How To Communicate So Your Patients Will Listen Full Version

Introduction of the Introduction of the Healthcare Ombudsman -Healthcare Ombudsman -

Mediator ( HCOM)Mediator ( HCOM)

David Richardson, PhDDavid Richardson, PhDFontana Medical CenterFontana Medical Center

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Purpose: Purpose: to resolve & addressto resolve & address concerns real or perceived, which may concerns real or perceived, which may include…include…

• Unanticipated adverse outcomes Unanticipated adverse outcomes (where significant event or (where significant event or disability/harm has occurred)disability/harm has occurred)

• Unanticipated deathsUnanticipated deaths

• Medical errors / surgical Medical errors / surgical misadventuresmisadventures

• Potentially Compensable Events (PCE)Potentially Compensable Events (PCE)

• Clinical or quality of care concernsClinical or quality of care concerns

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Possible Causes of Adverse Possible Causes of Adverse OutcomesOutcomes

• Uncorrected “unreasonable” Uncorrected “unreasonable” expectationsexpectations

• Biological variability and low Biological variability and low probability risksprobability risks

• Decisions that don’t work out wellDecisions that don’t work out well

• Medical or Systems errorsMedical or Systems errors

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Possible Causes of Adverse Possible Causes of Adverse OutcomesOutcomes

• Doing the right thing the wrong wayDoing the right thing the wrong way

• Doing the wrong thing the right wayDoing the wrong thing the right way

• The right thing the right wayThe right thing the right way

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When Unanticipated Adverse When Unanticipated Adverse Outcomes Occur:Outcomes Occur:

Clinicians are emotionally Clinicians are emotionally effectedeffected- - Fear of Fear of malpracticemalpractice

- Perceived threats to - Perceived threats to professionalprofessional pride pride and and reputationreputation

- Feelings shame and - Feelings shame and guiltguilt

Post traumatic stress (Post traumatic stress (PTSDPTSD))

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When Unanticipated Adverse When Unanticipated Adverse Outcomes Occur:Outcomes Occur:

Patients’ and families’ desirePatients’ and families’ desire- - AcknowledgmentAcknowledgment of their feeling of their feeling

- Understanding of the - Understanding of the factsfacts

- Protection for others- Protection for others

- - ApologyApology if appropriate if appropriate

- Perhaps - Perhaps compensationcompensation for the injury for the injury

How Does an How Does an Ombudsman/Mediator Work?Ombudsman/Mediator Work?

• Advocates for aAdvocates for a fair processfair process for patients, for patients, providers, and Kaiser Permanenteproviders, and Kaiser Permanente

• Remains Remains independentindependent and offers and offers confidentiality, neutrality, and confidentiality, neutrality, and impartialityimpartiality

• Resolve health care conflicts as Resolve health care conflicts as close toclose to the event as possiblethe event as possible

• Facilitates discussionsFacilitates discussions between patients, between patients, family & providersfamily & providers

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How Does an How Does an Ombudsman/Mediator Work?Ombudsman/Mediator Work?

• Advocates for aAdvocates for a fair fair processprocess for patients, providers, and for patients, providers, and Kaiser PermanenteKaiser Permanente

• Remains Remains independentindependent and offers and offers confidentiality, neutrality, and confidentiality, neutrality, and impartialityimpartiality

• Resolve health care conflicts as Resolve health care conflicts as close toclose to the the event as possibleevent as possible

• Facilitates discussionsFacilitates discussions between patients, between patients, family & providersfamily & providers

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How Does It Work?How Does It Work?

