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Introduction of the  Healthcare Ombudsman - Mediator ( HCOM) David Richardson, PhD Fontana Medical Center
Purpose:  to resolve & address   concerns real or perceived, which may include… <ul><li>Unanticipated adverse outcomes (wh...
Possible Causes of Adverse Outcomes <ul><li>Uncorrected “unreasonable” expectations </li></ul><ul><li>Biological variabili...
Possible Causes of Adverse Outcomes <ul><li>Doing the right thing the wrong way </li></ul><ul><li>Doing the wrong thing th...
When Unanticipated Adverse Outcomes Occur: <ul><li>Clinicians are emotionally effected </li></ul><ul><li>-  Fear of  malpr...
When Unanticipated Adverse Outcomes Occur: <ul><li>Patients’ and families’ desire </li></ul><ul><li>-  Acknowledgment  of ...
How Does an Ombudsman/Mediator Work? <ul><li>Advocates for a   fair process  for patients, providers, and Kaiser Permanent...
How Does an Ombudsman/Mediator Work? <ul><li>Advocates for a   fair process  for patients, providers, and Kaiser Permanent...
How Does It Work? <ul><li>Focuses on underlying  issues, needs , and  interests </li></ul><ul><li>Clarifies perceptions,  ...
Desired Outcome:  <ul><li>Provider and patient develop a partnership with shared decision making </li></ul><ul><li>Members...
Desired Outcome:  <ul><li>Physicians, staff and members feel supported when facing these events </li></ul><ul><li>Members ...
How to Contact the Health Care Ombudsman <ul><li>David Richardson, PhD </li></ul><ul><li>Phone: (909)  427-7719* </li></ul...
Please call my Daddy x7719
FREQUENTLY ASKED QUESTIONS <ul><li>How can you be neutral if… </li></ul><ul><li>Are you just for the hospital </li></ul><u...
Physician - Patient Communication Improving Communication and  Strengthening Relationships David Richardson Ph.D. Health C...
Overview <ul><li>Ombudsman / Mediator Role In Communication Issues </li></ul><ul><li>Challenges to Effective Communication...
Ombudsman / Mediator Role <ul><li>Approximately 5 - 10 new cases per week </li></ul><ul><li>Nearly half of all cases were ...
Challenges to Communication <ul><li>1.  Multiple providers </li></ul>
Challenges to Communication from the Patient’s perspective <ul><li>1.  Multiple providers </li></ul><ul><li>Effects: </li>...
Challenges to Communication from the Patient’s perspective <ul><li>2.  Complex care involving multiple medical conditions....
Challenges to Communication from the Patient’s perspective <ul><li>2.  Complex care involving multiple medical conditions....
Challenges to Communication from the Patient’s perspective <ul><li>3.  Patients and families are in a heightened emotional...
Challenges to Communication from the Patient’s perspective <ul><li>3.  Patients and families are in a heightened emotional...
Communication Difficulties <ul><li>1.  Blaming others </li></ul><ul><li>Outcome: </li></ul><ul><ul><li>Loss of trust </li>...
Communication Difficulties <ul><li>2.  Blaming the System </li></ul><ul><li>Outcome: </li></ul><ul><ul><li>Loss of trust <...
Communication Difficulties <ul><li>3.  Dividing the Patient into Pieces </li></ul><ul><li>Outcome: </li></ul><ul><ul><li>E...
6 Step Communication Strategy <ul><li>Effects </li></ul><ul><li>Improved communication  </li></ul><ul><li>Stronger relatio...
6 Step Communication Strategy <ul><li>Using AALEE as a mnemonic device  </li></ul><ul><li>A – Anticipate </li></ul><ul><li...
6 Step Communication Strategy <ul><li>A – Anticipate  </li></ul><ul><li>What are the likely communication needs of this pa...
6 Step Communication Strategy <ul><li>A – Adjust </li></ul><ul><li>In what ways might you have to modify your communicatio...
6 Step Communication Strategy <ul><li>L – Listen </li></ul><ul><ul><li>More than you speak </li></ul></ul><ul><ul><li>Prov...
6 Step Communication Strategy <ul><li>E – Empathize </li></ul><ul><ul><li>Demonstration of your understanding of the patie...
6 Step Communication Strategy <ul><li>E – Explain </li></ul><ul><li>Only after the others steps are successful </li></ul><...
6 Step Communication Strategy <ul><li>A – Anticipate </li></ul><ul><li>A – Adjust </li></ul><ul><li>L – Listen </li></ul><...
 
<ul><li>Beck and colleagues conducted a systematic review of research examining office consultations in primary care setti...
