Decreasing DialysisPatient-Provider Conflict (DPC)

Session #3 – Staff Training Modules 4-6

A Collaborative Presentationby

Western Pacific Renal Network, LLCESRD Network #17Connie Lorenz, LMSWPatient Services Director505 San Marin Dr., Bldg. A 300Novato, CA 94945

Southern California Renal Disease Council, Inc. ESRD Network #18Cecilia Torres-Correa, RN/BSNPatient Services Director 6255 Sunset Blvd., Ste. 2211Los 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 conflictHandout #1: Closed-ended and Open-ended QuestionsHandout #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 ConceptsBrainstorm 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 PointsThe 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.orgwww.esrdnet15.org

* Developed by ESRD NW#15

CEU RequirementsEVALUATION!

Evaluation forms can be found on NW #17 or NW #18 websites under:

“DPC WebEx Evaluation”

www.esrdnet17.orgwww.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) 897-2422RNs - 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