INTRODUCTION) TO)FLEXCARE)–) ONLINE)€¦ · INTRODUCTION) TO)FLEXCARE)–) ONLINE)!....

INTRODUCTION TO FLEX CARE – ONLINE . Introduction to Flex Care is based on the original work by Susan Brock, PhD and Judy Allen, MA, RGN and has been adapted and used with permission for this handout only.

Participants Guide

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INTRODUCTION TO FLEX CARE – ONLINE PARTICIPANTS GUIDE INTRODUCTION – Welcome to Flex Care! Flex Care™ is an interactive training program based on an understanding of fundamental differences in individual personalities. Simply put, instead of assuming that all people are the same and therefore have the same communication needs, this program uses psychological type theory (developed by Jung, Myers and Briggs) to introduce participants to the observable differences in personality between individuals. If we can understand and accept these differences we can then learn how these differences are likely to influence individual communication needs.

A basic understanding of psychological type theory can provide health care practitioners with a powerful tool to help them to—

First recognize their own preferred style of communication Identify the personal communication styles of others Adjust (or “Flex”) – when necessary -‐ their own style to better meet the needs of others

This abbreviated version of the Flex Care™ program has been developed using the materials designed by the program authors, Susan Brock and Judy Allen, to provide you with a basic understanding of the Flex Care™ approach to communication within a health care setting (see References at the conclusion of this document). The original program was designed for a 12 hour, on-‐site training workshop. Shorter, more tailored, programs have been developed based on the needs of the participants. Contact the ICCC for more information. When ready, select the first video—Flex Care: Welcome & Background (8 minutes, 36 seconds)

EXERCISE: THINK OF A PATIENT Think of a patient (or any person) that you would like to communicate with better and answer the following questions: -‐How do you usually communicate with this person? -‐What works and what does not work? Where are the “road blocks?” What would you most like to change? When ready, select the video #2—Flex Care: What is it & Why should I care? (15 minutes, 32 seconds)

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PRESENTATION NOTES: The Flex Care training program is based on Judy Allen & Susan Brock’s book, Health Care Communication Using Personality Type: Patients are different! Flex Care is a tool that can help us understand how different people prefer to: • Be approached • Gain information • Make decisions When you work with people, why is a FOCUS on how others prefer to communicate important to you? 1. Effective communication in health care requires us to “tune into” the other people. 2. There are two important parts to our work—WHAT and HOW: -‐WHAT we bring, the skills, knowledge and experience -‐HOW we work, the way we interact and communicate with our patients -‐Since patients don’t know that WHAT, they will “judge” or “evaluate” us based on our HOW or our ability to communicate with the 3. Health care diagnostics and treatments are more sophisticated today than ever before; far

exceeding the average person or patients understanding. Financial and time constraints continue to squeeze available resources. Therefore, as the WHAT becomes more complex, the HOW becomes increasingly important.

When ready, select the video #3—Flex Care: Psychological Type Theory & the MBTI (11 minutes; 30 seconds) What is the MBTI®? The Myers-‐Briggs Type Indicator® • Was developed by Carl Jung (Swiss psychiatrist), and the mother-‐daughter team, Isabel Myers and

Katharine Briggs • Is the most widely used instrument of its kind worldwide • Is well researched and highly validated • Addresses PREFERENCES, not abilities • Demonstrates that the differences between individuals lies in the EMPHASIS and the ORDER of use EXERCISE: WHAT IS A PREFERENCE? Sign your name in the space below first using the hand that you do not normally use and then with the hand that you normally use. Then complete the instructions below.

Right hand Left hand

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Think about the above task and complete the remaining questions before restarting the video: • Could I sign my name with both hands (circle one): Yes No • How did it feel to sign your name with the hand that you don’t normally use? • How did it feel to sign your name with the hand that you normally use? When ready, continue with video #4—Flex Care: Four Preference Scales (54 minutes; 11 seconds) PRESENTATION NOTES: The MBTI® provides a frame work to explain how different people prefer to: 1. Direct their energy 2. Gain information 3. Basis for decision making 4. Orientation to life (not covered in this training program) The four preference pairs look like this:

Each of these pairs represents a dichotomous scale or a scale with two opposite ends. It looks something like: OR MALE FEMALE LEFT RIGHT BLACK Versus WHITE

