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A MEDIATOR’S TOOLKIT FOR
NAVIGATING DIFFICULT
CLINICAL CONVERSATIONS
Groupement Hospitalier de l'Ouest Lémanique, Nyon
Jun...
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
C...
Reactive Devaluation
• Slow Down
• Repeat what we hear
• Acknowledge common ground
Kate Michi Ettinger, JD
@k8ethics
mural...
Take A Deep Breath
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clini...
Objectives
• What are common sources of conflict?
• What tools can be applied when you
encounter a conflict?
MEDIATOR’S TOOL...
Call Dr. Pepper
for
H - E - L - P
Humanize
Engage
Listen
Partner
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Me...
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
“...
Emergency!
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conv...
Time
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversati...
Social Structure
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinica...
Social Structure
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinica...
Power
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversat...
Power
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversat...
Communication Style
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clin...
Communication Style
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clin...
Information & Decisions
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult ...
Information & Decisions
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult ...
Common Sources of Conflict
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficul...
!
Figure 1. Ethics in a Pluralistic Society
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for ...
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
E...
“Toto,
I don’t think
we’re in
Kansas
anymore”
- Dorothy in the
Wizard of Oz
Kate Michi Ettinger, JD
@k8ethics
muralinstitu...
“We would
like to
welcome
you to
Munchkinland”
- The Lollipop Kids
welcome Dorothy
Kate Michi Ettinger, JD
@k8ethics
mural...
“Tell me about Mama”
- Nancy N. Dubler
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navig...
Conversational Justice
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult C...
Strategies to Engage
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Cli...
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
L...
Listening for Layers
Data/Facts
Emotions
Values
Concerns/Needs
Identity
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.o...
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
L...
• Listen for Layers
• Listen to Understand
• Reflective Listening
• Acknowledge &Validate
• Ask-Tell-Ask
Kate Michi Ettinge...
MultipleViewpoints Matrix
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficul...
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
P...
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
P...
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
P...
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
P...
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
P...
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
P...
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
P...
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
P...
What are common sources of conflict?
• Time
• Social Structure
• Power
• Communication Style
• Information & Decisions
MEDI...
What tools can be applied to conflict?
• Humanize
• Engage
• Listen
• Partner
MEDIATOR’S TOOLKIT
Kate Michi Ettinger, JD
@k...
MEDIATOR’S TOOLKIT
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clini...
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A Mediator's Toolkit for Navigating Difficult Clinical Conversations

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A Mediator's Toolkit for Navigating Difficult Clinical Conversations

