Transcript Frontline Floor Staff Workshop

Frontline Floor Staff
Workshop
“Together Performing at
a Higher Standard”
The Florida ESRD Network
Agenda
Your Role in the Patient Experience:
• How to build professional relationships with patients while
maintaining boundaries
• Customer service and effective communications skills
• Interactive communication scenarios
• Staff–to-Staff teambuilding communication
Vascular Access – The Patient Chronicles:
• Common physical, emotional, and psychological challenges patients
face when migrating from a catheter to a permanent vascular access
(VA)
• Engaging patients in discussions regarding VA and infection control
• VA Assessment – What complications look like, what staff will see
with stenosis
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Why Have a Frontline Staff
Workshop?
• Quality care starts and ends with you
• Your jobs require building good working
relationships, working in a team-oriented
environment, and providing outstanding clinical
care
• You build meaningful and sometimes personal
relationships with the patients because you have
the most one-on-one time with them
• Patient and facility feedback
• There is always room for improvement
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We’re all Friends
CUSTOMER SERVICE VIDEO
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Joe Karan, Network 7 Patient Subject Matter Expert
THE PATIENT PERSPECTIVE
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Dorothy Craft, RN, CDN
LET’S TALK ABOUT CUSTOMER
SERVICE AND PROFESSIONALISM
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What the 2008 ESRD Conditions for
Coverage Require
494.60 Physical Environment
• Building/furnishings/equipment – must be safe
and functional
• All equipment operated according to
manufacturer’s guidelines
• Patient care environnent sufficient to prevent
cross contamination and accommodate
emergency equipment
• Comfortable temperature
• Accommodations for patient privacy
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2008 ESRD Conditions for Coverage
494.70: Patients’ Rights
• Informed within the first six treatments
• Informed regarding:
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Right to participate in care
Advance directives
Treatment modalities
Facility policies regarding patient care and isolation
How to file a grievance
The facility’s discharge and transfer policies including
involuntary discharges
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Patient’s Rights
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Information that is easy to understand
Care that is respectful
Involved in decisions about care
Privacy and confidentiality
Make a complaint and receive a response
Clear information about facility policies including
discharge and transfer policies
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The Patient Experience of Care
In-Center Hemodialysis Consumer Assessment of
Healthcare Providers and Systems Survey (ICH
CAHPS)
• Not a Consumer Satisfaction Survey
• Administered once in 2014 and semiannually in
2015 and subsequent years
• Results reported to CMS as part of the Quality
Incentive Program (QIP)
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ICH CAHPS
• In the last 3 months, how often did you feel the
dialysis center staff really cared about you as a
person?
• In the last 3 months, how often did dialysis
center staff make you as comfortable as
possible during dialysis?
• In the last 3 months, did you feel comfortable
asking the dialysis center staff everything you
wanted about dialysis care?
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ICH CAHPS
• In the last 3 months, how often did dialysis
center staff insert your needles with as little pain
as possible?
• In the last 3 months, how often did dialysis
center staff check you as closely as you wanted
while you were on the dialysis machine?
• In the last 3 months, how often did dialysis
center staff behave in a professional manner?
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Empathy
• The ability to identify
with and understand
another’s situation,
feelings, and motives
• Put yourself in the
patient’s shoes
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Who Would You Prefer Caring for You?
Source: 5-Diamond Patient Safety Program, “Professionalism in the
Dialysis Setting.” www.5diamondpatientsafety.org.
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Professionalism
• Describes a certain type of behavior in the
workplace
• Is based on our values and understanding of our
professional roles
• Is evidenced in our behavior and judged
through:
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Our image
Our communication
Our competence
Our demeanor
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From the Patient’s Perspective
A professional is:
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Trustworthy
Competent
Empathetic
Respectful
Caring
Culturally aware
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Becoming Personally Involved
• Sharing that shifts focus from the patient to
the staff member
• Disclosing personal problems/employee
concerns
• Losing the ability to respond objectively
• Giving/receiving gifts
• Showing favoritism
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Other Pitfalls
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Flirtation
Inappropriate dress/language
Ordering/parenting
Having the last word
Threatening termination
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What if I am Not Sure if I am Being
Professional?
Ask yourself these questions:
• Would this be allowed in another medical
setting?
• How does this activity assist the patient in care
of his or her ESRD?
• Can this be documented in the medical record?
• Are you willing to do this for all patients?
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Proper Professional Behavior
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Encouraging patient self‐determination
Providing informed consent
Competence
Not taking unfair advantage of any relationship
Avoiding dual relationships
Respecting privacy/confidentiality
Empowering patients rather than creating
dependency
• Not taking things personally
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How do We Not Take Things
Personally?
• Know yourself: What pushes your buttons?
• Recognize your limits: What is your tolerance
level?
• Anticipate situations and have a plan: Positive
outlets and coping skills.
• Understand that our response can either
escalate or deescalate the situation.
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Patient Engagement
• Maintaining professionalism, boundaries, and
showing respect for patients’ care builds trust
• Having trust in staff leads patients to engage
more in their care
• Together this leads to better outcomes for
patient and facility
• Utilizing new patient orientation, plan of care
meetings, and patient education to engage
patients
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Customer Service
• Think about your own experiences.
• What would your patients say about your
facility’s customer service?
• Does staff at your facility welcome and engage
every patient the same way?
• Are concerns addressed quickly?
• Is the customer always right?
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Conflict Resolution
• Conflicts or complaints are rarely isolated
incidents.
• All staff can look for indicators that the patient is
unhappy.
• Try to take personal feelings out of the equation.
 This is not about you!
• Address complaints immediately.
 Do not wait until the “right moment.”
