they all antisocial? Psychiatric Quarterly, Vol. 73, No. 2, Winter
2002.
Dvoskin JA, Spiers EM: On the role of correctional officers in prison
mental health. Psychiatric Quarterly, Vol. 75, No. 1, Spring 2004.
Allen B, Bosta D: Games Criminals Play: How You Can Profit by Knowing
Them. CA, Rae Hohn Publishers, 2007.
Buffington PW, Cheap Psychological Tricks: What To Do When Hard
Work, Honesty and Perseverance Fail. GA, Peachtree Publishers 1996.