Physicians' Verbal Behaviors Promoting Positive Interpersonal Relations <ul><li>Empathy </li></ul><ul><li>Courtesy/friendl...
Physicians' Verbal Behaviors Promoting Positive Interpersonal Relations <ul><li>Support/reassurance/positive reinforcement...
Physicians' Verbal Behaviors Enhancing Information Exchange <ul><li>Listening </li></ul><ul><li>Giving health education </...
Physicians' Verbal Behaviors Enhancing Information Exchange <ul><li>Talking at patients' level </li></ul><ul><li>Addressin...
Physicians' Nonverbal Behaviors Associated With Patient Satisfaction <ul><li>Head nodding </li></ul><ul><li>Leaning forwar...
Physicians' Behaviors Associated With Reduced Patient Satisfaction <ul><li>Excessive focus on medical questions </li></ul>...
Physicians' Behaviors Associated With Reduced Patient Satisfaction <ul><li>Leaning back or angled away from patient </li><...
 
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How To Communicate So Your Patients Will Listen Full Version

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How To Communicate So Your Patients Will Listen Full Version

  1. 1. Introduction of the Healthcare Ombudsman - Mediator ( HCOM) David Richardson, PhD Fontana Medical Center
  2. 2. Purpose: to resolve & address concerns real or perceived, which may include… <ul><li>Unanticipated adverse outcomes (where significant event or disability/harm has occurred) </li></ul><ul><li>Unanticipated deaths </li></ul><ul><li>Medical errors / surgical misadventures </li></ul><ul><li>Potentially Compensable Events (PCE) </li></ul><ul><li>Clinical or quality of care concerns </li></ul>
  3. 3. Possible Causes of Adverse Outcomes <ul><li>Uncorrected “unreasonable” expectations </li></ul><ul><li>Biological variability and low probability risks </li></ul><ul><li>Decisions that don’t work out well </li></ul><ul><li>Medical or Systems errors </li></ul>
  4. 4. Possible Causes of Adverse Outcomes <ul><li>Doing the right thing the wrong way </li></ul><ul><li>Doing the wrong thing the right way </li></ul><ul><li>The right thing the right way </li></ul>
  5. 5. When Unanticipated Adverse Outcomes Occur: <ul><li>Clinicians are emotionally effected </li></ul><ul><li>- Fear of malpractice </li></ul><ul><li>- Perceived threats to professional pride and reputation </li></ul><ul><li>- Feelings shame and guilt </li></ul><ul><li> Post traumatic stress ( PTSD ) </li></ul>
  6. 6. When Unanticipated Adverse Outcomes Occur: <ul><li>Patients’ and families’ desire </li></ul><ul><li>- Acknowledgment of their feeling </li></ul><ul><li>- Understanding of the facts </li></ul><ul><li>- Protection for others </li></ul><ul><li>- Apology if appropriate </li></ul><ul><li>- Perhaps compensation for the injury </li></ul>
  7. 7. How Does an Ombudsman/Mediator Work? <ul><li>Advocates for a fair process for patients, providers, and Kaiser Permanente </li></ul><ul><li>Remains independent and offers confidentiality, neutrality, and impartiality </li></ul><ul><li>Resolve health care conflicts as close to the event as possible </li></ul><ul><li>Facilitates discussions between patients, family & providers </li></ul>
  8. 8. How Does an Ombudsman/Mediator Work? <ul><li>Advocates for a fair process for patients, providers, and Kaiser Permanente </li></ul><ul><li>Remains independent and offers confidentiality, neutrality, and impartiality </li></ul><ul><li>Resolve health care conflicts as close to the event as possible </li></ul><ul><li>Facilitates discussions between patients, family & providers </li></ul>
  9. 9. How Does It Work? <ul><li>Focuses on underlying issues, needs , and interests </li></ul><ul><li>Clarifies perceptions, reframes issues </li></ul><ul><li>Assist parties to identify options , reach sustainable & mutually satisfactory resolution </li></ul>
  10. 10. Desired Outcome: <ul><li>Provider and patient develop a partnership with shared decision making </li></ul><ul><li>Members / families receive honest, timely and accurate communication regarding disappointing medical outcomes </li></ul>
  11. 11. Desired Outcome: <ul><li>Physicians, staff and members feel supported when facing these events </li></ul><ul><li>Members re-gain trust in their provider and Kaiser </li></ul><ul><li>We acknowledge, apologize and show compassion in the face of medical errors </li></ul>
