Transcript No Slide Title

Handling disgruntled patients
and conflict resolution
Overview
Staff conflict
Disgruntled patients
Complaints
Abusive or violent patients
Drug seekers
Staff conflict
Prevent
Restore
Isolate
Manage
Prevent
Lead by example from the top down
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stamp out poor role modelling
focus on team building
communication skills
ongoing coaching and effective performance reviews
Robust recruitment process to avoid importing the problem
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recruitment for attitude, train for skills
consider person specification pertinent to the role and the team fit
effective pre employment checks
personality and/or psychometric (cognitive) testing – particularly for senior
positions
effective induction
Clear, legally compliant documentation
General responsibilities listed in employment agreements
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your responsibilities as well as theirs
serious misconduct definition
procedure for resolution of employment relationship problems
Position description
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details the tasks, the expected standards and outcomes for the role
Code of conduct
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developed in conjunction with the practice team and applies to the whole
team
Isolate and identify any causal factors
• Environmental
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adequate working space
equipment
training needs
realistic time frames
Bullying in the workplace
Behavioural or attitudinal
Stress – work or personal
Staff not knowing the boundaries
Incompatibility
Investigate
Look for solutions
Third party mediation and counselling
Act in a fair and reasonable manner
• meet legal compliance
Mutual termination – comes with risk GET ADVICE FIRST
Performance improvement plan
Drawn up in conjunction with the employee to:
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identify the behaviours you are unhappy with
define what is expected
agree to pathway and timeframe to achieve expectations
include what you need to do – any training, support or equipment needs
Review and update progress at prescribed intervals
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annotate with date and initials of both parties
Proceed to disciplinary process if expectations not met
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seek advice first
advise insurer if you have employee disputes cover
Manage
Be familiar with and expect accountability to terms in:
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employment agreement
position description
practice policies and guidelines – including code of conduct
Comply with principle of fairness and reasonableness
Regular and timely observation
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“You handled that well”
“That seemed like a difficult situation, let’s talk about it”
“That is not appropriate, let’s go and have a coffee...”
“Things don’t seem happy here, please tell me what the problem is”
Conflict of interest: staff as patients
Managing business needs versus employment relationship
issues
• e.g. request for medical certificate for extended sick leave due to
stress in the workplace
Familiarity
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potential clinical safety issues
Document,
document, DOCUMENT!
You may well need to
depend on these notes
in the future.
Restoring the team
Acknowledge a difficult time has passed
Celebrate moving forward
Review and model expected behaviours
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the ideal team working environment
Keep your finger on the pulse
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avoid slippage
Disgruntled patients
Sometimes you can spot
them coming a mile away.
What is driving the patient’s behaviour?
Frustration
Emotionally or stress driven
Unmet expectations
Poor self control
Outright bad behaviour
The aggrieved patient
Triggered by outcome of certificates and reports for
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work capacity
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insurance
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ACC
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government departments and other agencies
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employers
See:
www.mcnz.org.nz for their statement Medical certification
www.workandincome.govt.nz Completing the Work Capacity Medical Certificate
Or contact MPS phone 0800 225 5677 or email [email protected]
Prepare = ability to respond appropriately
1. Self awareness
• identifying and controlling our own behaviours and responses
• understanding the reactions we get
2. Staff training
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how you want them to react
2. Know how to diffuse
• speak calmly and clearly
• treat with respect
Avoiding patient frustration
Phone system
Reception interaction
Appointment availability
Waiting times
Waiting room
Privacy
Don’t put up with abusive or threatening behaviour
Look after your own safety first and don’t hesitate to
call the police if necessary
Ignore personal insults – do not retaliate
Call for help from the practice team if necessary
Get to the bottom of the problem
Listen and take accurate notes
– document, document, document!
Investigate
Has the patient inadvertently caused the issue?
Tell them what you need to do
e.g. follow complaints protocol and explain what that entails
The Code of Health and Disability Services Consumers’ Rights
states patients have the right to:
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Be treated with respect
Freedom from discrimination, coercion, harassment, and exploitation
Dignity and independence
Services of an appropriate standard
Effective communication
Be fully informed
Make an informed choice and give informed consent
Support
In respect of teaching or research
Complain
Who is at fault?
Don’t be too proud to say “I am sorry we could have
done that better”
“Let me take your contact details so we can...”
Ask them what they would like to see happen
Body language
awareness
You can’t always put it right!
Sometimes all the patient wants is an apology
An apology is not an admission of guilt or liability
– but saying sorry can help a lot
Complaints procedure
Staff need to:
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be familiar with your policy, feel comfortable about receiving
complaints and know who to hand them on to
Patients need to:
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feel comfortable about complaining and have easy access to the
process
Privacy Act requires you to:
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have at least one privacy officer
ensure staff are aware of and up to date with privacy obligations
acknowledge receipt of complaints within 5 working days
respond within 10 working days
Ending patient relationship
Process
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verbal or written notice with reason for termination and opportunity to
respond
– CANNOT be on basis of health need, anticipated health need or
discrimination
PHO or provider must help find suitable new provider
keep an auditable trail
recommendation to seek advice before proceeding
Resources:
NZMC statement Ending a doctor-patient relationship www.mcnz.org.nz
MoH Enrolment Requirements for Primary Health Organisations – version 2.3,
enrolment parameter 8 www.moh.govt.nz
MPS 0800 225 5677, email [email protected]
Finally – write it up as a significant event
Debrief – are there any:
• lessons learned?
• policy changes to make?
• staff training needs identified?
Or did you earn a pat on the back confirming that the
practice is well prepared with good policies and
training in place?
Armed
robbery
Survival is the number one rule
• Remain calm and exercise self-control
• Don’t play the hero or resist – you may put other
people at unnecessary risk
• Co-operate and listen carefully and do what you are
told without question
• Don’t make sudden movements, talk to, or stare at
the offender
• If the offender has a firearm, consider it loaded
Once the offender has left
• Dial 111 and ask for police
• Render first aid to any victims
• Preserve the scene for evidential purposes
– don’t touch anything the offender may have touched
– isolate area/s used by the offender and ask witnesses to stay until police
have arrived
• Without staring, note the offender’s description
– physical features, clothing, distinguishing characteristics, weapon/s, actions
• If safe, note the direction the offenders go following the robbery
– vehicle type, colour, make, number plates
• Don’t chase the offenders
Drug seekers – determining if legitimate
Treat them like any other new patient, ask for:
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full name
address
date of birth
phone contact details
details of previous GP to request transfer of records
Ask for proof of identification
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passport
drivers licence
some kind of card that confirms their identity
Seek help from the experts:
Medicines Control Office
www.moh.govt.nz/moh.nsf/indexmh/medicinescontrol
Northern (09) 580 9088
Central (04) 496 2000
Southern (03) 474 8074
MPS 0800 225 5677 [email protected]
MCNZ statement Good prescribing practice
www.mcnz.org.nz/portals/0/news/Good%20prescribing%20practice.pdf
Work shop
Questions?
Chris Wills – business advisor
Business Advisory Services
Medical Assurance Society
Telephone
E-mail
0800 800 MAS (627)
[email protected]