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 The ESRD Network of Texas, Inc. Professionalism & Working with Difficult Patients.

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Presentation on theme: " The ESRD Network of Texas, Inc. Professionalism & Working with Difficult Patients."— Presentation transcript:


2  The ESRD Network of Texas, Inc. Professionalism & Working with Difficult Patients

3  “Patients with renal disease are challenged by many stressors, including loss of biochemical and physiologic kidney functions, development of digestive and neurological disorders, bone disease and anemia, inability to function in the family and to maintain one’s occupation, decreased mobility, decreased physical and cognitive competence, and loss of sexual function ” Kimmel, MD & Peterson, MD Seminars in Dialysis, 2005 Our Patients

4  It’s not an easy life Sometimes this causes denial, anger and behavior issues

5   That facilities are desperately seeking ways to work with challenging patients.  That resources are few  That there are no concrete answers  That each individual patient represents a new challenge What Do We Know?

6  “we believe that every dialysis facility has the resources and responsibility to work with every patient, including patients perceived to be disruptive or challenging” -Conditions of Coverage From CMS….


8   More compassion  More understanding  More staff education  How to work with mentally challenged individuals  In many cases PCT’s have limited training on working with difficult patients  More support for staff and patients What is needed?

9   Kindness  Recognition  Comfort  Emotional support Patients want from staff This requires Caring Communications

10 Compassion (Advocacy) Efficiency (Stewardship) Excellence (Quality) Balance (Tension) Jim Rohack, MD, Medical Director SWHP

11   Non-adherence  Mental Health & Substance Abuse Issues  Cultural & Racial Issues  Complex Environment  Communication Difficulties 10 Reasons for Conflict

12   Be objective  Hear all sides  Gather information  Facilitate resolution  Make a determination Role of Network in grievances


14   Tantamount to DEATH SENTENCE?  “We have no other choice”  “Our back is against the wall on this”  “We have tried everything else” Growing Number of Involuntary Dismissals nationally Some Will Die…

15 Beneficiary/Representative Contacts Category by Quarter for 2013

16  Trending Involuntary Discharge 2008 to 2013 Maintaining a steady number is not good enough!

17  January-April, 2013 Number of all Involuntary Discharges by Type IVD must be decreased by 1 or 5% per quarter Number = 19

18  How does Professionalism & Working with Difficult Patients fit together?

19   Purpose  Balance of Power  Focus Relationships: Personal vs. Professional

20 Challenging situations are often the delayed result of professional boundary violations.

21   Becoming personally involved  Gifts  Showing favoritism  Dual relationships Common Problems: Boundaries Crossed

22  Becoming Personally Involved  Sharing that shifts FOCUS from pt to professional  Lose ability to respond objectively  React emotionally

23  Gifts  Unit policy against giving/receiving of gifts  Federal regulations against giving to patients  Protects pts from feeling that they need to pay extra for quality  Protects staff from feeling they need to give extra attention

24 Showing Favoritism  Show that you favor one pt over another, or facilitate a pt favoring you over other staff  Creates expectation that it will be done again  Expectation that other staff will do the same  Distrust of other staff

25   Exchange of goods or services Dual Relationships

26   Demeaning to the patient  It is usually intentional  It is a breach of TRUST  Long-term effects can be devastating but may not be readily apparent  THE BREACH OF TRUST IS USUALLY FAR MORE SERIOUS THAN THE ACTUAL SEXUAL CONTACT SEXUAL MISCONDUCT

27   Decreasing Dialysis Patient- Provider Conflict Toolkit  Caring Communications Tips TOOLS TO HELP

28 DPC Toolbox IG-”At the time of publication of these rules, each facility had received a copy of an interactive program developed by the ESRD Networks on Decreasing Dialysis Patient Provider Conflict (DPC) that addresses proactive techniques to resolve such issues before progression to involuntary discharge.”