  12. 12. How to Contact the Health Care Ombudsman <ul><li>David Richardson, PhD </li></ul><ul><li>Phone: (909) 427-7719* </li></ul><ul><li>Pager: (909) 209-1186 </li></ul><ul><li>Location: Hospital, 1 st floor </li></ul>
  13. 13. Please call my Daddy x7719
  14. 14. FREQUENTLY ASKED QUESTIONS <ul><li>How can you be neutral if… </li></ul><ul><li>Are you just for the hospital </li></ul><ul><li>When are you available </li></ul><ul><li>How are you different from… </li></ul>
  15. 15. Physician - Patient Communication Improving Communication and Strengthening Relationships David Richardson Ph.D. Health Care Ombudsman / Mediator
  16. 16. Overview <ul><li>Ombudsman / Mediator Role In Communication Issues </li></ul><ul><li>Challenges to Effective Communication </li></ul><ul><li>Common Inpatient Communication Difficulties And Effects On Care </li></ul><ul><li>6 Step Strategy to improve communication and strengthen relationships </li></ul>
  17. 17. Ombudsman / Mediator Role <ul><li>Approximately 5 - 10 new cases per week </li></ul><ul><li>Nearly half of all cases were referred for serious communication difficulties resulting in concern about patient care </li></ul><ul><li>All cases include some communication issues </li></ul>
  18. 18. Challenges to Communication <ul><li>1. Multiple providers </li></ul>
  19. 19. Challenges to Communication from the Patient’s perspective <ul><li>1. Multiple providers </li></ul><ul><li>Effects: </li></ul><ul><li>Confusion </li></ul><ul><li>Perception that care is disjointed </li></ul><ul><li>Differences between providers are highlighted </li></ul>
  20. 20. Challenges to Communication from the Patient’s perspective <ul><li>2. Complex care involving multiple medical conditions. </li></ul>
  21. 21. Challenges to Communication from the Patient’s perspective <ul><li>2. Complex care involving multiple medical conditions. </li></ul><ul><li>Effects: </li></ul><ul><li>Treatment plans seem disorganized to patients/families </li></ul><ul><li>Misalignment of care priorities </li></ul>
  22. 22. Challenges to Communication from the Patient’s perspective <ul><li>3. Patients and families are in a heightened emotional state. </li></ul>
  23. 23. Challenges to Communication from the Patient’s perspective <ul><li>3. Patients and families are in a heightened emotional state. </li></ul><ul><li>Effects: </li></ul><ul><li>Challenging, mistrustful, panicked or demanding patients/families </li></ul><ul><li>Barriers to how patients/families receive or process information </li></ul>
  24. 24. Communication Difficulties <ul><li>1. Blaming others </li></ul><ul><li>Outcome: </li></ul><ul><ul><li>Loss of trust </li></ul></ul><ul><ul><li>Increased anger </li></ul></ul><ul><ul><li>Litigation risk </li></ul></ul>
  25. 25. Communication Difficulties <ul><li>2. Blaming the System </li></ul><ul><li>Outcome: </li></ul><ul><ul><li>Loss of trust </li></ul></ul><ul><ul><li>Anger and frustration </li></ul></ul><ul><ul><li>Concern regarding Kaiser’s priorities </li></ul></ul>
  26. 26. Communication Difficulties <ul><li>3. Dividing the Patient into Pieces </li></ul><ul><li>Outcome: </li></ul><ul><ul><li>Experienced as disorganized </li></ul></ul><ul><ul><li>Concerns about quality of care </li></ul></ul><ul><ul><li>Fear and anxiety </li></ul></ul>
  27. 27. 6 Step Communication Strategy <ul><li>Effects </li></ul><ul><li>Improved communication </li></ul><ul><li>Stronger relationships </li></ul>
  28. 28. 6 Step Communication Strategy <ul><li>Using AALEE as a mnemonic device </li></ul><ul><li>A – Anticipate </li></ul><ul><li>A – Adjust </li></ul><ul><li>L – Listen </li></ul><ul><li>E- Empathize </li></ul><ul><li>E - Explain </li></ul>
  29. 29. 6 Step Communication Strategy <ul><li>A – Anticipate </li></ul><ul><li>What are the likely communication needs of this patient </li></ul><ul><li>Are they: </li></ul><ul><ul><li>Informational </li></ul></ul><ul><ul><li>emotional </li></ul></ul><ul><ul><li>social </li></ul></ul>
  30. 30. 6 Step Communication Strategy <ul><li>A – Adjust </li></ul><ul><li>In what ways might you have to modify your communication </li></ul><ul><ul><li>Language </li></ul></ul><ul><ul><li>Culture </li></ul></ul><ul><ul><li>Nonverbal </li></ul></ul><ul><ul><li>Education </li></ul></ul><ul><ul><li>Pace </li></ul></ul><ul><ul><li>Depth </li></ul></ul><ul><ul><ul><li>What vs what and how </li></ul></ul></ul>
