arthur brewer, md, cchp, clinical assistant professor, department of family medicine, robert wood...
TRANSCRIPT
![Page 1: ARTHUR BREWER, MD, CCHP, CLINICAL ASSISTANT PROFESSOR, DEPARTMENT OF FAMILY MEDICINE, ROBERT WOOD JOHNSON MEDICAL SCHOOL STATEWIDE MEDICAL DIRECTOR MECHELE](https://reader035.vdocuments.us/reader035/viewer/2022062217/56649c6f5503460f94921d9e/html5/thumbnails/1.jpg)
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
![Page 2: ARTHUR BREWER, MD, CCHP, CLINICAL ASSISTANT PROFESSOR, DEPARTMENT OF FAMILY MEDICINE, ROBERT WOOD JOHNSON MEDICAL SCHOOL STATEWIDE MEDICAL DIRECTOR MECHELE](https://reader035.vdocuments.us/reader035/viewer/2022062217/56649c6f5503460f94921d9e/html5/thumbnails/2.jpg)
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
![Page 3: ARTHUR BREWER, MD, CCHP, CLINICAL ASSISTANT PROFESSOR, DEPARTMENT OF FAMILY MEDICINE, ROBERT WOOD JOHNSON MEDICAL SCHOOL STATEWIDE MEDICAL DIRECTOR MECHELE](https://reader035.vdocuments.us/reader035/viewer/2022062217/56649c6f5503460f94921d9e/html5/thumbnails/3.jpg)
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
![Page 4: ARTHUR BREWER, MD, CCHP, CLINICAL ASSISTANT PROFESSOR, DEPARTMENT OF FAMILY MEDICINE, ROBERT WOOD JOHNSON MEDICAL SCHOOL STATEWIDE MEDICAL DIRECTOR MECHELE](https://reader035.vdocuments.us/reader035/viewer/2022062217/56649c6f5503460f94921d9e/html5/thumbnails/4.jpg)
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
![Page 5: ARTHUR BREWER, MD, CCHP, CLINICAL ASSISTANT PROFESSOR, DEPARTMENT OF FAMILY MEDICINE, ROBERT WOOD JOHNSON MEDICAL SCHOOL STATEWIDE MEDICAL DIRECTOR MECHELE](https://reader035.vdocuments.us/reader035/viewer/2022062217/56649c6f5503460f94921d9e/html5/thumbnails/5.jpg)
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
![Page 6: ARTHUR BREWER, MD, CCHP, CLINICAL ASSISTANT PROFESSOR, DEPARTMENT OF FAMILY MEDICINE, ROBERT WOOD JOHNSON MEDICAL SCHOOL STATEWIDE MEDICAL DIRECTOR MECHELE](https://reader035.vdocuments.us/reader035/viewer/2022062217/56649c6f5503460f94921d9e/html5/thumbnails/6.jpg)
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
![Page 7: ARTHUR BREWER, MD, CCHP, CLINICAL ASSISTANT PROFESSOR, DEPARTMENT OF FAMILY MEDICINE, ROBERT WOOD JOHNSON MEDICAL SCHOOL STATEWIDE MEDICAL DIRECTOR MECHELE](https://reader035.vdocuments.us/reader035/viewer/2022062217/56649c6f5503460f94921d9e/html5/thumbnails/7.jpg)
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
![Page 8: ARTHUR BREWER, MD, CCHP, CLINICAL ASSISTANT PROFESSOR, DEPARTMENT OF FAMILY MEDICINE, ROBERT WOOD JOHNSON MEDICAL SCHOOL STATEWIDE MEDICAL DIRECTOR MECHELE](https://reader035.vdocuments.us/reader035/viewer/2022062217/56649c6f5503460f94921d9e/html5/thumbnails/8.jpg)
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