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In this next exercise, I will describe each end of the scale and ask you to determine which end best represents your preference. EXERCISE: The “4” Preference Scales In this exercise you will be introduced to three of the four MBTI® preference scales. In order to maximize the time available for this program our primary focus will be on the second and third scales, which are the most relevant in terms of communication. We will briefly discuss the first scale but not the fourth. Use the material provided in this section to assist you as you view the video. Pause the video and complete the exercises when instructed. 1. The first scale:

Basic differences between TALK IT OUT and THINK IT THROUGH regarding their direction of energy:

TALK IT OUT—Are energized by: • By people, activities, things outside of me • By talking things out or taking action

THINK IT THROUGH—Are energized by: • By reflection on ideas, emotions, impressions • By quiet times

Answer this question: • Regarding my “Direction of Energy,” I think I have preferences for (check one): TALK IT OUT THINK IT THROUGH 2. The second scale: Let’s start this scale with an exercise. After you observe the picture on the video, write about the picture. What did you see?

Scale ONE: Direction of

Energy

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Now, let’s introduce the second scale:

Basic differences between SPECIFICS and BIG PICTURE regarding their preferred focus of gathering information:

SPECIFICS—Focus on: • Facts • Details • Realities • Past or present experiences

BIG PICTURE—Focus on: • Possibilities • The context of “Why” • Insights • Future

S/N EXERCISE—Describing the picture Let’s discuss the typical response I receive from the describing the picture exercise (shared in the video at the beginning of scale #2). Typically, the descriptions are as follows (by preference): • Those with SPECIFIC preferences will typically share an itemized list of what they see in the picture. This

would include number of men and women, number of wine bottles and glasses on the table, number of individuals with hats on versus those without hats, etc. Others would describe the period of dress or the facial expressions of those in the picture.

• Those with BIG PICTURE preferences will typically share a scenario or story of what they imagine is going on or what might be about to happen. They will talk about the celebratory environment or how some of the characters seem engaged while others were gazing off.

Considering the descriptions provided regarding SPECFICS and BIG PICTURE, look at what you wrote about the picture shared in the video, and then answer this question: • Regarding my preference for “Gathering Information,” I think I prefer (check one) : SPECIFICS BIG PICTURE

3. The third scale:

Scale TWO: How we gather

information

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Basic differences between LOGICAL IMPLICATIONS and IMPACT ON PEOPLE regarding their preferred focus for decision making: LOGICAL IMPLICATIONS—Focus on: • Principles, especially those that follow a

non personal logic • Objective information • An outcome that “makes sense”

IMPACT ON PEOPLE—Focus on: • Values, especially people oriented values • Subjective information • A harmonious outcome that “feels right”

Answer the following: • Regarding my preference for “Basis of Decision Making,” I think I prefer (check one) : LOGICAL IMPLICATIONS IMPACT ON PEOPLE • Respond to the “Hawaii Trip” exercise here: Introducing the Type Table:

Scale THREE: Basis of decision

making

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• Can you locate the “ENFJ” room? How about “ISTJ?” Finally, before leaving this section, use your work above, to determine what are your middle two MBTI letters are: • Preference for Gathering Information(check one): SPECIFICS (“S”) BIG PICTURE (“N”) • Preference for Basic of Decision Making (check one): LOGICAL IMPLICATION (“T”) IMPACT ON PEOPLE (“F”) • The middle two letters of my type are: _____ _____ S or N T or F EXERCISE: Personal Journal In the space provided, reflect on your thoughts and experiences of the program contents thus far. When ready, select the video #5—FlexCare: “Self” Focus to “Others” Focus (16 minutes, 12 seconds) PRESENTATION NOTES:

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Quick REVIEW of where we’ve been Behavior Cues for 3 Preference Scales*: TALK IT OUT (E)

• Rapid speech • Appears to “think aloud” • Interrupts • Louder volume

THINK IT THROUGH (I) • Pauses in answering or giving information • Appears to be thinking things through • Quieter voice volume • Shorter sentences, not run-‐on

SPECIFICS (S) • Asks for step by step information or

Instructions • Asks about the present situation • Asks “what” and “how” questions • Uses precise descriptions

BIG PICTURE (N) • Asks for the purpose of an action • Asks for current and long-‐range implications • Asks “why” questions • Talks in general terms and possibilities

LOGICAL IMPLICATIONS (T) • Appears to be “testing you” or your

knowledge • Weighs the “objective” evidence • Not impressed by what others decide • Conversations follow a pattern of

checking logic, “if this, then that”