• Focuses on underlying Focuses on underlying issues, needsissues, needs, , and and interestsinterests

• Clarifies perceptions, Clarifies perceptions, reframesreframes issues issues

• Assist parties to identify Assist parties to identify optionsoptions, , reach sustainable & mutually reach sustainable & mutually satisfactory satisfactory resolutionresolution

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Desired Outcome: Desired Outcome:

• Provider and patient develop a Provider and patient develop a partnership with shared decision partnership with shared decision makingmaking

• Members / families receive honest, Members / families receive honest, timely and accurate communication timely and accurate communication regarding disappointing medical regarding disappointing medical outcomesoutcomes

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Desired Outcome: Desired Outcome:

• Physicians, staff and members feel Physicians, staff and members feel supported when facing these eventssupported when facing these events

• Members re-gain trust in their provider Members re-gain trust in their provider and Kaiserand Kaiser

• We acknowledge, apologize and show We acknowledge, apologize and show compassion in the face of medical compassion in the face of medical errors errors

How to Contact theHow to Contact theHealth Care OmbudsmanHealth Care Ombudsman

David Richardson, PhDDavid Richardson, PhD

• Phone: (909) 427-7719*Phone: (909) 427-7719*

• Pager: (909) 209-1186Pager: (909) 209-1186

• Location: Hospital, 1Location: Hospital, 1stst floor floor

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Please call my Daddy x7719

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FREQUENTLY ASKED FREQUENTLY ASKED QUESTIONSQUESTIONS

• How can you be neutral if…How can you be neutral if…

• Are you just for the hospitalAre you just for the hospital

• When are you availableWhen are you available

• How are you different from…How are you different from…

Physician - Patient Physician - Patient CommunicationCommunication

Improving Communication and Improving Communication and Strengthening RelationshipsStrengthening Relationships

David Richardson Ph.D.David Richardson Ph.D.

Health Care Ombudsman / Health Care Ombudsman / MediatorMediator

OverviewOverview

• Ombudsman / Mediator Role In Ombudsman / Mediator Role In Communication IssuesCommunication Issues

• Challenges to Effective CommunicationChallenges to Effective Communication

• Common Inpatient Communication Common Inpatient Communication Difficulties And Effects On CareDifficulties And Effects On Care

• 6 Step Strategy to improve communication 6 Step Strategy to improve communication and strengthen relationshipsand strengthen relationships

Ombudsman / Mediator RoleOmbudsman / Mediator Role

• Approximately 5 - 10 new cases per weekApproximately 5 - 10 new cases per week

• Nearly half of all cases were referred for Nearly half of all cases were referred for serious communication difficulties serious communication difficulties resulting in concern about patient careresulting in concern about patient care

• All All cases include some communication cases include some communication issuesissues

Challenges to Challenges to CommunicationCommunication

1. Multiple providers1. Multiple providers


from the Patient’s perspectivefrom the Patient’s perspective

1. Multiple providers1. Multiple providers

Effects:Effects:• ConfusionConfusion

• Perception that care is disjointedPerception that care is disjointed

• Differences between providers are Differences between providers are highlightedhighlighted



2. Complex care involving multiple 2. Complex care involving multiple medical conditions.medical conditions.



2. Complex care involving multiple 2. Complex care involving multiple medical conditions.medical conditions.

Effects:Effects:

• Treatment plans seem Treatment plans seem disorganized to patients/familiesdisorganized to patients/families

• Misalignment of care prioritiesMisalignment of care priorities



3. Patients and families are in a 3. Patients and families are in a heightened emotional state.heightened emotional state.


from the Patient’s perspectivefrom the Patient’s perspective3. Patients and families are in a 3. Patients and families are in a

heightened emotional state.heightened emotional state.

Effects:Effects:• Challenging, mistrustful, panicked Challenging, mistrustful, panicked

or demanding patients/familiesor demanding patients/families

• Barriers to how patients/families Barriers to how patients/families receive or process informationreceive or process information

Communication DifficultiesCommunication Difficulties

1. Blaming others

Outcome:– Loss of trust– Increased anger– Litigation risk


2. Blaming the System

Outcome:– Loss of trust– Anger and frustration– Concern regarding Kaiser’s priorities


3. Dividing the Patient into Pieces

Outcome:– Experienced as disorganized – Concerns about quality of care– Fear and anxiety

How To Talk So Your Patients Will How To Talk So Your Patients Will ListenListen

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6 Step Communication 6 Step Communication StrategyStrategy

EffectsEffects

• Improved communication Improved communication

• Stronger relationshipsStronger relationships


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Using AALEE as a mnemonic device Using AALEE as a mnemonic device

