ARTHUR BREWER, MD, CCHP, CLINICAL ASSISTANT PROFESSOR, DEPARTMENT OF FAMILY MEDICINE,

ROBERT WOOD JOHNSON MEDICAL SCHOOLSTATEWIDE MEDICAL DIRECTOR

MECHELE MORRIS, PHDDIRECTOR OF TRAINING

UNIVERSITY CORRECTIONAL HEALTHCAREOF

THE UNIVERSITY OF MEDICINE & DENTISTRY OF NEW JERSEY

Decreasing Patient Complaints & Improving Satisfaction in a

Correctional Environment

PARTICIPANTS WILL:

U N D E R S TA N D T H E R E L AT I O N S H I P B E T W E E N G R I E VA N C E S &

L I T I G AT I O N

B E A B L E T O D I S C U SS T H E I M P O RTA N T A S P E C T S O F A N I N M AT E G R I E VA N C E P R O C E SS

B E A B L E T O I D E N T I F Y VA R I O U S T R A I N I N G M E T H O D S P R OV I D E D T O M E D I C A L S TA F F

L E A R N T H E B E N E F I T S I M P R OV E D C O M M U N I C AT I O N S T R A I N I N G H A S O N G R I E VA N C E S

OBJECTIVES

PATIENT COMPLAINTS

Allows patients to provide feedback

Provides helpful information to health organizations about:

Systems that may need improvement

Staff

Areas with the potential for liability

Patient Complaints & Malpractice Risk

Unsolicited patient complaints are positively associated with physicians’ risk management experiences.

Risk appears to be related to patients’ dissatisfaction with their physicians’ ability to:

Establish rapport

Provide access

Communicate effectively

SOURCE: JAMA, JUNE 12, 2002

Malpractice Risk by Specialty

7.4% of all physicians had a malpractice claim

Range

19.1% in Neurosurgery to 2.6% in Psychiatry

5.2 % Family Practice

8 % Internal Medicine

Source: NEJM Aug 18, 2011

Physician Patient Communication

Routine MD – Patient communication differs in primary care MDs with malpractice claims versus those without malpractice claims

Orienting to the process

Use of humor

Facilitation

Active Listening Source: JAMA Feb 19, 1997

Why Patients Sue

Deserting the patient (32%)

Devaluing the patient &/or family views (29%)

Deliver information poorly (26%)

Failing to understand patient &/or family perspective (13%)

Source: Arch Intern Med June 27 1994

Inmate Grievance Process

Standardized

Patient Representative at each facility

Complaints received centrally & distributed

Response timelines enforced

Analysis & monitoring ongoing

Results used for training & process evaluation

Top Medical Grievances

Co pay

Relationship between patient & practitioner*

Medication issues

*Practitioners cite the relationship with some patients to be their

biggest challenge

Relationship Between Patient & Provider

Staff conduct

Dissatisfaction with provider

Delay in treatment (perception)

Failure to treat (perception)

Relationship Between Patient & Provider

Common thread for these complaints is inadequate communication

Perceived lack of focus on issues of concern to patient

Patient not fully understandingPatient doesn’t feel engagedMutual trust & shared decisions are

challenging at best

INTERVENTION

Introduction of staff training

Invitation to submit details of difficult patient encounters

Site visits/training with medical staff

General meeting with role play video

Online training options including CME

BATHE TECHNIQUE

Brief Psychotherapeutic Patient-Centered Technique

fitted into a 15 minute appointment

BackgroundAffectTroubleHandlingEmpathy

MD Anderson Online CME

Interpersonal Communication And Relationship Enhancement I*CARE I*CARE Program

Designed to improve communication among patients, their families & their clinical team 

Provide information on “how-to's” of patient-doctor communication (breaking bad news, non-verbal communication skills, medical errors, end of life & more)

Basic Strategieso Learn four useful communication strategies

Non-Verbal Communication Review techniques for effectively using non-verbal communication Discover how paying attention to non-verbal behavior in clinical encounters

can help with the messages you send to others

Managing Difficult Communication Disbelief/Denial Serious Illness/Sensitive Discussions Crossroads

ONSITE TRAINING

STAFF PRESENT DIFFICULT CASESWhat was difficult about the case?Why was it difficult?

RESPONSEPeers offer feedback & share their experiences

with the same patient

REPEATED RESULTStaff often take difficult interactions personally

EFFECTIVE ENGAGEMENT

Introduce patient to the service relationshipExplain our roleTry to find common ground to build onNon-threateningRespect, accept, supportActive listeningHelp patient make informed choicesIs consistent with repeated, predictable

patterns of interaction when you meet and incorporate the things above

CULTURAL ADAPTATION

Personality Disorder: “…enduring pattern of inner experience & behavior that deviates

markedly from expectations of the individual’s culture.” DSM IV

Suspiciousness, hostility, social withdrawal & self centeredness

Adaptive & expected patterns of behaviorLooking out for self & distrust of others are

necessary to survive

Would I want to work with me?

Monitor Your BehaviorPosture

Tone

Eye contact or lack thereof

Are you listening/paying attention

Are you focused on now or later

Taking Crap With Dignity & Style

No matter what you do, you’re still going to get crap!

Acknowledge crap is being flung at you

Consider your options Resist, dismiss, defend Give the insults & negativity no power

Try giving into the crap

WHY ME?

Are you utilizing all the skills available ?

Mental Health

Nursing

Correctional staff

Colleagues

Tips You Can Actually Use

Paraphrasing

Anticipate resistance but focus on the here & now

Avoid telling patient what to do…present options

Learn to let them say what they want

Give respect even when it’s not deserved

Practice patience

Humor

Medical Grievances Data

Year Request for

services

Unfair Treatmen

t

MD/NPCommunicatio

n

Med Issues

DOC Issues

Total

2011

882 784 846 688 251 3510

2012

1015 679 586 492 138 2910

13% reductio

n

30%reduction

28% reductio

n

45% reductio

n

17% reductio

n

THE BOTTOM LINE

Treatment in corrections takes many forms;

but most important is basic human respect

& concern!

REFERENCES

Stuart MR, Lieberman JA: The Fifteen Minute Hour: Therapeutic Talk in Primary Care. UK, Radcliff Publishing, 2008.

Thompson GJ, Jenkins JB: Verbal Judo, The Gentle Art of Persuasion. NY, Harper Collins, 2004.

Rotter M, Way B, Steinbacher M, et al: Personality disorders in prison: aren’t they all antisocial? Psychiatric Quarterly, Vol. 73, No. 2, Winter 2002.

Dvoskin JA, Spiers EM: On the role of correctional officers in prison mental health. Psychiatric Quarterly, Vol. 75, No. 1, Spring 2004.

Allen B, Bosta D: Games Criminals Play: How You Can Profit by Knowing Them. CA, Rae Hohn Publishers, 2007.

Buffington PW, Cheap Psychological Tricks: What To Do When Hard Work, Honesty and Perseverance Fail. GA, Peachtree Publishers 1996.