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The Florida ESRD Network
Frontline Floor Staff Workshop
“Together Performing at
a Higher Standard”
November 20, 2014 Gaylord Palms Hotel & Convention Center • Kissimmee, FL
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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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CUSTOMER SERVICE VIDEOWe’re all Friends
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THE PATIENT PERSPECTIVEJoe Karan, Network 7 Patient Subject Matter Expert
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LET’S TALK ABOUT CUSTOMER SERVICE AND PROFESSIONALISM
Dorothy Craft, RN, CDN
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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:
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
• 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?
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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: Our image Our communication Our competence Our demeanor
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From the Patient’s Perspective
A professional is:• 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
• 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
• 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 ThingsPersonally?
• 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: Scheduling Medication Attitudes Access skills
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COMMUNICATION SCENARIOSStaff-to-Patient
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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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COMMUNICATION STRATEGIES FOR TEAM BUILDING
Staff-to-Staff
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The Sustainable Circle of Success!
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Happy Patients
Happy StaffHappy Facility
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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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VASCULAR ACCESS – THE PATIENT CHRONICLES
Christina Beale, RN, CNN
Lifeline Vascular Access
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Network Contacts
Helen Rose, MSW,[email protected]
Beverly Whittet, RN,[email protected]
Mary Fenderson, RN, CNN,MSHSA [email protected]
Phone: 813-383-1530 Fax: 813-354-1514
www.fmqai.com
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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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