D ecreasing D ialysis P atient- P rovider C onflict ( DPC )

Decreasing DialysisPatient-Provider Conflict(DPC) Session #3 – Staff Training Modules 4-6 A Collaborative Presentation by Western Pacific Renal Network, LLC ESRD Network #17 Connie Lorenz, LMSW Patient Services Director 505 San Marin Dr., Bldg. A 300 Novato, CA 94945 Southern California Renal Disease Council, Inc. ESRD Network #18 Cecilia Torres-Correa, RN/BSN Patient Services Director 6255 Sunset Blvd., Ste. 2211 Los 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

Focus on the Issue - Module 4 Purpose: • To practice communication techniques that can be used in the dialysis clinic to help dialysis professionals stay focused on a single, clearly defined issue Time Required: • 45 minutes Preparation /Material Needed: • Article “What are you trying to tell me?”

Focus on the Issue - Module 4 “When conflict occurs, there is a tendency to lose sight of the issue that started the disagreement and it can quickly become a disagreement about the facility staff, the clinic operations, or the physician care.”

Focus on the Issue - Module 4 cont. • During a conflict, it’s common for additional & unrelated concerns to be raised. Be prepared • Be willing to ask the patient to explain their concern if you don’t understand what they are saying • Do not assume that you already know what the patient is upset about

Focus on the Issue – Module 4 Teaching Concepts • Use positive communication skills • Seek patient agreement on what the conflict is about • Demonstrate a willingness to address the conflict • Maintain focus on the agreed upon issue

Focus on the Issue - Module 4 Group Activities • A group discussion on key points for how to focus on the issue • Go over article “What are you trying to tell me?” with group • Role playing in pairs • Open discussion with questions

Focus on the Issue - Module 4 Conclusion • Do your best to give the patient your full attention when discussing the concern • It’s difficult for dialysis patients who may not be feeling well to clearly say exactly what they are concerned about during treatment

Look for Solutions - Module 5 Purpose: • To gain a greater understanding of communication strategies that decrease conflict Time Required: • 30 minutes Preparation /Material Needed: • Write a list of points for solutions to resolve conflict • Handout #1: Closed-ended and Open-ended Questions • Handout #2: Practice Finding Solutions

Look for Solutions - Module 5 “Not all conflicts can be resolved nor are all conflicts based on valid complaints. But, working in collaboration with the patient will improve the likelihood of a positive outcome.”

Look for Solutions - Module 5 Teaching Concepts • Brainstorm possible solutions with the patient • Patient care conference with family, friends, staff, and physician • Be creative and flexible • Let the patient know if it is not possible to fix the entire problem • Don’t make promises you can’t keep

Look for Solutions - Module 5 Group Activities • Key points covered from handout “Look for Solutions” • Short lecture from trainer on the importance of open–ended questions • Brainstorming session with group • Role playing sessions • Wrap up and questions

Look for Solutions - Module 5 Key Points • The objective is to negotiate an agreement • It’s not about winning or losing • Timing is critical • Be willing to negotiate a solution • Find a solution that really works

Look for Solutions - Module 5 Key Points cont. • Talk with a neutral third party • Brainstorming possible solutions to a conflict can lead to more effective policies • Use open-ended questions which can lead to a more thorough discussion of the conflict

Using Open-ended Questions • What is the patient’s perception of the conflict? • Usually begin with words such as what, will, or how • A question that starts with ‘Why’ could be considered open-ended • Don’t involve your opinion or impose your judgment on the patient.

Using Closed-ended Questions • Closed-ended questions generally get a “yes” or “no” response • Hand out “Closed-ended and Open-ended Questions” • Example: Closed-ended: “Are you mad at me?” Open-ended: “Would you tell me a little bit more about why you are angry?”

Alternative Solutions - Module 5 Conclusion • The ability and willingness to be creative and flexible • Not uncommon for staff responses to conflicts or patient complaints to be quick and routine • It’s OK to take time to think about new solutions and ask others for input

Implement Agreement - Module 6 Purpose: • To discuss how to implement an agreement after professional dialysis staff have worked through conflict with a patient Time Required: • 30 minutes Preparation /Material Needed: • None

Implement Agreement - Module 6 “If you take the time to work through the conflict, it is likely that you will reach a stage of agreement when changes will need to be put into action.”

Implement Agreement- Module 6 Teaching Concepts • Use action statements to describe the agreement • Document and communicate the agreement that has been reached • Be consistent with any agreements that are made

Implement Agreement– Module 6 Group Activities • Group discussion on implementing an agreement and the steps Key Point • Use action statements to describe the agreement so the patient knows they can count on us to follow through

Implement Agreement - Module 6 Conclusion • Implement the agreement by being consistent, communicating it to other parties, and documenting • Emphasize the importance of the entire staff to be consistent

Additional Resources *DPC Tip Sheet #2 Staff Training Modules 1–3 *DPC Tip Sheet #1 –Administration www.esrdnet17.org www.esrdnet15.org * Developed by ESRD NW#15

CEU Requirements EVALUATION! Evaluation forms can be found on NW #17 or NW #18 websites under: “DPC WebEx Evaluation” www.esrdnet17.org www.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: April 20, 2010 TIME: 9:00am - 10:00am SUBJECT: Staff Training Modules 7-9 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

D ecreasing D ialysis P atient- P rovider C onflict ( DPC )