Decreasing Patient Complaints & Improving Satisfaction in a Correctional Environment

1. 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

2. 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

3. 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

4. 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 rapport • Provide access • Communicate effectively Source: JAMA, June 12, 2002

5. 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

6. 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

7. 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

8. 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

9. Top Medical Grievances Co pay Relationship between patient & practitioner* Medication issues *Practitioners cite the relationship with some patients to be their biggest challenge

10. Relationship Between Patient & Provider Staff conduct Dissatisfaction with provider Delay in treatment (perception) Failure to treat (perception)

11. 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

12. 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

13. BATHE TECHNIQUE Brief Psychotherapeutic Patient-Centered Technique fitted into a 15 minute appointment Background Affect Trouble Handling Empathy

14. 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 • 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. WHY ME? Are you utilizing all the skills available ? • Mental Health • Nursing • Correctional staff • Colleagues

21. 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

22. Medical Grievances Data

23. THE BOTTOM LINE Treatment in corrections takes many forms; but most important is basichuman respect & concern!

24. 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.