 Things tend to escalate the longer they go without
resolution.
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Conflict Resolution
• Try to determine the “real” cause of the conflict:
 Is there a problem that effects multiple patients or
only one?
 Is there a win/win solution?
• With a little effort most issues can be resolved:
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Scheduling
Medication
Attitudes
Access skills
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Staff-to-Patient
COMMUNICATION SCENARIOS
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For Our Discussion
After reading the scenarios that follow we will
discuss the questions below.
• What rule of professionalism or code of conduct
was broken?
• What boundaries (if any) were crossed?
• What should have happened?
• If you were the staff member in this scenario,
how would you have handled it?
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I’m Going Through a Terrible
Divorce!
A patient told the facility manager that he refused
to have a certain technician cannulate him
because the technician has been talking, non-stop,
about a terrible divorce and custody battle that she
is going through. He describes her in a constant
state of impatience and anger. He refuses to let
her work with him because he is afraid that she
won’t concentrate on his arm. He’s afraid that she
will ultimately cause him pain because she is not
focused on her job or her patients.
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For Our Discussion
• What rule of professionalism or code of conduct
was broken?
• What boundaries (if any) were crossed?
• What should have happened?
• If you were the staff member in this scenario,
how would you have handled it?
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It’s a big deal to me!
A dialysis patient often sees technicians at the dialysis
facility move from one patient to another without
washing their hands or changing gloves. One morning
the patient’s machine started beeping and a technician
walked over from another patient area and hit a button
on his machine to reset the alarm without changing
his/her gloves. The patient stated to the technician
“You did not wash your hands or change your gloves
before you touched my machine!” The technician
stated back to the patient, “Don’t worry about it, I know
what I am doing, it’s not that big of a deal.”
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For Our Discussion
• What rule of professionalism or code of conduct
was broken?
• What boundaries (if any) were crossed?
• What should have happened?
• If you were the staff member in this scenario,
how would you have handled it?
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There, There Sweet Baby…
A retired colonel stated to the facility manager that
a new technician was being very disrespectful.
When asked what the technician had done to be
disrespectful, he stated, “She calls me hon, honey,
sweetie pie, and cutie. She even called me a baby
because I complained about how bad I was
feeling. I’m a Colonel in the United States Army! I
served in two wars! She should be calling me
Colonel Jones, Mr. Jones or Sir!”
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For Our Discussion
• What rule of professionalism or code of conduct
was broken?
• What boundaries (if any) were crossed?
• What should have happened?
• If you were the staff member in this scenario,
how would you have handled it?
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Stop Telling Me What to Do!
A dialysis facility dietitian has been trying to
explain to a patient the importance of monitoring
potassium. The patient begins yelling at the
dietitian, “I’ve given up everything I love!
Tomatoes, strawberries, and bananas. I don’t have
any potassium in me. I’m sick and tired of being
harassed by you. You’re one to talk! Look at you,
Miss Fatty Pants! Who are you to tell me how to
diet?” The dietitian then yells at the patient, “If you
don’t shut up right now, you’ll never be able to
come back here!”
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For Our Discussion
• What rule of professionalism or code of conduct
was broken?
• What boundaries (if any) were crossed?
• What should have happened?
• If you were the staff member in this scenario,
how would you have handled it?
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I’m the Only Caregiver for You,
Babe!
A patient refuses to allow any technician, except
for his absolute favorite, to cannulate him. It was
discovered that the technician had told the patient,
“I’m the best technician here and the only one you
need. I’ll take the best care of you and make sure
nothing bad happens to you while you are on the
unit.” Now this technician has moved to another
dialysis unit across town. The patient is furious and
scared. He’s demanding to know, “Where has my
girlfriend gone?”
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For Our Discussion
• What rule of professionalism or code of conduct
was broken?
• What boundaries (if any) were crossed?
• What should have happened?
• If you were the staff member in this scenario,
how would you have handled it?
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Staff-to-Staff
COMMUNICATION STRATEGIES FOR
TEAM BUILDING
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The Sustainable Circle of Success!
Happy
Patients
Happy
Facility
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Happy
Staff
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Communication Scenarios
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Failure is Not an Option!
What is the most
important reason to
support and assist
other staff?
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Teachable Moments
• Give immediate assistance when possible.
• Provide examples within a non-parental,
non-judgmental, “What I’ve learned,” or
“What helped me,” framework.
• Use the opportunity
to reinforce both staff and
patient teaching, so that everyone
learns at the same time.
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Why Be Mean?
Why do people bully others?
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Teachable Moments
• Reduce criticism and inspire confidence.
• Mentor using a “walk through” technique.
• Allow for questions, feedback, and learning
curves.
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R-E-S-P-E-C-T
The Rebound Effect
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Teachable Moments
• How important are you?
• What really happens when you discourage
communication?
• The “day after” conversation
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Take It Away
Two final thoughts as we close
this portion of the workshop:
It is so awesome; you get to do this every day.
Your words have the power to change things.
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BREAK
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Christina Beale, RN, CNN
Lifeline Vascular Access
VASCULAR ACCESS – THE
PATIENT CHRONICLES
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Network Contacts
Helen Rose, MSW,LCSW
[email protected]
Beverly Whittet, RN,CDN
[email protected]
Mary Fenderson, RN, CNN,MSHSA
[email protected]
Phone: 813-383-1530
Fax: 813-354-1514
www.fmqai.com
This material was prepared by ESRD Network 7, under contract with the Centers for Medicare & Medicaid Services
(CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily
reflect CMS policy nor imply endorsement by the U.S. Government. FL-ESRD-Aim1-11142014-01
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PROGRAM EVALUATION
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