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International Ombusman Association 2010 Annual Conference

HealthCare Ombudsman/Mediators Purpose

To serve as an advocate for a fair process for patients, families, clinicians, and the organization, without assuming the role of an advocate for any party.

HealthCare Ombudsman/Mediators Goals

Primary: Enhance staff and patient satisfaction and improve patient safety

Secondary: Offer alternatives to litigation

Today’s Agenda Setting the Stage - Why Communication Is

Important

The Good News! Communication is A Skill

Barriers

Active Listening

6 Steps to Speaking

How to Listen So Your Visitor Will Speak Top Ten Reasons to “Listen” to Today’s

Presentation #10 What’s the Big Deal? #9 The Good News! #8 “Doing The Right Thing” The

Presentation #7 Cousin Vinny’s Words of Wisdom #6 Active Listening #5 Which Conversation Is It?

Presentation #4 How to Speak – No Mistake #3 How to Speak – Mistake! Yikes! #2 See It Done Right*

How to Listen So Your Visitor Will Speak The Most Important Reason:

#1 What’s in it for you ??

(How you might secure your next promotion!)

How to Listen So Your Visitor Will Speak Two Perspectives –

Healthcare Traditional Workforce

How to Listen So Your Visitor Will Speak “There’s been a great deal of emphasis on

communication in general in health care…”

Vital Smarts President, Joseph Grenny (2006)

How to Listen So Your Visitor Will Speak Setting the Stage – Patient’s Perspective

Multiple Providers/Healthcare Delivery Sites Complex Healthcare Environment Heightened Emotional State Fear Broken Trust

How to Listen So Your Visitor Will Speak Setting the Stage -Physician’s Perspective

Complex Healthcare Environment Fatigue High Stress

How to Listen So Your Visitor Will Speak Setting the Stage -Employer’s Perspective

Fast changing environment Increased Competition Lack of Resources

How to Listen So Your Visitor Will Speak Setting the Stage -Employer’s Perspective

Insufficient Notice No Voice Resource Allocation Disagreements Lack of Job Security

How to Listen So Your Visitor Will Speak Setting the Stage – The Organization’s

Perspective Ineffective communication costs

How to Listen So Your Visitor Will Speak This same study suggests – Costs to the

Organization Loss of time Loss of business Loss of people

How to Listen So Your Visitor Will Speak Costs to the Organization cont:

Behavior problems amongst the staff Misunderstandings at all levels Failed Collaboration

How to Listen So Your Visitor Will Speak Costs to The Workforce cont:

Mistrust Stress Related Illness Dissatisfaction with the Work

How to Listen So Your Visitor Will Speak What is a leader to do?

“As a leader one must have facility in tempting the hearer into that leap of imagination that connects the verbal concept to the hearer’s own experience”

Greenleaf (1977)

How to Listen So Your Visitor Will Speak The Good News!

“Regardless of personal style, education, or experience, better communication skills can be learned and practiced.”

Ron Classen

How to Listen So Your Visitor Will Speak Communication is a Skill~

Reading, Writing, Speaking & Listening can be learned!

Requires practice, practice, practice Has universal applications*

How to Listen So Your Visitor Will Speak “Communication lies at the heart of personal

interactions...” Ron Classen

How to Listen So Your Visitor Will Speak Why is Communication Important?

Benefits Connection Clarity Partnership/Collaboration Creative Problem Solving Openness

How to Listen So Your Visitor Will Speak Barriers

External distractions Physical environment Other people

Internal Distracters Physical Psychological Cognitive Emotional

Physical Pain Fatigue Comfort

Psychological Stress Self Absorption Inner Dialogue Anxiety

How to Listen So Your Visitor Will Speak My Cousin Vinny

How anxiety and stress may impact our ability to listen…

Click on the box to launch the video

Emotional Uncomfortable Feelings Overly Concerned About One’s Well-being Embarrassment

Cognitive Expectations Rebuttal Yes, But Making the Dots

How to Listen So Your Visitor Will Speak How cognitive factors may impact one’s

communication…. Notice how this young man reacts to his internal

expectations and how he creates the dots.

Click on the box to launch the video

How to Listen So Your Visitor Will Speak Listening is about RESPECT

“Listening to someone may be the cheapest concession you can make. We all feel a deep need to be understood”

William Ury

How to Listen So Your Visitor Will Speak Promoting Listening

Space Engagement Eye Contact Body Language Paraphrasing Effective Questions Curiosity Acknowledging Feelings Empathy

Gerald Monk, Ph.D & Stacey Sinclair, Ph.D

How to Listen So Your Visitor Will Speak Listening

Helps people relax and develop trust Facilitates focus on relevant issues Conveys empathy, respect and acceptance of

persons

Helps identify and summarize each person’s ideas, perceptions and concerns

Leads to a clear statement of problems and issues

Intent 3 (listen):1 (speak) Message quality

How to Speak So Your Visitor Will Listen “Good is the enemy of great.”