IMPACT ON PEOPLE (F) • Strives for harmony in the interaction • May talk about “values” • Ask how others have acted or resolved the

situation • Matters to them whether others have been

taken into account *Adapted from Flex Care Work Book CAPT 2000© Judy Allen and James Gray with permission. EXERCISE: Back to “THINK OF A PATIENT” Think about your interactions with this patient (or person) and try to complete the following. • What is their preferred Direction of Energy (circle one): TALK IT OUT (E) THINK IT THROUGH (I) • What is their preference for Gathering Information (circle one): SPECIFICS (S) BIG PICTURE (N) • What is their preference for Basis their Decision Making (circle one): LOGICAL IMPLICATIONS (T) IMPACT ON PEOPLE (F) When ready, select the video #6—Observing Type in Others (5 minutes; 53 seconds) PRESENTATION NOTES: Introduction to “Type Mode” • It is not practical to know someone’s 4-‐letter MBTI type code. It can also be misleading. • With Flex Care we focus on identifying the preferences the individual is using in this situation —this is

referred to as “Type Mode” • If we listen and watch for behavior cues-‐ this alone can improve our communication

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• We can practice identifying behavior cues EXERCISE: Observing Behavior Cues – Two Minute Videos Watch each of the videos paying close attention to the individual’s behavior cues. Immediately after each video, make notes below (Part A, only) on what you HEAR and what you SEE. Once you’ve completed Part A, complete Part B by determining what was the individuals Type Mode is. Video # What did HEAR; What did you SEE? 1.A. Teri

1.B. What is their preferred Direction of Energy? (E or I)

How do they prefer to Gather Information? (S or N)

What is their preferred Basis for Decision Making? (T or F)

What did HEAR; What did you SEE? 2.A. Marianne

2.B. What is their preferred Direction of Energy? (E or I)



What did HEAR What did you SEE? 3.A. Courtney

3.B.

What is their preferred Direction of Energy? (E or I)



What did HEAR What did you SEE? 4.A. Electra

4.B.

What is their preferred Direction of Energy? (E or I)



After viewing all 4 videos and completing the table above, compare your observations with the behavior cues I captured in the table below. The letter (E, I, S, N, T, F) that most closely matches each statement will be put in brackets at the end of each bullet point.

Teri (IST) Marianne (ENF)

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• Measured energy; steady pace to conversation (I) • Shared sequential story with beginning, middle

and (S) • Gave details, 2006, Colorado, skiing (S) • Talked about “pop” with knee and knowing some-‐

thing was wrong (S) • Comfort with skill and competence of patrol and

doctor; liked that they had seen a lot of this (T) • Used medical terminology (tibial plateau fracture!) (S) • Asked to see x-‐ray (S) • Described physician as having good bedside

manner because he set out the treatment plan and gave logical options (T)

• Rapid speech, not a lot of space (or breaths) between parts of story, animated (E)

• General descriptions “it was a holiday of some kind, not sure what.” (N)

• Concerned with impact of visit on her sick daughter (F) • Described receptionist as “short,”

“didn’t acknowledge,” “no eye contact,” “didn’t care,” and, “not overly friendly” Concluded the staff were pre-‐occupied with working on a holiday(F)

• Wanted small talk; friendly interaction between staff and her daughter (i.e. “hand out stickers”) (F)

• Pleased with first pediatrician (he made them “feel good”) but changed clinics because of staff behavior

• Not exactly sure what the physician did but and felt that he was going to help their daughter feel better (N)

• Changed physician, not because he was bad but because of the personal shortcomings of his staff (F)

Courtney (ISF) • Steady pace of conversation, eyes cast down (I) • Clear and to the point, told only the actual details

of the experience (S) • Gave a lot of details e.g. two hour wait, TV and

magazines in waiting room (S) • Commented that receptionist was “sweet” because

she “felt bad” about the wait (F) • Upset by the fact that the staff seemed in a hurry

and rushed; didn’t seem concerned about her anxiety or fear (F)

• Sequential story describing (in some detail) what happened (infection in wisdom tooth (S) two hours, remove all four wisdom teeth, no anesthesia would be used)

• Upset/disappointed that dentist and assistant didn’t seem to care. She said she had hoped to get “a little comfort” from the dentist and was scared when she didn’t (F)

• Focus on her need for empathy (F)

Electra (ENT) • Easy to hear; animated (used lot of hand movement);

