1. Decreasing Dialysis Patient-Provider Conflict (DPC) Session #3 – Staff Training Modules 4-6 A Collaborative Presentation by Western Pacific Renal Network, LLC ESRD Network #17 Connie Lorenz, LMSW Patient Services Director 505 San Marin Dr., Bldg. A 300 Novato, CA 94945 Southern California Renal Disease Council, Inc. ESRD Network #18 Cecilia Torres-Correa, RN/BSN Patient Services Director 6255 Sunset Blvd., Ste. 2211 Los Angeles, CA 90028

2. Objectives ● Facilitate key educational strategies ● Encourage critical thinking ● Stimulate meaningful staff discussion ● Complete in a timely fashion ● Keep participants energized and interested ● Increase understanding & build communication skills ● Understand the root cause of the patient conflict

3. Focus on the Issue - Module 4 Purpose: ● To practice communication techniques that can be used in the dialysis clinic to help dialysis professionals stay focused on a single, clearly defined issue Time Required: ● 45 minutes Preparation /Material Needed: ● Article “What are you trying to tell me?”

4. Focus on the Issue - Module 4 “When conflict occurs, there is a tendency to lose sight of the issue that started the disagreement and it can quickly become a disagreement about the facility staff, the clinic operations, or the physician care.”

5. Focus on the Issue - Module 4 cont. During a conflict, it’s common for additional & unrelated concerns to be raised. Be prepared Be willing to ask the patient to explain their concern if you don’t understand what they are saying Do not assume that you already know what the patient is upset about

6. Focus on the Issue – Module 4 Teaching Concepts ● Use positive communication skills ● Seek patient agreement on what the conflict is about ● Demonstrate a willingness to address the conflict ● Maintain focus on the agreed upon issue

7. Focus on the Issue - Module 4 Group Activities ● A group discussion on key points for how to focus on the issue ● Go over article “What are you trying to tell me?” with group ● Role playing in pairs ● Open discussion with questions

8. Focus on the Issue - Module 4 Conclusion ● Do your best to give the patient your full attention when discussing the concern ● It’s difficult for dialysis patients who may not be feeling well to clearly say exactly what they are concerned about during treatment

9. Look for Solutions - Module 5 Purpose: To gain a greater understanding of communication strategies that decrease conflict Time Required: 30 minutes Preparation /Material Needed: Write a list of points for solutions to resolve conflict Handout #1: Closed-ended and Open-ended Questions Handout #2: Practice Finding Solutions

10. Look for Solutions - Module 5 “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.”

11. Look for Solutions - Module 5 Teaching Concepts Brainstorm possible solutions with the patient Patient care conference with family, friends, staff, and physician Be creative and flexible Let the patient know if it is not possible to fix the entire problem Don’t make promises you can’t keep

12. Look for Solutions - Module 5 Group Activities ● Key points covered from handout “Look for Solutions” ● Short lecture from trainer on the importance of open–ended questions ● Brainstorming session with group ● Role playing sessions ● Wrap up and questions

13. Look for Solutions - Module 5 Key Points The objective is to negotiate an agreement It’s not about winning or losing Timing is critical Be willing to negotiate a solution Find a solution that really works

14. Look for Solutions - Module 5 Key Points cont. Talk with a neutral third party Brainstorming possible solutions to a conflict can lead to more effective policies Use open-ended questions which can lead to a more thorough discussion of the conflict

15. Using Open-ended Questions What is the patient’s perception of the conflict? Usually begin with words such as what, will, or how A question that starts with ‘Why’ could be considered open-ended Don’t involve your opinion or impose your judgment on the patient.

16. Using Closed-ended Questions Closed-ended questions generally get a “yes” or “no” response Hand out “Closed-ended and Open-ended Questions” Example: Closed-ended: “Are you mad at me?” Open-ended: “Would you tell me a little bit more about why you are angry?”

17. Alternative Solutions - Module 5 Conclusion The ability and willingness to be creative and flexible Not uncommon for staff responses to conflicts or patient complaints to be quick and routine It’s OK to take time to think about new solutions and ask others for input

18. Implement Agreement - Module 6 Purpose: ● To discuss how to implement an agreement after professional dialysis staff have worked through conflict with a patient Time Required: ● 30 minutes Preparation /Material Needed: ● None

19. Implement Agreement - Module 6 “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.”

20. Implement Agreement- Module 6 Teaching Concepts ● Use action statements to describe the agreement ● Document and communicate the agreement that has been reached ● Be consistent with any agreements that are made

21. Implement Agreement– Module 6 Group Activities ● Group discussion on implementing an agreement and the steps Key Point ● Use action statements to describe the agreement so the patient knows they can count on us to follow through

22. Implement Agreement - Module 6 Conclusion Implement the agreement by being consistent, communicating it to other parties, and documenting Emphasize the importance of the entire staff to be consistent

23. Additional Resources *DPC Tip Sheet #2 Staff Training Modules 1–3 *DPC Tip Sheet #1 –Administration www.esrdnet17.org www.esrdnet15.org * Developed by ESRD NW#15

24. CEU Requirements EVALUATION! Evaluation forms can be found on NW #17 or NW #18 websites under: “DPC WebEx Evaluation” www.esrdnet17.org www.esrdnetwork18.org You must attend all 5 sessions to receive CEU credit! Please return completed evaluation forms by fax to: Social Workers - NW #17 (415) 897-2422 RNs - NW #18 (323) 962-2891

25. Upcoming DPC WebEx WHEN: April 20, 2010 TIME: 9:00am - 10:00am SUBJECT: Staff Training Modules 7-9 Please feel free to contact us with questions Network #17: Connie Lorenz (415) 897-2400 clorenz@nw17.esrd.net Network #18: Cecilia Torres-Correa (323) 962-2020 ctorres@nw18.esrd.net