A – AnticipateA – Anticipate

A – AdjustA – Adjust

L – ListenL – Listen

E- EmpathizeE- Empathize

E - ExplainE - Explain


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A – Anticipate A – Anticipate What are the likely communication What are the likely communication needs of this patientneeds of this patientAre they:Are they:– InformationalInformational– emotionalemotional– socialsocial


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A – AdjustA – AdjustIn what ways might you have to modify In what ways might you have to modify your communication your communication – LanguageLanguage– CultureCulture– NonverbalNonverbal– EducationEducation– PacePace– Depth Depth

• What vs what and howWhat vs what and how


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L – ListenL – ListenMore than you speakMore than you speak– Provides informationProvides information– Gives access to subtle cuesGives access to subtle cues– Demonstrates respectDemonstrates respect– Fosters connectionFosters connection


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E – EmpathizeE – EmpathizeDemonstration of your understanding of Demonstration of your understanding of

the patients situationthe patients situation– ConcernsConcerns– FearsFears– HopesHopes– AnxietiesAnxieties– NeedsNeeds


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E – ExplainE – Explain

Only after the others steps are Only after the others steps are successfulsuccessful– TimelyTimely– AccurateAccurate– SensitiveSensitive


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A – AnticipateA – Anticipate

A – AdjustA – Adjust

L – ListenL – Listen

E- EmpathizeE- Empathize

E - ExplainE - Explain

How To Talk So Your Patients Will How To Talk So Your Patients Will Listen Listen

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• Beck and colleagues conducted a Beck and colleagues conducted a systematic review of research systematic review of research examining office consultations in examining office consultations in primary care settings. They describe primary care settings. They describe verbal and nonverbal behaviors verbal and nonverbal behaviors shown to influence patient shown to influence patient responses.responses.

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.


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Physicians' Verbal Behaviors Physicians' Verbal Behaviors Promoting Positive Promoting Positive Interpersonal RelationsInterpersonal Relations• EmpathyEmpathy

• Courtesy/friendlinessCourtesy/friendliness

• Attentiveness during history takingAttentiveness during history taking



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Physicians' Verbal Behaviors Physicians' Verbal Behaviors Promoting Positive Promoting Positive Interpersonal RelationsInterpersonal Relations• Support/reassurance/positive Support/reassurance/positive

reinforcement regarding patient reinforcement regarding patient actionsactions

• Encouragement of patient questionsEncouragement of patient questions

• Laughter as a tension releaseLaughter as a tension releaseBeck 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.


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Physicians' Verbal Behaviors Physicians' Verbal Behaviors Enhancing Information Enhancing Information ExchangeExchange• ListeningListening

• Giving health educationGiving health education

• Clarifying statementsClarifying statements

• Summarizing patient statementsSummarizing patient statementsBeck 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.


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Physicians' Verbal Behaviors Physicians' Verbal Behaviors Enhancing Information Enhancing Information ExchangeExchange• Talking at patients' levelTalking at patients' level

• Addressing patients' Addressing patients' – daily lives, daily lives, – problems, problems, – social relations, and social relations, and – emotionsemotions



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Physicians' Nonverbal Physicians' Nonverbal Behaviors Associated With Behaviors Associated With Patient SatisfactionPatient Satisfaction• Head noddingHead nodding

• Leaning forwardLeaning forward

• More direct body orientationMore direct body orientation

• Uncrossed arms and legsUncrossed arms and legs

• Less mutual gazeLess mutual gaze



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Physicians' Behaviors Physicians' Behaviors Associated With Reduced Associated With Reduced Patient SatisfactionPatient Satisfaction• Excessive focus on medical questionsExcessive focus on medical questions

• Showing tension, anger, or Showing tension, anger, or nervousnessnervousness

• Allowing interruptionsAllowing interruptions

• Withholding information or Withholding information or explanationsexplanations


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Physicians' Behaviors Physicians' Behaviors Associated With Reduced Associated With Reduced Patient SatisfactionPatient Satisfaction

• Leaning back or angled away from Leaning back or angled away from patientpatient

• Frequent touchingFrequent touching

• Unduly dominant approachUnduly dominant approach

• Directive behaviorsDirective behaviors

How To Communicate So Your Patients Will Listen Full Version

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