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Communication skills How to deal with complaints

Communication skills How to deal with complaints

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Communication skills How to deal with complaints

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  1. Communication skillsHow to deal with complaints David Bartle Consultant Paediatrician RDE

  2. Outline • Aims • To consider why patients / parents complain • Consider the skills we need when dealing with complaints • How to avoid complaints

  3. Exercise • Think of a time when you were involved in a patient complaint – either directly or as a bystander • How was the complaint handled? • How well was it handled? • What went well and what could have been done better?

  4. Scale of the problem • 5% of population reported adverse outcome from healthcare. 1:3 said it caused permanent effect • 850,000 estimated AE per year in acute trusts – 10% 0f admissions • 5,426 claims against NHSLA in 2006-7 • Far higher number of people complain

  5. When people complain, what do they want? • Discuss in pairs for two minutes

  6. Why do people sue? • 70% of litigation related to poor communication after an adverse outcome where patient feels they have been • Deserted • Devalued • Poorly informed • Misunderstood • Poor explanation of procedures • To find out what happened and why • To enforce accountability • Compensation for accrued or future costs

  7. Why do people complain? • Apology and explanation 34% • Enquiry 23% • Non-financial support 17% • Money 11% • Disciplinary action 6% • Other 9%

  8. You are on duty at 11 o’clock at night. SpR & consultant are busy in A&E. Nurses have done a drug round and realised that the dose of domperidone prescribed earlier that day was 5 times greater than it should have been. One dose was given by the afternoon shift. Nurses have told parents who are upset and angry. What do you do?

  9. Risk factors • Negative communication behaviour by doctors increases litigious intent – even if no adverse outcome • >50% of patients who sued were minded to do so before the event happened

  10. Who gets sued? • Males >>> females • 87% of complaints against male doctors • Those who have had training in risk management less likely to be sued • No evidence that litigation history is directly linked to clinical competence • BUT – complaints are accurate predictor of future lawsuits • 5% of doctors account for 30% of complaints • Further 4% account for 20% of complaints

  11. Patient Expectations • Disappointment related to unmet expectations • Identifying and addressing patient expectations is important strategy in risk management

  12. Expectations • Personal qualities of doctor • Quality of treatment received • How much time will be spent with them • How they will be treated as people • Doctor availability • Competence • How ancillary staff will treat them • Amount of information they will receive

  13. Realistic Vs unrealistic expectations • Realistic • Adequate time • Doctor interested • Other staff helpful • Appropriate access to doctors • Respect • Heard • Unrealistic • Unlimited time • Unlimited availability • Errors or adverse events never occur • All treatment successful 100% of time • All issues addressed in one consultation

  14. In the absence of predisposing factors, a precipitating factoris unlikely to lead to patient action against a doctor • What are predisposing/precipitating factors?

  15. Expextation Management • This is a very difficult/easy operation • Moving the bar to achieve satisfaction • Dell computer delivery promised within 10/7 • Vast majority within 3-4/7 • Very nearly all within 10/7

  16. What skills are needed when addressing complaints? • Effective communication • Verbal and non-verbal • Making human connection early • Listening as important as talking • Conveying empathy helps people feel heard and understood

  17. Behaviours Non-sued Sued Patients felt rushed Received no explanations Felt less time was spent Felt ignored • Asked patient opinions • Laughed • Patient perceived sufficient time spent • Explained process • Confirmed patient understanding • Offered emotional support

  18. Starting off the right way • First impressions • Staff, environment, greeting, CAR PARKING • Patient “rapid assessment” • Are you listening? • Do you care? • Are you going to get this right?

  19. Comm skills • Greeting / welcoming • Maintain eye contact • Same eye level • Personal connection • Allow patients to tell their story • Often rehearsed, very important to tell in full • Tendency to interrupt • Expect you to listen • Failure to listen makes meeting feel rushed or you are not interested • Non-verbal communication very important

  20. Non-verbal communication • 80% of communication is non-verbal • Doctors with competent NVC have significantly higher patient satisfaction scores and are rated as more caring • Poor body language can make things much worse

  21. NVC • Mirroring body language • Adopt postures, gestures and expressions of patient • Appropriate eye contact • Matching voice and vocabulary • Rate of speech • Volume of speech • Vocabulary • Tone of voice • Convey empathy • Short summarising sentences • Relay history and add emotion

  22. Establish patient expectations • “What were you hoping to achieve today?” • “What else would you like to discuss? • “Are you sure there’s nothing else?” • Check understanding • Check your understanding of patient’s expectations • Allow opportunities to ask questions • Provide information using non-technical vocabulary- Translate medical talk to English • Establish a management plan in partnership with patient

  23. Working in teams • Up to 50% litigation initiated at suggestion of another health care professional • Ill advised comments • Encourage litigation against colleagues • Make sure you have facts right • May cause resentment against you • Acknowledge need for an answer, but need all the facts • Ask person to speak to the individual involved directly

  24. If patient raises concerns about colleague • Confirm your commitment to care for patient • Stress you work as a team and each brings different skills • Realise you may not have the full facts • Offer to speak to others for further information and / or clarification

  25. Documentation • Essential for good medical care • Reflects professionalism • Forms the basis for defence • “Claims were twice as likely to be successfuly defended if documentation was judged to be adequate”

  26. Documentation • Contemporaneous record of relevant history (within 24 hours) • Recommended treatment (pro’s and con’s) • Record decisions made jointly • Actions expected by patient • Follow up plans • Questions you have answered

  27. Documentation • Additions to records chould be • Clearly labelled • Dated • Signed • Altering records in any other way renders them at best worthless and at worst contributing to evidence against you

  28. Summary • Cause of litigation is complex • As a result of predisposing and precipitating factors • Patients make an assessment of our competence based on our interactive skills • Convey Empathy • Address unrealistic expectations • Treat staff and colleagues with respect • Be honest