29  Toolbox Contents 1.Ethical, Legal, Regulatory Statement 2.Poster 3.Brochure 4.Pocket Card 5.Bibliography 6.Taxonomy & Glossary 7.Tip Sheets 8.“Top Ten” Responses 9.Interactive Web-Based Training 10.Training Modules 11.QI Tracking Tool

30   Critical thinking algorithms and video  Clips of “real life” situations  Use of Taxonomy & Glossary  Use of conflict resolution techniques  Sent to each facility in US  Interactive educational software Toolbox Contents cont.

31  DPC “CONFLICT” Resolution Model 9 step program

32  “CONFLICT” Resolution Model C- Create a Calm Environment O- Open Yourself to Understanding N- Need A Nonjudgmental Approach F- Focus on the Issue L - Look for Solutions I - Implement Change C - Continue to Communicate T - Take Another Look

33  “In order to effectively address a conflict, you need to be aware of the physical surroundings, as well as the thoughts and feelings you are experiencing because of the conflict” C reate A Calm Environment

34  “When addressing a conflict, it is important to acknowledge the perspective and feelings of the other individual(s) involved” O pen Yourself to Understanding Others

35  “ As a dialysis professional, it is important for you to maintain an objective and professional approach as you address the conflict. Keep in mind that words exchanged in the heat of an argument are often not intended as personal attacks.” N eed A Nonjudgmental Approach

36  “ When conflict occurs, there is a tendency to lose sight of the issue that started the disagreement. What starts out as a concern about starting dialysis on time can quickly become a disagreement about the facility staff, the clinic operations, or the physician care.” F ocus On The Issue

37  “Not all conflicts can be resolved nor are all conflicts based on valid complaints. But working in collaboration with the patient will improve the likelihood of a positive outcome.” L ook For Solutions

38  “ If you take the time to work through the conflict, it is likely that you will reach a stage of agreement when changes will need to be put into action.” I mplement Agreement

39  “Effective resolution of a conflict requires follow up communication. This allows you to monitor the progress being made. And demonstrates to the patient your commitment to resolving the conflict.” Continue To Communicate

40  “ Handling a conflict, like successfully performing dialysis related tasks, requires practice, understanding, education, and monitoring. Regardless of whether a conflict is minor or major, reviewing the steps used in addressing the conflict will be beneficial.” T ake Another Look

41   DPC Brochure: “Decreasing Conflict & Building Bridges”  DPC CONFLICT Poster  DPC CONFLICT Pocket Guide Tools to help you use the Conflict Resolution Model



44 Heart-Head-Heart Communication: Two Sides to a Satisfying Service Experience Feelings, personal attention, caring We’re so busy the heart messages get lost. Information, tasks Dialysis is so full of tasks Heart Head

45  1.Acknowledge patients likely feeling. 2.Share your good intentions: How are your actions for the customer’s sake ? 3.Ask open-ended, not yes-no questions. 4.Use the words “ for you.” 5.Express appreciation to the person. Caring Communication Hints

46   You are not a number.  YOU, uniquely YOU matter to me.  I respect your thoughts and feelings.  I want you to feel my support.  Yes, I’m here to care for you. And, I also care ABOUT you. Messages Key to Patient Satisfaction

47   Educate their staff about caring communications tips  Contact the Network as soon as possible  Suggestions, tips, ideas  Objective party 46 When the team is struggling with a patient…

48  Patient Care Conference (PCC) Behavior Agreements Patient Advocacy Meetings Professionalism Trainings Additional ideas to consider

49   If the patient is an actual and immediate danger to others  Weapons  Striking others  CALL 911  Immediate Discharge How to handle a situation… IG- An "immediate severe threat" is a threat of physical harm. For example, if a patient has a gun or a knife or is making credible threats of physical harm, this would be considered an "immediate severe threat."

50  The Renal Professional You Make A Difference

51   Thank you for your participation  For assistance contact the Patient Services Department : Treneva Butler Ron Davis Maria Bustamante ex 344 ESRD Network of Texas, Inc.

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