  31. 31. 6 Step Communication Strategy <ul><li>L – Listen </li></ul><ul><ul><li>More than you speak </li></ul></ul><ul><ul><li>Provides information </li></ul></ul><ul><ul><li>Gives access to subtle cues </li></ul></ul><ul><ul><li>Demonstrates respect </li></ul></ul><ul><ul><li>Fosters connection </li></ul></ul>
  32. 32. 6 Step Communication Strategy <ul><li>E – Empathize </li></ul><ul><ul><li>Demonstration of your understanding of the patients situation </li></ul></ul><ul><ul><li>Concerns </li></ul></ul><ul><ul><li>Fears </li></ul></ul><ul><ul><li>Hopes </li></ul></ul><ul><ul><li>Anxieties </li></ul></ul><ul><ul><li>Needs </li></ul></ul>
  33. 33. 6 Step Communication Strategy <ul><li>E – Explain </li></ul><ul><li>Only after the others steps are successful </li></ul><ul><ul><li>Timely </li></ul></ul><ul><ul><li>Accurate </li></ul></ul><ul><ul><li>Sensitive </li></ul></ul>
  34. 34. 6 Step Communication Strategy <ul><li>A – Anticipate </li></ul><ul><li>A – Adjust </li></ul><ul><li>L – Listen </li></ul><ul><li>E- Empathize </li></ul><ul><li>E - Explain </li></ul>
  35. 36. <ul><li>Beck and colleagues conducted a systematic review of research examining office consultations in primary care settings. They describe verbal and nonverbal behaviors shown to influence patient responses. </li></ul>Beck RS, Daughtridge R, Sloane PD. Physician-patient communication in the primary care office: a systematic review. J Am Board Fam Pract. 2002;15:25-38.
  36. 37. Physicians' Verbal Behaviors Promoting Positive Interpersonal Relations <ul><li>Empathy </li></ul><ul><li>Courtesy/friendliness </li></ul><ul><li>Attentiveness during history taking </li></ul>Beck RS, Daughtridge R, Sloane PD. Physician-patient communication in the primary care office: a systematic review. J Am Board Fam Pract. 2002;15:25-38.
  37. 38. Physicians' Verbal Behaviors Promoting Positive Interpersonal Relations <ul><li>Support/reassurance/positive reinforcement regarding patient actions </li></ul><ul><li>Encouragement of patient questions </li></ul><ul><li>Laughter as a tension release </li></ul>Beck RS, Daughtridge R, Sloane PD. Physician-patient communication in the primary care office: a systematic review. J Am Board Fam Pract. 2002;15:25-38.
  38. 39. Physicians' Verbal Behaviors Enhancing Information Exchange <ul><li>Listening </li></ul><ul><li>Giving health education </li></ul><ul><li>Clarifying statements </li></ul><ul><li>Summarizing patient statements </li></ul>Beck RS, Daughtridge R, Sloane PD. Physician-patient communication in the primary care office: a systematic review. J Am Board Fam Pract. 2002;15:25-38.
  39. 40. Physicians' Verbal Behaviors Enhancing Information Exchange <ul><li>Talking at patients' level </li></ul><ul><li>Addressing patients' </li></ul><ul><ul><li>daily lives, </li></ul></ul><ul><ul><li>problems, </li></ul></ul><ul><ul><li>social relations, and </li></ul></ul><ul><ul><li>emotions </li></ul></ul>Beck RS, Daughtridge R, Sloane PD. Physician-patient communication in the primary care office: a systematic review. J Am Board Fam Pract. 2002;15:25-38.
  40. 41. Physicians' Nonverbal Behaviors Associated With Patient Satisfaction <ul><li>Head nodding </li></ul><ul><li>Leaning forward </li></ul><ul><li>More direct body orientation </li></ul><ul><li>Uncrossed arms and legs </li></ul><ul><li>Less mutual gaze </li></ul>Beck RS, Daughtridge R, Sloane PD. Physician-patient communication in the primary care office: a systematic review. J Am Board Fam Pract. 2002;15:25-38.
  41. 42. Physicians' Behaviors Associated With Reduced Patient Satisfaction <ul><li>Excessive focus on medical questions </li></ul><ul><li>Showing tension, anger, or nervousness </li></ul><ul><li>Allowing interruptions </li></ul><ul><li>Withholding information or explanations </li></ul>
  42. 43. Physicians' Behaviors Associated With Reduced Patient Satisfaction <ul><li>Leaning back or angled away from patient </li></ul><ul><li>Frequent touching </li></ul><ul><li>Unduly dominant approach </li></ul><ul><li>Directive behaviors </li></ul>

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