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Studer Spotlight: DIFFICULT CONVERSATIONS: THREE MODELS FOR YOUR LEADERSHIP TOOLKIT

Posted on Tue, Dec 16, 2014
Studer Spotlight: DIFFICULT CONVERSATIONS: THREE MODELS FOR YOUR LEADERSHIP TOOLKIT

Since 2010, EmCare has maintained a strong partnership with Studer Group to improve clinical and operational results for our client hospitals. As a result of this partnership, Studer Group has provided access to exclusive content only available on StuderGroup.com. Each month, one of Studer Group's insightful articles will be made available to Emcare.com blog readers. For more information about EmCare's partnership with Studer Group, click here. For more exclusive content, including webinars, learning labs, networking opportunities and more, visit StuderGroup.com

THREE MODELS FOR YOUR LEADERSHIP TOOLKIT
By: Lynne Cunningham, MPA, FACHE

After spiders, snakes and public speaking, people seem most afraid of having difficult conversations. It doesn't matter if the conversation needs to occur with an employee, peer, boss, spouse or child; we all shy away from these critical communications. Why? It's likely because we don't understand the seriousness of biting the bullet and having the conversation and don't have the skills to have these difficult conversations successfully.

Click here to watch Lynne Cunningham's video!

At Studer Group®, we have three models for difficult conversations which are part of a leaders' toolkit. The key is to learn about the models, practice them, and pick the appropriate model for the situation. More about that in a minute. First, let's look at why it's so important to have these conversations.

One key to having a difficult conversation successfully is to be a good listener. Studies show us that we spend 9% of our time writing; 15% reading; 35% talking and 40% listening. It's time we focus on learning to listen. We need to listen for the tone of an individual's voice in addition to their words and observe their body language. We need to practice active listening.

Now back to the difficult conversation models. The first difficult conversation model is the Impact Messagedeveloped by Studer Group and my colleague Beth Keane. Beth has shared this model with audiences across the country and talks about it in her popular "Spinach in your Teeth" webinar. There are four steps to this model:
 

  1. Describe the behavior
  2. Describe the impact
  3. Indicate the desired change
  4. Get a commitment

When using this model for a difficult conversation, it can sound like this:
  • When you interrupt me while I'm talking...
  • The result is that I don't feel as if I've been able to explain myself adequately
  • I need you to let me finish before you respond
  • Do you agree that you can do this?

This model is ideal for a leader-to-employee conversation, a conversation between a team or committee chair and a member of the committee, or between colleagues.

The second model is "Cup of Coffee Conversations" which is based on research and curriculum developed by the Center for Patient and Professional Advocacy at Vanderbilt University. Although the model was originally developed for conversations with physicians, it is easily adapted to all employee groups and is a conversation that can be held with peers, employees, or even your boss. Many organizations utilize this model and have made it their own, such as "Cup of Tea" or a "Glass of Pop/Soda" conversations.

A "Cup of Coffee Conversation" is typically precipitated when you see or hear a colleague exhibiting behaviors that are contrary to your Standards of Performance or Behavior. This is a conversation that occurs at the time you witness the behavior to make the individual aware that their behavior is not consistent with your standards.

Start by telling them you value them as a colleague or appreciate their skills. Then let them know you heard or saw something that was uncharacteristic and not consistent with your Standards. For example: "Donna, let's go have a "cup of coffee." I noticed that you didn't wash your hands when you entered the patient's room. This doesn't live our values or standards and is concerning to me." Then pause – thus the cup of coffee – and take a sip.

The typical reaction from the person is appreciation for bringing this to their attention. If they deny or justify the behavior, be patient and ask them to "look in the mirror." You're not telling the person they are "bad"; you are merely relating what you experienced.

The third model is the Low Performer conversation. This is part of Studer Group's highmiddlelow® evidence-based leadership tool and is designed for use with someone who persistently demonstrates inappropriate behavior that is inconsistent with policies, procedures, Standards or other work rules. This is a conversation that typically a leader would hold with an employee on their unit or team.

Start the conversation on a serious and professional note. This is probably a conversation you've had with this person before and performance hasn't improved. Then use the DESK model:

D: Describe what has been observed.
E: Evaluate how you feel.
S: Show what needs to be done.
K: Know the consequences of continued same performance.


With proper training and skill building in the non-threatening Leadership Development Institute or team meeting environment, leaders and staff can successfully have difficult conversations using these models. One method for experiential training is to role play in triads with one person being the conversation initiator, one person is the individual you're having the conversation with, and the third person is an observer who provides feedback to the first two people. Then rotate so everyone gets a chance to play each of the three roles. Use real scenarios that individuals in the LDI or team meeting have created. That keeps the conversation focused on real-life situations and makes sure everyone is serious about the skill development.