![Page 9: ARTHUR BREWER, MD, CCHP, CLINICAL ASSISTANT PROFESSOR, DEPARTMENT OF FAMILY MEDICINE, ROBERT WOOD JOHNSON MEDICAL SCHOOL STATEWIDE MEDICAL DIRECTOR MECHELE](https://reader035.vdocuments.us/reader035/viewer/2022062217/56649c6f5503460f94921d9e/html5/thumbnails/9.jpg)
Top Medical Grievances
Co pay
Relationship between patient & practitioner*
Medication issues
*Practitioners cite the relationship with some patients to be their
biggest challenge
![Page 10: ARTHUR BREWER, MD, CCHP, CLINICAL ASSISTANT PROFESSOR, DEPARTMENT OF FAMILY MEDICINE, ROBERT WOOD JOHNSON MEDICAL SCHOOL STATEWIDE MEDICAL DIRECTOR MECHELE](https://reader035.vdocuments.us/reader035/viewer/2022062217/56649c6f5503460f94921d9e/html5/thumbnails/10.jpg)
Relationship Between Patient & Provider
Staff conduct
Dissatisfaction with provider
Delay in treatment (perception)
Failure to treat (perception)
![Page 11: ARTHUR BREWER, MD, CCHP, CLINICAL ASSISTANT PROFESSOR, DEPARTMENT OF FAMILY MEDICINE, ROBERT WOOD JOHNSON MEDICAL SCHOOL STATEWIDE MEDICAL DIRECTOR MECHELE](https://reader035.vdocuments.us/reader035/viewer/2022062217/56649c6f5503460f94921d9e/html5/thumbnails/11.jpg)
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
![Page 12: ARTHUR BREWER, MD, CCHP, CLINICAL ASSISTANT PROFESSOR, DEPARTMENT OF FAMILY MEDICINE, ROBERT WOOD JOHNSON MEDICAL SCHOOL STATEWIDE MEDICAL DIRECTOR MECHELE](https://reader035.vdocuments.us/reader035/viewer/2022062217/56649c6f5503460f94921d9e/html5/thumbnails/12.jpg)
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
![Page 13: ARTHUR BREWER, MD, CCHP, CLINICAL ASSISTANT PROFESSOR, DEPARTMENT OF FAMILY MEDICINE, ROBERT WOOD JOHNSON MEDICAL SCHOOL STATEWIDE MEDICAL DIRECTOR MECHELE](https://reader035.vdocuments.us/reader035/viewer/2022062217/56649c6f5503460f94921d9e/html5/thumbnails/13.jpg)
BATHE TECHNIQUE
Brief Psychotherapeutic Patient-Centered Technique
fitted into a 15 minute appointment
BackgroundAffectTroubleHandlingEmpathy
![Page 14: ARTHUR BREWER, MD, CCHP, CLINICAL ASSISTANT PROFESSOR, DEPARTMENT OF FAMILY MEDICINE, ROBERT WOOD JOHNSON MEDICAL SCHOOL STATEWIDE MEDICAL DIRECTOR MECHELE](https://reader035.vdocuments.us/reader035/viewer/2022062217/56649c6f5503460f94921d9e/html5/thumbnails/14.jpg)
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
![Page 15: ARTHUR BREWER, MD, CCHP, CLINICAL ASSISTANT PROFESSOR, DEPARTMENT OF FAMILY MEDICINE, ROBERT WOOD JOHNSON MEDICAL SCHOOL STATEWIDE MEDICAL DIRECTOR MECHELE](https://reader035.vdocuments.us/reader035/viewer/2022062217/56649c6f5503460f94921d9e/html5/thumbnails/15.jpg)
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
![Page 16: ARTHUR BREWER, MD, CCHP, CLINICAL ASSISTANT PROFESSOR, DEPARTMENT OF FAMILY MEDICINE, ROBERT WOOD JOHNSON MEDICAL SCHOOL STATEWIDE MEDICAL DIRECTOR MECHELE](https://reader035.vdocuments.us/reader035/viewer/2022062217/56649c6f5503460f94921d9e/html5/thumbnails/16.jpg)
