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 SH 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 SC 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 VAN 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 STA 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 IN 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.
