Managing Difficult Conversations PowerPoint Presentation, PPT - DocSlides

Managing Difficult Conversations

Social Psychology 201for ED’s

Stephen H. Anderson M.D., FACEPPresident, WA State Chapter ACEP

Presented at WSHA Safe Table - ER is for Emergencies

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September 24, 2012

Seven Conversations

Grieving1) Someone is dying/ died.2) Your child is going to have a bad outcome.

Presented at WSHA Safe Table - ER is for Emergencies

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Seven Conversations

Sheriff/ Parenting3) I think you have a drug/ alcohol problem.4) I think you’re here too often.5) Why are you REALLY here?

Presented at WSHA Safe Table - ER is for Emergencies

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Seven Conversations

Colleague/ Political6) I disagree with you as a colleague.7) That’s not how administration foresees it.

Presented at WSHA Safe Table - ER is for Emergencies

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Overlying Principles

There are rules/ givens.You have to listen.

Presented at WSHA Safe Table - ER is for Emergencies

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Principles

Know your allies…Know their allies.Find your support…Find their support.

Presented at WSHA Safe Table - ER is for Emergencies

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Principles

Believe in WIN- WIN.To thine own self be true.Document.

Presented at WSHA Safe Table - ER is for Emergencies

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There Are Rules/ Givens

Some are hard…Some are soft. Some are “ours”… Some are “only mine”.

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There Are Rules/ Givens

The KeyOwnership

Presented at WSHA Safe Table - ER is for Emergencies

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You Have To Listen

Conversations are two way.Find out their goals. Find out their fears.Give them enough rope…

Presented at WSHA Safe Table - ER is for Emergencies

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Know Your Allies…

Rally your troops.Build your allies.Do you want to be an expert witness?

Presented at WSHA Safe Table - ER is for Emergencies

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Know Their Allies…

Introductions for EVERYONE.Note “Alleged Allies” not present Acknowledge as appropriate.

Presented at WSHA Safe Table - ER is for Emergencies

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Find Your SupportFind Their Support

Key to the Grieving ConversationIf you’re headed to war… take them with you.

Presented at WSHA Safe Table - ER is for Emergencies

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Believe In WIN-WIN

Try never to define your win, by their loss.

Presented at WSHA Safe Table - ER is for Emergencies

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Believe In WIN-WIN

ListenRepeat backWork toward a common goalCompromise?

Presented at WSHA Safe Table - ER is for Emergencies

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To Thine Own Self Be True

Never LieNever LieNever LIE!

Presented at WSHA Safe Table - ER is for Emergencies

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These Are DifficultStressfulConversations!

DebriefAvoid being the one with the disease

Presented at WSHA Safe Table - ER is for Emergencies

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Not All ConversationsWill End WIN-WIN

Some won’t end.Have an exit strategy.

Presented at WSHA Safe Table - ER is for Emergencies

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Document

ANY conversation with “potential” is worth documenting.Two documented views are better then one.“They” know how to document too!

Presented at WSHA Safe Table - ER is for Emergencies

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Someone Is Dying/ Died

It’s someone’s job, take ownership.Find your supportFind their support

#1MostImportant

Presented at WSHA Safe Table - ER is for Emergencies

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Someone Died

Focus on the closest, talk to everyoneListenAccount for beliefs/ culturesPhysical contact, the “healing touch”.

Presented at WSHA Safe Table - ER is for Emergencies

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Someone DiedGoals To Express

1) We did everything appropriate.2) Address pain & suffering.3) “Now we are here to help you… & others.”

Presented at WSHA Safe Table - ER is for Emergencies

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Someone Is Dying

Don’t lieDon’t steal hopeBe realistic

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Someone Is Dying

Listen ( Is the PATIENT speaking through an advanced directive?)Find your support/ Find their supportStart the conversationGeography/ proximity

Presented at WSHA Safe Table - ER is for Emergencies

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Your Child Is Going To Have A Bad Outcome

Find your support/ Find their supportDon’t steal hopeBe honest “in that moment”

Presented at WSHA Safe Table - ER is for Emergencies

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Bad Outcome

Negative attitude leads to negative outcomes…Blame is for later

Presented at WSHA Safe Table - ER is for Emergencies

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Bad Outcome

Child’s safety firstWhen do you include the child in the conversation?

Presented at WSHA Safe Table - ER is for Emergencies

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I Think You Have A Drug/ Alcohol Problem

Society/ Legislature/ Peers now tell us We MUST have these conversationsTHIS is the pivotal time.

Presented at WSHA Safe Table - ER is for Emergencies

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Drug & Alcohol ProblemsThe Principles

There are rules/ guidelinesListen firstYour allies/ their allies “Their support” might turn out to be your best ally!”WIN-WINBe true to yourself

Presented at WSHA Safe Table - ER is for Emergencies

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Drug & AlcoholTools to Help

Old RecordsEDIEWA state Prescription Monitoring Program Educate patients that these exist

Presented at WSHA Safe Table - ER is for Emergencies

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I Think You’re Here Too Often

PRCPatient’s Requiring Co-ordination

Presented at WSHA Safe Table - ER is for Emergencies

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You’re Here Too OftenNew WA Hospital Requirements

Identify PRC clients upfrontNotify their PCP of visitDischarge patient with instructions along:“the right patient-to the right place-at the right time”Shouldn’t be a punitive discussion

Presented at WSHA Safe Table - ER is for Emergencies

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You’re Here Too Often

“You’re Unique, but…”Educate“The Econ Lecture”

Presented at WSHA Safe Table - ER is for Emergencies

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Why Are You REALLY Here?

Constructively focuses the scatter.Gives an opening to the REAL difficult conversation.NEVER demean the answer

Presented at WSHA Safe Table - ER is for Emergencies

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I Disagree With YouAs A Colleague

Fatal Error VS. Difference Of OpinionFatal ErrorSuccess comes through education first

Presented at WSHA Safe Table - ER is for Emergencies

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Difference of Opinion With A Colleague

Praise in Public/ Debate in PrivateAsk yourself going in:What’s my goal?Am I a team builder?How can I make this WIN-WIN?Focus on the patient

Presented at WSHA Safe Table - ER is for Emergencies

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Difference Of Opinion With A Colleague

ListenAgree on the easy, Work toward the hard.Set the stage for “The Next Time”If necessary, use the chain of command.

Presented at WSHA Safe Table - ER is for Emergencies

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That’s Not How Administration Foresees It

Presented at WSHA Safe Table - ER is for Emergencies

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Administration’s Viewpoint

The Golden RuleDo unto others, as you would have others do unto you.Those with the gold, make the rules.Every pathway has an economic angle.

Presented at WSHA Safe Table - ER is for Emergencies

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Administration’s Viewpoint

What brought you to the table?What do they need from you?What motivates you?PrinciplesPriorities

Presented at WSHA Safe Table - ER is for Emergencies

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Administration’s Viewpoint

Great leadersget input fromgreat followers

Presented at WSHA Safe Table - ER is for Emergencies

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Managing Difficult Conversations

There are rules/ givensYou have to listenKnow your allies/ know their allies Find your support/ find their supportBelieve in WIN-WINTo thine own self be trueDocument

Presented at WSHA Safe Table - ER is for Emergencies

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