Calming Upset Customers - NHSGGC

Calming Upset Customers

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Barriers to Good Communication

• Unresponsive client

• Abusive client

• Lack of client care

• Poor listening technique

• Unresponsive manager

• Lack of knowledge

• Poor questioning technique

• Background noise

How to overcome the barriers

• Know your receiver

• Take notes

• Ask for help if you need it

• Know your role

• Plan your communication

• Talk to each other

• Summarise agreements

• The VAL factor

The VAL Factor

• Voice

• Attitude

• Listening

Voice

• Pitch• Inflection• Courtesy• Tone• Understand(ability)• Rate• Enunciation

Attitude

• Know your role and department

• Speak clearly

• Show empathy for your client/colleague

• Be open minded and prepared to help

• Professionalism and versatility are vital

• Be positive

Attitude

• The behaviour you get from a client is the behaviour they perceive from you

• Your behaviour can influence your colleagues; therefore we need to get it right

Behaviour Breeds Behaviour

• Give me an example of how this can happen?

• If you are negative or lacking in focus then in all probability, that is the same attitude that you will get back

• This is the attitude that clients perceive from your department

On the other hand

• When you are around positive and enthusiastic people, you tend to feel positive and enthused by their behaviour

• What are the positive and negative behaviours that you have experienced?

Words Make a Difference

• Fight Starter

• You can’t do that

• You sure have a problem

‘You can’t do that’‘You sure have a problem’

‘Let me tell you what we can do’

‘Let me tell you how we can sort this problem’

Form a Team

Words Make A Difference

• Fight Starter

• Communication Helper

‘You didn’t fill in the form properly’

‘There are are few areas on the form that we need to complete’

Keep it Impersonal


• Fight Starter


‘You aren’t making sense’‘That’s definitely wrong’‘Did you say’

‘Can I clarify…’‘Let me see if I understand…’‘My understanding is…’

Get Clarification


• Fight Starter


‘You’re crazy’‘I know how you feel’‘I don’t know why you are so upset’

‘I can appreciate what you are saying’‘I can understand why you would feel that way’‘I can understand how that would be upsetting’

Use Verbal Cushions - Show Empathy


• Fight Starter


‘You are always late’‘You don’t want to do that’‘What’s your problem?’

‘This is the third time this week you have been late’‘An alternative is..’‘Let me help by..’

Avoid Causing Defensiveness


• Fight Starter

• Communication helper

‘I can’t…’‘It’s not my job to do that’

‘What I have to do is put you on hold, whilst I connect you with someone who can’

‘Let me tell you what I CAN do for you’

Take Responsibility


• Fight Starter


‘You have to…’‘You should have done it this way’‘Hold’‘Wait’

‘Would you…please’‘This may assist you in the future’‘To be able to help you would you…please’

Avoid Giving Orders


• Fight starter


‘You’re wrong’

‘You’re confusing me’

‘I can see that there has been a misunderstanding’

‘My understanding is’

Use ‘I’ Instead of ‘You’


• The Easy 4 Step Plan

• Stay Calm

• Let them Vent

• Express Empathy

• Focus on a Solution


• Stay Calm

• The first 2 steps require you to be patient and poised. It is important to Stay Calm because if you are not you will only aggravate your customer further.

• Let them Vent

• It is also important to let the customer vent, at least briefly. In many cases, the opportunity to express their frustration is all they need. Then the will be ready to work with you to find a solution.


• Express Empathy

• Expressing empathy doesn't necessarily mean apologising - it just means letting your customer feel validated. Use the following phrases to show empathy:

• 'I can appreciate how you feel' Rather than 'I know.'

• 'I understand what you are saying' Rather than 'You are right.'


• Focus on a Solution

• This is the most important step; you need to move on from 'problem' to 'solution' if you are going to be of any help at all to the customer. Use the following phrases to show empathy and focus on a solution:

• 'I understand, that was a long time to wait. Thanks for your patience. Now, how may I help you today?'

Other Hints

• Avoid Defensiveness

• Remember that your job is to serve your customers - even highly challenging ones - not to defend yourself against them.

• If a customer makes disparaging remarks, or blames you for the problem, don't react defensively or take it personally.

• Stick to the facts and carryon with finding a solution.

Other Hints

• Don't take it Personally

• Although it is hard not to feel attacked when a customer is angry or dissatisfied, keep in mind that you are not to blame. Do take ownership of the problem and make every effort to finding the solution

SBAR

• Background

• Originally used in the military and aviation industries, this report system was developed for healthcare use.

• Michael Leonard, MD, Physician Leader for Patient Safety, along with colleagues Doug Bonacum & Suzanne Graham at Kaiser Permanente of Colorado USA.

• SBAR technique has been implemented widely in the USA and the NHS.

