Enhancing Patient-Staff Communication in Dialysis Units

Evan Smith, LMSW, MBAPatient Services DirectorEnd-Stage Renal Disease Network of New York

Presentation Objectives

-Understanding the prevalence of communication related conflict in dialysis units

-Describe the role of dialysis facility staff in promoting positive communication

-Define Communication and understand techniques used to facilitate positive communication

-Develop an understanding of best practices related to communication on dialysis units

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Communication Related Grievances

- The Network performed a focused grievance audit for the 1st quarter of 2014 to identify trends/ root causes of patient grievances

-During this period, a total of (21) grievances were filed

-61% of all patient grievances was related to staff-patient interactions

- Staff related issues were then analyzed further. Ineffective or unprofessional communication was the root cause related to nearly all staff related grievances received.

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Focused Grievance Audit Q1 2014: Findings

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61%

25%

9%

5%

Patient- Staff CommunicationQuality of CareEnvironmentPolicy / Procedure

Patient Grievance Quotes

- “(staff member) called me a ________________”

- “(staff member) always walks up without greeting me or saying anything”

- “(staff member) was giving me a bad look and rolled their eyes”

- “(staff member) always complains about personal issues to me”

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Communication in ICH CAHPS

Question 10. In the last 3 months, how often did the dialysis center staff listen carefully to you?

Question 11. In the last 3 months, how often did the dialysis center staff explain things in a way that was easy for you to understand?

Question 12. In the last 3 months, how often did the dialysis center staff show respect for what you had to say?

Question 14. In the last 3 months, how often did you feel the dialysis center staff really cared about you as a person?

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What is Communication?

Communication is the process of transferring signals and messages between a sender and a receiver through various methods (written words, nonverbal cues, spoken words). It is also the mechanism we use to establish and modify relationships

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Positive Communication

We promote positive communication to create an atmosphere that is both

professional and comfortable for patients and staff

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Overview of Communication Tips

-The five steps of active listening

-Non-verbal communication

-Managing your stress

-Emotional awareness

-Dealing with patient anger

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Communication Tips: Active Listening

“One of the best ways to persuade others is with your ears—by listening to them”~ Dean Rusk

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Communication Tips: Active Listening

Active Listening: 5 Easy StepsDefinition: Active listening is a communication technique which requires the listener to feed back what they hear to the speaker, by way of re-stating what they have heard in their own words and confirm the understanding of both parties

1) Pay attention

2) Show that your listening

3) Provide feedback

4) Defer judgment

5) Respond appropriately

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Communication Tips: Active Listening

1) Pay Attention

Give the speaker your undivided attention, and acknowledge the message

Look at the speaker directly

Put aside distracting thoughts

Avoid being distracted by outside factors

"Listen" to the speaker's body language

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Communication Tips: Active Listening

2) Show You're Listening

Use your body language and gestures

You can nod to acknowledge understanding

Smile and use facial expressions

Note your posture and make sure it is open and non threatening

Prompt the speaker to continue with verbal comments like “yes” and “uh huh”

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Communication Tips: Active Listening

3) Provide Feedback

As a listener, your role is to understand what is being said. This may require you to reflect what is being said and ask questions

Reflect what has been said by paraphrasing. "What I'm hearing is," and "Sounds like you are saying," are great ways to reflect back

Ask questions to clarify certain points. "What do you mean when you say." "Is this what you mean?"

Summarize the speaker's comments frequently.

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Communication Tips: Active Listening

4) Defer Judgment

Interrupting is counterproductive. It frustrates the speaker and limits full understanding of the message

Allow the speaker to finish each point before asking questions

Don't initiate a counter argument

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Communication Tips: Active Listening

5) Respond Appropriately

Active listening is a model for respect and understanding. You are gaining information and perspective. You add nothing by attacking the speaker or otherwise putting him or her down

Be candid, open, and honest in your response

Assert your opinions respectfully

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Communication Tips: Active Listening

Avoid “Selective Listening”: the act of hearing and interpreting only parts of a message that seem relevant to you, while ignoring or devaluing the rest. Often, selective listeners will form arguments before they’ve heard the full story

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Communication Tips: Nonverbal Communication

“The most important thing in communication is hearing what isn't said” �-Peter F. Drucker

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Communication Tips: Nonverbal Communication

-When we communicate things that we care about, we do so mainly using nonverbal signals

-Wordless communication, or body language, includes facial expressions, body movement and gestures, eye contact, posture, the tone of your voice, and even your muscle tension and breathing.

-The way you look, listen, move, and react to another person tells them more about how you’re feeling than words alone ever can.

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Communication Tips: Nonverbal Communication

-When we communicate things that we care about, we do so mainly using nonverbal signals

-Wordless communication, or body language, includes facial expressions, body movement and gestures, eye contact, posture, the tone of your voice, and even your muscle tension and breathing.

-The way you look, listen, move, and react to another person tells them more about how you’re feeling than words alone ever can.

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Communication Tips: Managing Stress

“Adopting the right attitude can convert a negative stress into a positive one” -Hans Selye

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Communication Tips: Managing Stress

-Recognize when you are becoming stressed- Your body will let you know, try to identify your personal signs of stress

-Take a moment to calm down- This is important, if you feel overly stressed walk away for a moment and postpone the conversation

-Be willing to compromise- sometimes if both parties meet a middle ground stress can be reduced and a solution can be reached

-Agree to disagree- if possible given the circumstances, or propose to re-visit the issue at a later date

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Communication Tips: Empathy / Emotional Awareness

“When you show empathy towards others, their defensive energy goes down, and positive energy replaces it. That’s when you can get more creative in problem solving”

-Stephen Covey

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Communication Tips: Empathy / Emotional Awareness

-Understand and empathize with what is really troubling other people

-Understand yourself, including what’s really troubling you and what you really want

-Stay motivated to understand and empathize with the person you’re interacting with, even if you don’t like them or their message

-Build strong, trusting, and rewarding relationships, think creatively, solve problems, and resolve conflicts

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Communication Tips: When a Patient is Angry

“Never respond to an angry person with a fiery comeback, even if he deserves it...Don't allow his anger to become your anger.”-Bohdi Sanders

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Communication Tips: When a Patient is Angry

When a Patient is Angry:

-Show respect and maintain professionalism

-Avoid a power struggle

-Remain calm in actions and the tone of your voice

-Remind the patient that you are there to help, ask them how can we help?

”I want to help you”

“We can get through this issue”

“If you can _____I can see if I can_____”

-Attempt to re-direct the patient and de-escalate if possible

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Network Communication Tools

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- The Network has just completed the development of an educational poster for dialysis patients

-The Dialysis Patient-Provider tool kit is available to train staff on communication and conflict reduction

http://esrdncc.org/professionals/decreasing-dialysis-patient-provider-conflict/

Questions?

For more information contact:

IPRO End Stage Renal Disease Network of New York1979 Marcus AvenueLake Success, NY 11042Phone: 516-209-5578Toll-free: 800-238-3773 (Patients only)Fax number: 516-326-8929Email: info@nw2.esrd.net

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