  1. 1. A MEDIATOR’S TOOLKIT FOR NAVIGATING DIFFICULT CLINICAL CONVERSATIONS Groupement Hospitalier de l'Ouest Lémanique, Nyon June 3, 2014 Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
  2. 2. Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations Case
  3. 3. Reactive Devaluation • Slow Down • Repeat what we hear • Acknowledge common ground Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations MEDIATOR’S TOOLKIT Case
  4. 4. Take A Deep Breath Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations MEDIATOR’S TOOLKIT Case
  5. 5. Objectives • What are common sources of conflict? • What tools can be applied when you encounter a conflict? MEDIATOR’S TOOLKIT Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations Toolkit
  6. 6. Call Dr. Pepper for H - E - L - P Humanize Engage Listen Partner Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations MEDIATOR’S TOOLKIT Toolkit Dr. PepperSalty Belle
  7. 7. Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations “If you don't know the kind of person I am and I don't know the kind of person you are a pattern that others made may prevail in the world.” - A Ritual to Read to Each Other William Stafford Humanize HUMANIZE
  8. 8. Emergency! Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations Humanize HUMANIZE
  9. 9. Time Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations HUMANIZE Humanize
  10. 10. Social Structure Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations HUMANIZE Humanize
  11. 11. Social Structure Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations HUMANIZE Humanize
  12. 12. Power Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations HUMANIZE CC 3.0 Huddle by Andrew McKinley Meeting by Sergi Delgado (The Noun Project) Humanize
  13. 13. Power Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations HUMANIZE Humanize
  14. 14. Communication Style Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations HUMANIZE Humanize
  15. 15. Communication Style Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations HUMANIZE Humanize
  16. 16. Information & Decisions Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations HUMANIZE Icon CC 3.0 Signpost by ZachVanDeHey from The Noun Project Humanize
  17. 17. Information & Decisions Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations HUMANIZE Humanize
  18. 18. Common Sources of Conflict Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations HUMANIZE • Know your profile • Understand the “other” person’s view • Acknowledge the spectrum to find common ground Humanize
  19. 19. ! Figure 1. Ethics in a Pluralistic Society Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations HUMANIZE Humanize Being ethical (aka “right”) in a pluralistic society is another spectrum of difference to mediate CC-BY 3.0 Kate Michi Ettinger
  20. 20. Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations ENGAGE “If you don't know the kind of person I am and I don't know the kind of person you are a pattern that others made may prevail in the world.” - A Ritual to Read to Each Other William Stafford Engage OSTRICH
  21. 21. “Toto, I don’t think we’re in Kansas anymore” - Dorothy in the Wizard of Oz Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations ENGAGE Engage
  22. 22. “We would like to welcome you to Munchkinland” - The Lollipop Kids welcome Dorothy Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations ENGAGE Engage
  23. 23. “Tell me about Mama” - Nancy N. Dubler Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations ENGAGE Engage
  24. 24. Conversational Justice Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations ENGAGE Engage
  25. 25. Strategies to Engage Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations ENGAGE • Anchor conversations with the Patient’s Narrative • Be hospitable in our “foreign” place • Give pt & family a role, purpose & belonging • Conversational Justice Engage
  26. 26. Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations LISTEN “If you don't know the kind of person I am and I don't know the kind of person you are a pattern that others made may prevail in the world.” - A Ritual to Read to Each Other William Stafford Listen Photo: Practical Sanskrit
  27. 27. Listening for Layers Data/Facts Emotions Values Concerns/Needs Identity Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations LISTEN Listen CC Wikimedia
  28. 28. Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations LISTEN Listen
  29. 29. • Listen for Layers • Listen to Understand • Reflective Listening • Acknowledge &Validate • Ask-Tell-Ask Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations LISTEN Listen
  30. 30. MultipleViewpoints Matrix Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations LISTEN Listen
  31. 31. Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations PARTNERS “If you don't know the kind of person I am and I don't know the kind of person you are a pattern that others made may prevail in the world.” - A Ritual to Read to Each Other William Stafford Partner
  32. 32. Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations PARTNERS Thomas Kilman Conflict Modes Avoidance Accommodating Compromise Competitive Collaborative ASSERTINGONE’SNEEDS CONSIDERING OTHERS‘ NEEDS Partner
  33. 33. Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations PARTNERS Whirlpool by Eli Ratner;Thomas Kilman Conflict Modes Avoidance Accommodating Compromise Competitive Collaborative ASSERTINGCLINICALGOALS HONORING PATIENT PREFERENCES Partner
  34. 34. Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations PARTNERS Whirlpool CC by Eli Ratner & PD Images from The Noun Project Avoidance Accommodating Compromise Competitive Collaborative Partner ASSERTINGCLINICALGOALS HONORING PATIENT PREFERENCES TIME
  35. 35. Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations PARTNERS Partner Graphics: Laura Thierry; 7 Coats: Kate Michi Ettinger
  36. 36. Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations PARTNERS Partner Graphics: Laura Thierry; 7 Coats: Kate Michi Ettinger
  37. 37. Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations PARTNERS Partner
  38. 38. Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations PARTNERS Partner Graphics: Laura Thierry; 7 Coats: Kate Michi Ettinger
  39. 39. What are common sources of conflict? • Time • Social Structure • Power • Communication Style • Information & Decisions MEDIATOR’S TOOLKIT Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations onclusion
  40. 40. What tools can be applied to conflict? • Humanize • Engage • Listen • Partner MEDIATOR’S TOOLKIT Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations onclusion
  41. 41. MEDIATOR’S TOOLKIT Kate Michi Ettinger, JD @k8ethics muralinstitute.org A Mediator’s Toolkit for Navigating Difficult Clinical Conversations HUMANIZE PEACE IN EVERY STEP, VEN. THICH NHAT HANH NON VIOLENT COMMUNICATION, MARSHALL ROSENBERG GETTINGTO YES, ROBERT FISHER AND WILLIAM URY.  DIFFICULT CONVERSATIONS, DOUGLAS STONE, BRUCE PATTON, SHEILA HEEN COMMUNITY BOARDS OF SAN FRANCISCO MEDIATION TRAINING. EMPATHIC LISTENING (STEVE ROSENBERG'S MEDIATION TRAINING) ASK-TELL-ASK Bibliography BIBLIOGRAPHY ENGAGE LISTEN PARTNER THINKING, FAST AND SLOW. DANIEL KAHNEMAN. CONTINUUM OF CONFLICT ADAPTED FROM: AVRUCH K, CULTURE & CONFLICT RESOLUTION, UNITED STATES INSTITUTE OF PEACE PRESS, 1998.   CHEW PK, THE CONFLICT & CULTURE READER, NYU PRESS 2001.  LEBARON M, BRIDGING CULTURAL CONFLICTS, JOSSEY-BASS PRESS, 2003.  "MAPPING CULTURES: STRATEGIES FOR EFFECTIVE INTERCULTURAL NEGOTIATIONS" IN SECOND TRACTK/CITIZENS' DIPLOMACY, EDITED BY J. DAVIES AND E. KAUFMAN.  LANHAM, MD: ROWMAN & LITTLEFIELD PUBLISHERS, INC.: 149-160.  MOORE, C.W. AND PETER WOODROW. 2002. AS WELL AS MYERS- BRIGGS LITERATURE.  BIOETHICS MEDIATION: SHAPING SHARED SOLUTIONS. NANCY DUBLER AND CAROL FRIEDMAN. SCARF: A BRAIN-BASED MODEL FOR COLLABORATING WITH AND INFLUENCING OTHERS, NEUROLEADERSHIP JOURNAL BY DAVID ROCK. PUBLIC CONVERSATIONS PROJECT: PUBLICCONVERSATIONS.ORG PACE E BENE: PACEEBENE.ORG THOMAS KILMAN CONFLICT MODES SIX HATS, EDUARDO DE BONO

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