Difficult conversations can be uncomfortable, but with training and practice, you too can hold difficult conversations – successfully.

To learn more about conducting difficult conversations, including guidelines, tracking logs and more, visit the Tools tab at www.studergroup.com.

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Studer Spotlight: Connecting with Patients While Using Electronic Health Records

Posted on Tue, Nov 25, 2014
Studer Spotlight: Connecting with Patients While Using Electronic Health Records

Since 2010, EmCare has maintained a strong partnership with Studer Group to improve clinical and operational results for our client hospitals. As a result of this partnership, Studer Group has provided access to exclusive content only available on StuderGroup.com. Each month, one of Studer Group's insightful articles will be made available to Emcare.com blog readers. For more information about EmCare's partnership with Studer Group, click here. For more exclusive content, including webinars, learning labs, networking opportunities and more, visit StuderGroup.com

CONNECTING WITH PATIENTS WHILE USING ELECTRONIC HEALTH RECORDS
By: Barbara Roehl, MD, MBA


There’s no substitute for “connecting” with the patient. Effective communication and demonstrating empathy is a critical component to quality patient care. New technologies such as Electronic Health Records (EHRs) can seem like a barrier for physicians and providers looking to build a connection.

According to a New England Journal of Medicine article (Wolpaw, MD, D.R., Shapiro, Ph.D. D; N Engl J Med 2014; The Virtues of Irrelevance 370:1283-1285, April 3, 2014, DOI: 10.1056/NEJMp1315661), personalized opening comments, “convey that we see patients as unique”, “reveal that we have shared experiences”, “are observant and attending to details”, and “indicate that we are open to a conversation.” All of these help to put the patient at ease and establish a therapeutic relationship.

As healthcare is getting even faster paced, and with an increased focus on productivity and utilization of EHR’s becoming the norm, how can we maintain the “connection” in our encounters with patients? As a practicing physician, I personally have been through two EHR implementations in the ambulatory setting, and currently planning for a third (one in inpatient setting and heading for a second), here are a few tips and tricks that can make a big impact:

Briefly review the chart prior to entering the room so the beginning of the encounter isn’t dominated by staring at a screen while rifling through the EHR to find basic information. Be clear on basics of their care, including last visit and needs for this one (prescriptions, referrals, etc.). Make sure the patient’s first and last name are known. If a note was made during the last visit of something special in their life, such as a birthday, wedding, or vacation, ask briefly about it. Patients will be more forgiving when we document in the computer if we’ve already made them feel we’re interested and listening.
Don’t forget your AIDET®.

An important part of AIDET® is the “A” for Acknowledge. This step helps us make a connection to patient. In addition to eye contact, smiling, addressing by name, sitting down, and shaking hands, opening the encounter with a personalized, genuine statement can help make a connection that will make the rest of the encounter more collaborative and satisfying. It can also make the patient more tolerant when we use EHRs.

Include EHR as part of the “Acknowledge” step. State why we use it and how it helps in patient care. Specifically indicate that we will periodically turn to EHR to capture important points for the patient’s shared care plan. When we aren’t documenting in EHR, it’s important to have good eye contact. When we do turn to use EHR, be sure to indicate what you are doing. For example, “Just let me capture that important information”, “Just a moment while I include that in your treatment plan”. Use whatever verbiage and phrasing that feels comfortable while acknowledging the transition to and from the computer.

Don’t forget the “T” in AIDET®: Thank You. Thank the patient for visiting us and close warmly. Don’t let documenting on the computer get in the way of a gracious end to the encounter, complete with eye contact, a hand shake, smile and genuine pleasantry.

Manage up the EHR (or at least don’t manage it down), just as we manage up the rest of the care team. This helps to create overall confidence in the care provided. 

A great way to engage patients with the EHR is through the use of graphics and visuals. For well child visits, try showing the growth curve. For chronic disease, show trending graphs for blood pressure, weight, A1Cs, or lipids. This is an excellent opportunity to be transparent with our patients and provide detailed explanations that patients appreciate.

Pay attention to body position in relation to the patient and computer. Is the physical layout of the office conducive so we can sit, talk, and document the encounter with an unobtrusive computer set-up, facing the patient? If not, think about rearranging the room. Consider seating the patient at your EHR station with proximity to both you and the monitor.

Try utilizing a scribe during patient visits. This allows providers to remain solely focused on the patient while the scribe captures plan of care notes in the EHR. Make sure that you inform the patient of the scribes name and role.