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
![Page 17: ARTHUR BREWER, MD, CCHP, CLINICAL ASSISTANT PROFESSOR, DEPARTMENT OF FAMILY MEDICINE, ROBERT WOOD JOHNSON MEDICAL SCHOOL STATEWIDE MEDICAL DIRECTOR MECHELE](https://reader035.vdocuments.us/reader035/viewer/2022062217/56649c6f5503460f94921d9e/html5/thumbnails/17.jpg)
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
![Page 18: ARTHUR BREWER, MD, CCHP, CLINICAL ASSISTANT PROFESSOR, DEPARTMENT OF FAMILY MEDICINE, ROBERT WOOD JOHNSON MEDICAL SCHOOL STATEWIDE MEDICAL DIRECTOR MECHELE](https://reader035.vdocuments.us/reader035/viewer/2022062217/56649c6f5503460f94921d9e/html5/thumbnails/18.jpg)
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
![Page 19: ARTHUR BREWER, MD, CCHP, CLINICAL ASSISTANT PROFESSOR, DEPARTMENT OF FAMILY MEDICINE, ROBERT WOOD JOHNSON MEDICAL SCHOOL STATEWIDE MEDICAL DIRECTOR MECHELE](https://reader035.vdocuments.us/reader035/viewer/2022062217/56649c6f5503460f94921d9e/html5/thumbnails/19.jpg)
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
![Page 20: ARTHUR BREWER, MD, CCHP, CLINICAL ASSISTANT PROFESSOR, DEPARTMENT OF FAMILY MEDICINE, ROBERT WOOD JOHNSON MEDICAL SCHOOL STATEWIDE MEDICAL DIRECTOR MECHELE](https://reader035.vdocuments.us/reader035/viewer/2022062217/56649c6f5503460f94921d9e/html5/thumbnails/20.jpg)
WHY ME?
Are you utilizing all the skills available ?
Mental Health
Nursing
Correctional staff
Colleagues
![Page 21: ARTHUR BREWER, MD, CCHP, CLINICAL ASSISTANT PROFESSOR, DEPARTMENT OF FAMILY MEDICINE, ROBERT WOOD JOHNSON MEDICAL SCHOOL STATEWIDE MEDICAL DIRECTOR MECHELE](https://reader035.vdocuments.us/reader035/viewer/2022062217/56649c6f5503460f94921d9e/html5/thumbnails/21.jpg)
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
![Page 22: ARTHUR BREWER, MD, CCHP, CLINICAL ASSISTANT PROFESSOR, DEPARTMENT OF FAMILY MEDICINE, ROBERT WOOD JOHNSON MEDICAL SCHOOL STATEWIDE MEDICAL DIRECTOR MECHELE](https://reader035.vdocuments.us/reader035/viewer/2022062217/56649c6f5503460f94921d9e/html5/thumbnails/22.jpg)
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
![Page 23: ARTHUR BREWER, MD, CCHP, CLINICAL ASSISTANT PROFESSOR, DEPARTMENT OF FAMILY MEDICINE, ROBERT WOOD JOHNSON MEDICAL SCHOOL STATEWIDE MEDICAL DIRECTOR MECHELE](https://reader035.vdocuments.us/reader035/viewer/2022062217/56649c6f5503460f94921d9e/html5/thumbnails/23.jpg)
THE BOTTOM LINE
Treatment in corrections takes many forms;
but most important is basic human respect
& concern!
![Page 24: ARTHUR BREWER, MD, CCHP, CLINICAL ASSISTANT PROFESSOR, DEPARTMENT OF FAMILY MEDICINE, ROBERT WOOD JOHNSON MEDICAL SCHOOL STATEWIDE MEDICAL DIRECTOR MECHELE](https://reader035.vdocuments.us/reader035/viewer/2022062217/56649c6f5503460f94921d9e/html5/thumbnails/24.jpg)
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.