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Transcript of Communication Is What - UW Health · Communication Is What Makes a Team Strong ... Differences in...
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Communication Is What Makes a Team Strong
Objective: Learn about communication tactics to help multidisciplinary teams
understand one another better and improve patient and family care.
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Communicating with Physicians
Nikole Neidlinger MD FACS
Chief Medical Officer Donor Network West Transplant Surgeon
California Pacific Medical Center
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Why this conversation?
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Concerns from Physicians regarding donation:
More involvement of the doctor earlier Communication, especially after a case, needs
improving Need to focus on the patient, not just the
organs More balance between family, OPO, doctor Better updates. Ongoing status Education in the moment when a case is
happening
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Concerns from Nursing staff
Number 1 Challenge to MD communication: 60% of you said finding time, limited
availability, and holding their attention 20% said helping physicians see the importance of
donation 20% cited not sounding like an idiot and
intimidation
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Objectives
Understanding Physician Training and Culture How do Physicians communicate? How do I communicate effectively as part of a
health care team? Difficult conversations and hospital
hierarchy?
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Objective 1 Understanding Physician Training
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Physician Training 4 years undergrad 4 years medical school 3-10 years residency
As PGY 10, $12.50/hour Average debt $419,738 50% regret the decision 28% received recent pay cut 30% of time spent administrative tasks More work does not equal more reward, so you have
to appeal to their emotions/commitment to patient care.
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Culture taught to Physicians
Trust no one, do it yourself (not great at being team members)
Eat and sleep when you can (take care of patients before yourself)
You are responsible for everything, whether you know about it or not, whether you were present or not (dislike for handoffs, shifts)
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Characteristics of Physicians
Decisive Self-Reliant Distance themselves from any non-physician Fiercely Independent Courageous (see one, do one, teach one) Expert Problem Solvers Terrible negotiators
Beckers Hospital Review
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Expectations on Physicians
Responsible for everything Typically managing 5-30 patients
simultaneously Availability: never turn off pager/cell phone Be evidence based, current, cost and quality
focused Frustrated with familiarity with hospital
business (MDs can do the admin job) yet administrators cant do the clinical job
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Objective 2 How do physicians communicate?
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How do Physicians Communicate?
Fast Paced, Task Oriented Problem Solvers Value headlines and critical thinking Typically poor negotiators Responsible for everything Will not read an email addressed to >6
people
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The 4 Personality Types Task-oriented People-oriented
Dire
ct,
fast
pac
ed
Indi
rect
, sl
ow p
aced
Get it Done!
Get Appreciated!
Get it Right!
Get Along!
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Differences in Communication Styles in the hospital
Nurses and midlevel providers complain that physicians: Do not view them as professionals See them as purveyors of tasks Do not know nurses scope of practice or
autonomy Are inattentive, especially at night Unwilling to discuss goals of care Felt a list of signs/symptoms had to be provided
rather than the nurses evaluation Dixon Et al. AACN advanced critical care 17(4):376
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Differences in Communication Styles in the hospital
Physicians complain that nurses: Are too narrative Present with disorganization of information,
illogical flow of content, lack of preparation for questions
Include extraneous or irrelevant information Are too descriptive, say too much Dont get to the point Do not clearly delineate the problem/request
Dixon Et al. AACN advanced critical care 17(4):376
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Objective 3 How do I communicate as part of a health
care team?
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SBAR-Situational Briefing Model Used in the nuclear submarine service for
concise and accurate communication Situation the punch line, give it in 5-10
seconds Background the context, objective data, the
numbers, how did we get here Assessment what is the problem Recommendation what do we need to do and
when?
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SBAR in OB
S Dr.X, Im worried about Ms. Klein, I think she is going to rupture her uterus
B She is a VBAC; she has a dense epidural, but she is having persistent breakthrough pain; she is complete and ready to push
A Im concerned something is wrong I dont want her to push
R I think we need to think about a C-Section. Please come in and see her as soon as you can.
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Situation
I see youre busy, can I get 5 minutes before you leave the unit regarding.
Are you taking care of pt X? I wanted to discuss the brain death notes on
__
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Background
Synopsis of treatment/procedures and date Current vitals, and other pertinent hemodynamic data He appears to be having clinical instability with
hypotension, tachycardia, and diabetes insipitus the family has been asking whats next and seems to
understand the prognosis I saw the brain death note on the chart, but am not
sure whether the patient was normothermic when examined
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Assessment Give your conclusions about the present
situation It seems to me this would be a good time to
speak with the family about options. Im worried that the brain death notes leave
the team at risk Im concerned that we dont have the IV
access for appropriate resuscitation
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Recommendation I think we should include the possibility of
donation as they consider EOL decisions I think we should re-document the brain
death exam now that the patient is warm Can we address perfusion and oxygenation so
that the family can make an informed decision?
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SBAR key points
5 second blurb about why youre calling, and what you hope to achieve
Use critical thinking to determine what is relevant beforehand
Make sure you have the correct person Being brief and succinct does not mean you
arent thorough What do you want and by when?
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Objective 4: Difficult Conversations
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Handling the difficult conversation
Asserting concerns is NOT
Accusatory (if you dont provide pressors ) Disrespectful (these brain death notes dont
adhere to policy) Bullying (if you refuse to help)
Its not personal! Change the focus: providing high quality patient
care and service for the grieving family
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Handling the difficult conversation
Asserting concerns IS Patient and family focused Succinct, crisp, and shows critical thinking Uses questions (help me understand? How can I
help? How can we make this easier?) Uses phrases I am concerned that and I am
worried that and I want to help provide quality care..
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What do physicians want regarding the donation process?
To be included as key players your patient/family Included in communication Clear expectations
Constant but Clear Communication Even when they seem disinterested. Daily. Never too often! SBAR style
Follow-Up Immediate. Day after the recovery. Again within 2-3
days of the transplant Debrief case. What happened?
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Communicating donation Focus on benefit of
donation for donor families
Hospital having primary responsibility and ownership
No discussions with family unless with attending first
Written in medical record and conveyed verbally to correct person
Teach with tact Follow-up
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Questions?
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A hero is within each of us. An everyday hero.
Consider your Call to Action
Guardian of the Gift Icon of Innovation Voice of Valor Illuminator of Life Idol of Inspiration Face of Fortitude
Slide Number 1Communication Is What Makes a Team StrongCommunicating with PhysiciansWhy this conversation?Concerns from Physicians regarding donation:Concerns from Nursing staffObjectivesObjective 1Physician TrainingCulture taught to PhysiciansCharacteristics of PhysiciansExpectations on PhysiciansObjective 2How do Physicians Communicate?The 4 Personality TypesDifferences in Communication Styles in the hospitalDifferences in Communication Styles in the hospitalObjective 3Slide Number 19SBAR-Situational Briefing ModelSBAR in OB SituationBackgroundAssessmentRecommendationSBAR key pointsSlide Number 27Objective 4:Handling the difficult conversationHandling the difficult conversationWhat do physicians want regarding the donation process?Communicating donationQuestions?A hero is within each of us.An everyday hero.