Jim Collins (2001)

Speaking So Others Will Listen Which conversation is it?

Meet and greet Information receiving Relationship building

Walking the talk Right - right

Speaking So Others Will Listen Which conversation is it?

Closing the deal Reporting findings

Or Righting a wrong

Speaking So Others Will Listen A 6 step strategy (A.A.L.E.E.)

A – anticipate A – adjust L – listen E – empathize E - explain

Speaking So Others Will Listen Anticipate

The visitor’s needs Information Emotional support Social connection Reflective listening

Speaking So Others Will Listen Adjust

Your communication for Language Culture Nonverbal Timing Pace Depth What vs what and how

Speaking So Others Will Listen Listen

How much Understanding Clues Respect Hook up

Speaking So Others Will Listen Empathize

Not agreement but recognition Situation Concerns Fears Hopes Anxieties Needs

Speaking So Others Will Listen Explain

Only after … Give the other notice Give the information

Timely Accurate Sensitive Transparent Complete

Take Notice

Speaking So Others Will Listen Recap A.A.L.E.E.

A – anticipate A – adjust L – listen E – empathize E – explain

Three times

Speaking So Others Will Listen A health care example

The conversation is both a Meet and greet

And Walk the talk

Speaking So Others Will Listen Note how the doctor:

Anticipates Adjusts Listens Empathizes Explains

Speaking So Others Will ListenHealth care demonstration of A.A.L.E.E.

Speaking So Others Will Listen What did your inquiry reveal?

The wrong thing the right way The right thing the wrong way The right thing the right way

Three health care examples

Speaking So Others Will Listen The T.E.A2.M. Approach

T - truth, transparency, teamwork E - empathy A - apology A - accountability M - management

Speaking So Others Will Listen T - truth, transparency, teamwork

But first… What How Who

Speaking So Others Will Listen E – Empathize

You show before they know Knowing is showing Pinching the pinky toe Platinum not gold

Speaking So Others Will Listen A - Apology

Effective apology Who offers

Speaking So Others Will Listen A - Apology

*5 Rs to effective apology Recognition Regret Responsibility Remedy Realignment

Speaking So Others Will Listen A - Accountability

Who owns the solution What is the plan Who are the players and what are the roles

Speaking So Others Will Listen M – Management

Emotional support Ongoing communication Help in recovery

Speaking So Others Will Listen Recap the T.E.A2.M. Approach

T - truth, transparency, teamwork E - empathy A – apology/accountability M - management

Speaking So Others Will Listen Wrap up

Use your tools Determine the conversation Maintain your focus Take care of your self Do good work Stay connected

Speaking So Others Will Listen

To understand or explain A – anticipate A – adjust L – listen E – empathize E - explain

To right a wrong T - truth, E - empathy A - apology A - accountability M - management

Summary

Final Thoughts

How does a 6 step strategy have only five steps? 5 steps to becoming good The hidden step From good to great The cost of greatness

Contact Information Susana Garcia

susana.j.garcia@kp.org (559) 448-5189

David Richardson david.m.richardson@kp.org (909) 427-7720

References Classen, R., & Reimer, D. (2005). Basic institute in

conflict management and mediation. Fresno, California: Fresno Pacific University.

Collins, J. (2001). Good to great (1st ed.). New York, NY: HarperCollins Publishers.

Fellowship Bible Church. (2005). Get Service. Retrieved July 26, 2008 from www.fbclr.org

Greenleaf, R. K. (1977). Servant leadership a journey into the nature of legitimate power and greatness. Ramsey, N.J.: Paulist Press.

References Launer, D. (Producer) & Schiff, P. (Producer). (1992). My

Cousin Vinny [Motion picture]. United States: Twentieth Century Fox Home Entertainment, Inc..

Monk, G. & Sinclair, S. (2008). Conflict Resolution and Narrative Mediation for Healthcare Professionals. Emeryville, California: Kaiser Permanente.

O’Connell, D. (2008). Communicating Unanticipated Adverse Outcomes with Patients. Oakland, California: Kaiser Permanente.

Potter, John W. "Communicating with the Unhappy Refractive IOL Patient." Mastering Refractive IOLs: the Art and Science. Thorofare: SLACK, 2008. 807-810.

References Sales and Marketing Management. (2006, December

22). The cost of poor communication. Retrieved March 16, 2010, from managesmarter.com

Ury, W. (1993). Getting past no (1st ed.). New York, New York: Bantram Books.

VitalSmarts. (2006, February 8). Silence kills, dialogue heals. Retrieved March 3, 2008, from silencekills.com

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