Made a lot of direct eye contact (E) • Got right to the story, no personal lead in (T) • Described the nurse as ‘kind’ because she laid out

the pros and cons (T) • The nurse explained the entire process (no

details recounted) (N) • Talked about the machinery as huge, but gave

no other details ) Described a lot of equipment used just as “things” (N)

• Was at ease with the nurse talking about herself but disclosed none of her own personal details (T)

• Ended up by saying “don’t want to do it again” (T)

• Compare and contrast your determination of your “Think of a Patient” person type mode with the

matching functional pair type above. • How did you do? When ready, select the video #7—FlexCare: Functional Pairs & Communication Preferences (19 minutes; 53 seconds) PRESENTATION NOTES:

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Understanding Type • Understanding your own type preference is key to understanding how you prefer to interact with others • Quote for doctor from Allen & Brock (2000): It is difficult for me to think as a patient….I suppose that’s

because I speak to them in the way that I would want to be spoken too… oh, I see now, there is no difference between what I do and what I would want for myself.

• Flex Care research suggests that our type preferences reliably predict (or are consistent with) our communication style

• In fact, Flex Care research suggests that the middle two letters of your 4-‐letter type represent the most significant difference in how patients prefer to be communicated with (see slide below).

EXERCISE: Flexing: Using the Model Part 1. Let’s test this model with another exercise. Turn back in your Participants Guide to the “Back to ‘THINK OF A PATIENT’” exercise you completed. Review your response to the exercise and give this a final “think.” Now move on to the following questions: Similar to the 2-‐ minute exercise you completed above, can you list a few behavior cues that you’ve

observed in a typical encounter with this person? What do you typically SEE and HEAR? Based on the behavior cues you’ve observed above, what do you think your persons Functional Pair (or

middle two letters) is (check one)? Practical Facts (ST) Support Their Vision (NF)

Marianne

Electra

Teri

Courtney

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Personal Service (SF) Logical Options (NT) • Now, compare those behavior cues you’ve identified above with the behavior cues you observed in the

same function pair, “2” minute video exercise you viewed earlier (The video of Teri, Marianne, etc.). Are there similarities in the behavior cues you observed between the video clip and the description you wrote? If so, you’re probably accurate on your determination of their Type Mode. If not, think again. Did you miss something?

Part 2. Select the Functional Pair (below) that matches your patient and review the advice provided to you by patients that verified their own function pairs (see next page). Once again, what is your Functional Pair? Practical Facts (ST) Support Their Vision (NF) Personal Service (SF) Logical Options (NT) • What are the differences between you and your patient or person? Are their areas of potential conflict?

What might they be? Part 3. Now, using this advice and the worksheet provided, how could you alter or “flex” your communication from your typical approach to a new way that considers your patients preferences. Please describe.

Communication Advice by Function Pair Type

Provided below is “to do” advice collected from the Flex Care research with real patients (who verified their type preferences):

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To Do’s for Type*

ST – Facts with Practically

• Be brief; give concise facts • Be straightforward and honest • Know the facts about my condition and

expect to be questioned on them • Give me information on the specific

treatment options so I can weigh them • Present the information in a logical way;

do not go off on a tangent

NF – Supporting Their Vision

• Treat me with respect-‐ as a whole person-‐ with unique perspective

• Listen to and value my concerns • Provide overall solutions-‐ an overview

without details • Take time to discuss my concerns; be honest

but kind • Know that my case is unique to me

SF – Personal Service

• Listen carefully to me, give me your time and complete attention

• Be warm and friendly • Give me factual information honestly,

but with a personal touch; for example, remember what I’ve already told you

• Provide practical information and examples about my condition

• Tell me about other people who have had the same treatment.

NT – Logical Options with Competence

• Respect my intelligence and my need to understand

• Demonstrate your competence • Answer my questions in an honest, open way;

do not hide anything • Give me overall options so I can see a pattern • Be informed about new alternative treatments

*Adapted from Flex Care Work Book CAPT 2000© Judy Allen and James Gray with permission.

When ready, select the video #8—FlexCare: Summary & Wrap Up (7 minutes; 17 seconds)

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REFERENCES:

• Stebbins, C. (2005). Enhancing empathy in medical students using FLEX Care™

communication training (Doctoral Dissertation, Iowa State University, 2005).

• Allen, J., & Brock, S. (2000). Health care communication using personality type: Patients

are different! Philadelphia, PA: Routledge.

• Allen, J. (2002). FLEX Care: Health care communication skills using personality type,

Participant workbook. Gainsville, FL: Center for the Application of Type.

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