As we move into a more electronic age, let’s not lose the connection to purpose and connection to patients. It doesn’t need to add significant time to a visit and can make a big impact. When we connect, the patient feels it, and so do we. It’s equally as good for the patient as it is for the physician. Happier patients lead to happier doctors. It connects to purpose, worthwhile work and why we got into healthcare in the first place. Connecting adds purpose and meaning, for both patient and doctor.

Additional Resources:

Gain additional tools, tips and perspective during the Physician Partnership tracks at Studer Conferences
Download the AIDET® Guidelines and Key Words document to gain tips for physicians and providers implementing AIDET®.

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Studer Spotlight: Does Provider Dress Code Impact Patient Experience?

Posted on Thu, Sep 25, 2014
Studer Spotlight: Does Provider Dress Code Impact Patient Experience?

Since 2010, EmCare has maintained a strong partnership with Studer Group to improve clinical and operational results for our client hospitals. As a result of this partnership, Studer Group has provided access to exclusive content only available on StuderGroup.com. Each month, one of Studer Group's insightful articles will be made available to Emcare.com blog readers. For more information about EmCare's partnership with Studer Group, click here. For more exclusive content, including webinars, learning labs, networking opportunities and more, visit StuderGroup.com

PROVIDER DRESS CODE AND ITS IMPACT ON PATIENT EXPERIENCE

By: Dan Smith, MD, FACEP

Copyright 2014 by Studer Group, reprinted with permission.

Physician attire and appearance is an area that many organizations discuss and, in hospital medicine, emergency medicine, radiology, surgery, anesthesiology, studer group, healthcare providerhospital medicine, emergency medicine, radiology, surgery, anesthesiology, studer group, healthcare provider some cases, struggle to define. Several factors come into play such as, variations in appearance, generational differences, business casual as commonplace, organizational branding without being overbearing on individuality and so on.

Although more commonly deployed for staff and non-physician positions, dress and attire standards are not a new concept. We find that many organizations have moved to uniform color codes for ease of identification of certain staff positions and have adapted stricter guidelines around dress code, including covering of tattoos.

The literature also suggests that this topic is being addressed across the industry. The common theme is professionalism. One Emergency Medicine study found that formal attire vs. scrubs was not associated with a significant difference in patient satisfaction or perception of professionalism. Another study published in an Archives Internal Medicine article suggests that certain physician appearances conjured "negative" perception.

Patients look for physician appearance to be one that garners trust and assuredness. As an example, a surgeon who meets a patient at surgical clinic with clean, ironed, hospital-issue scrubs is perceived as professional and dress-appropriate. Why? Because a patient associates a surgeon in their professional work attire, which often times include scrubs. On the other hand, a surgeon in fashion-distressed jeans and an open collar shirt with psychedelic design might be perceived as too casual to an anxious patient who faces a major surgery.

Let's say that a provider says, "I don't care about the patient's preference of my appearance or attire". But what if the doctor knew that their appearance and attire might alter a patient's perception, particularly in a negative way? What if we were aligned and committed enough to an organization that we put our individual preferences on hold during the care hours? What if the patient's anxiety reduced when they saw a professional-appearing physician who exuded confidence? What if uniform dress reflected "team", "collaboration" and reduction of variance? That is the essence of dress code.

My thoughts and coaching on this as a practicing physician are as follows:
 

  1. Patients are the focus of what we do in healthcare. I am more than willing to be professionally dressed if it helps my patient have a better experience under my care.
  2. We are professionals in a high stakes, high impact arena. Patient opinion and perception of professionalism should guide our approach.

I would say, though, that we don't want a "cookie-cutter" mandate, like male physician hair parted from the left to the right, hair 1 cm above ear and Johnston-Murphy loafers only! My feeling is what we do in healthcare holds us to a higher standard. The precise dress code and attire your practice embraces is a decision that each group must make and embrace. I hope this content helps you make an informed decision.

Physician engagement and buy-in is an important step to ensuring everyone is on board with changes in policy, such as new physician attire and appearance. Several resources that can assist include:
 
My colleagues, Doctors Stephen Beeson and Jay Kaplan also discuss the importance of aligned, engaged and fully integrated physicians during Studer Group’s Physician Partnership institute. Attendees gain the tools, tactics, behaviors, and best practices that are proven to increase physician satisfaction, improve patient compliance and gain market share through a collaborative partnership with physicians. Click here to learn more.

References:
  • The Journal of Emergency Medicine, Vol. 29, No. 1, pp.1-3, 2005
  • Gjerdingen, Simpson, Titus, Patients’ and Physicians Attitudes Regarding the Physician’s Professional Appearance. Arch Intern Med. 1987; 147(7): 1209-1212.

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