SBAR

• Situation

• Background

• Assessment

• Recommendation

SBAR

• Easy mechanism you can use to frame communication

• Enables you to clarify what information should be communicated between members of the team and how

• Helps to develop teamwork and foster a culture of patient safety

• 4 sections of standardised prompt questions to ensure staff are sharing concise and focused information

• Allows you to communicate assertively and effectively reducing the need for repetition

• Helps staff anticipate the information needed by colleagues and encourages assessment skills

• Using SBAR prompts staff to formulate info with the right level of details

SBAR

• S Situation

• Identify yourself and site/unit you are calling from

• Identify the patient by name and the reason for your report

• Describe your concern

• Firstly describe the specific situation about which you are calling, including the patients name consultant, patient location, code status and vital signs.

SBAR

• Situation Example

• “This is Lou, a registered nurse on Nightingdale Ward. The reason I am calling is that Mrs Taylor in room 225 has become suddenly short of breath, her oxygen saturation has dropped to 88% on room air, her respiration rate is 24 per minute, her heart rate is 110 and her blood pressure is 85/50. We have placed her on 6 liters of oxygen and her saturation is 93%, her work of breathing is increased, she is anxious, her breath sounds are clear throughout and her respiratory rate remains greater than 20. She has full code status”

SBAR

• B Background

• Give the patient’s reason for admission

• Explain significant medical history

• You then inform the consultant of the patients background: admitting diagnosis, date of admission, prior procedures, current medications, allergies, pertinent laboratory results and other relevant diagnostic results. For this, you need to have collected information from the patients chart, flow sheets and progress notes.

SBAR

• “Mrs Smith is a 69 year old woman who was admitted 10 days ago following a MVC, with a T 5 burst fracture and a T 6 ASIA B SCI. She had T 3 - T 7 instrumentation and fusion nine days ago, her only complication was a right haemothorax for which a chest tube was put in place. The tube was removed 5 days ago and her CXR has shown significant improvement. She has been mobilising with physio and has been progressing well. Her heamoglobin is 100 gm/L; otherwise her blood work is within normal limits. She has been on Enoxaparin for DVT prophylaxis and Oxycodone for pain management.”

SBAR

• A Assessment

• Vital signs

• Contraction pattern

• Clinical impressions, concerns

• You need to think critically when informing the doctor of your assessment of the situation. This means that you have considered what might be the underlying reason for your patients condition. Not only have you reviewed your findings from your assessment, you have also consolidated these with other objective indicators, such as lab results

SBAR

• If you do not have an assessment you may say;

• “ I think she may have had a pulmonary embolus” or “I am not sure what the problem is but I am worried”

SBAR

• R Recommendation

• Explain what you need - be specific about request and timeframe

• Make suggestions

• Clarify expectations

• Finally what is your recommendation? That is, what would you like to happen by the end of the conversation? Any order that is given on the phone needs to be repeated back to ensure accuracy.

SBAR

• “Would you like me to get a stat CXR? And ABGs? Start an IV?”

• “Should I begin organising a spiral CT?”

• “When are you going to be able to get here?”

SBAR

• Incorporating SBAR may seem simple, but it takes considerable training. It can be very difficult to change the way people communicate, particularly with senior staff.

• The NHS is often criticised for poor communication, however there are few tools that actively focus on improving communication.

• SBAR prevents hit and miss process of ‘hinting and hoping’

SBAR

• Uses for SBAR• Inpatient or outpatient• Conversations with physician, in person or

phone• Particularly in nurse to doctor

consultation• Also helpful in doctor to doctor

consultation• Discussion with allied health professionals

• Respiratory therapy• Physiotherapy

• Conversations with peers• Change of shift report• Escalating a concern

SBAR

• Tips for Implementation

• Anxiety about giving recommendations

• Some less experienced clinical staff have found making recommendations a challenge. Recommendation is important as it clearly describes the action the messenger needs. Where staff are anxious about doing so, they will need extra support and encouragement. A good place to start is by practicing with supportive colleagues.

SBAR

• Remembering to use SBAR

• Notepads or paper with the tool printed on it

• Pocket cards

• Stickers on or next to the phone to act as a visual prompt

SBAR

• Example

• Multidisciplinary team

• Many people present

• Most can help to formulate most appropriate management for patient

• Person directly responsible presents situation and relevant background

• Assessment includes discussion to clarify and joint review ensues

• Recommendations agreed by all present

• Documented in records for implementation

SBAR

• What Next?

• Once you adopt this tool you will need to check it is making a difference

• Focus on making sure the checklist (your own) are being used

• Make it become ‘the way things are done around here’

SBAR

• Ways of doing this include:

• Using prompts, visual aids

• Ensuring people feel its alright to prompt each other

• E.g. ‘What is you recommendation here?’

• Make time for team discussion, reflection and refinement

• Disseminate your good practice to other teams by modelling the communication behaviour your aiming for from them

Training needs

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Calming Upset Customers - NHSGGC

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