CONFLICT RESOLUTION ON THE PHONE

Transcription

1 CONFLICT RESOLUTION ON THE PHONE MODULE: COMMUNICATION SKILLS AND PROFESSIONAL CONDUCT TARGET: PSYCHIATRY TRAINEES ST4-6 BACKGROUND: Prfessinals are expected t cmmunicate effectively with clleagues n the telephne thrughut their career. The telephne can be a particularly difficult medium as there is n pprtunity t assess bdy language and all cmmunicatin has t be cnveyed thrugh the vice. Peple may behave differently n the telephne due t the distancing effect. This scenari allws trainees t experience a difficult telephne cnversatin with a senir clleague as the basis fr an educatinal sessin explring cnflict reslutin, de- escalatin, liaising effectively with senir clleagues and managing emtins. The sessin can als include linked cncepts such as hw t manage cmplaints. RELEVANT AREAS OF THE CURRICULUM Curriculum ILO 4 Assess and Manage Risk ILO 9 Wrk effectively with clleagues ILO 17 Act in a prfessinal manner at all times Details Demnstrate expertise in applying the principles f crisis interventin in emergency situatins Make care plans in urgent situatins where infrmatin may be incmplete Cmpetently manage a service, r a part f the service, alngside cnsultant trainer Shw cmpetence in supervised autnmus wrking Use effective negtiatin skills Manage divergent pinins n patient treatment r interventin Manage cmplaints made abut services Maintain gd prfessinal attitudes and behaviur when respnding t situatins f ambiguity and uncertainty Supprt and advise clleagues in dealing with cmplex prfessinal interactins Recgnise wn limitatins Versin 9 May

2 INFORMATION FOR FACULTY LEARNING OBJECTIVES / INTENTIONS Greater cnfidence dealing with difficult phne calls A framewrk fr managing these situatins An understanding f the cncepts and issues underlying these situatins A framewrk fr managing cmplaints SCENE SETTING Lcatin: Expected duratin f scenari: Expected duratin f debriefing: Training rm, simulatin suite 5-10 mins 10 mins individual feedback r 20 minutes in grup setting EQUIPMENT AND CONSUMABLES PERSONNEL- IN- SCENARIO Table, Telephne, Speakerphne (if applicable) Vide camera and TV mnitr (if applicable) ED Cnsultant (if bserving scenari) Trainee dctr PARTICIPANT BRIEFING Yu are the n- call Registrar fr Psychiatry. Yu cver a large gegraphical area and yur ut- f- hurs rle generally invlves undertaking Mental Health Act assessments in plice statins and prviding telephne advice t ther prfessinals and the cre trainees. There is a cre trainee dctr wh is respnsible fr ward wrk and admissins and will undertake assessments in the Emergency Department ut- f- hurs if the Crisis team ask them t. Yu have just finished yur clinic and started yur n- call. Yu receive a call at 5.01pm frm the Emergency Department Cnsultant. Instructins Speak t the Cnsultant and address their cncerns FACULTY BRIEFING The rle f the faculty depends n the methd chsen fr using the scenari. If trainees are taking part in the simulatin the rle f the facilitatr is t c- rdinate the rm changes, supprt the trainees wh are listening t the cnversatin, and facilitate the feedback, althugh this will predminantly be frm the ther trainees and the actr. The facilitatr will als ensure that the actr r faculty playing the rle knws their brief and parameters. If the scenari is a frum theatre bserved simulatin the facilitatr s rle is t set the scene fr the scenari, ensure the actrs are adequately briefed, then interrupt at key pints t allw the trainees t reflect n what they have seen/heard and ffer their interpretatins. The facilitatr is nt teaching as such, nr impsing specific learning bjectives, but allwing time fr trainees t learn frm each ther thrugh practicing and bserving. Ntes fr facilitatrs Allay anxiety Make the envirnment ne f mutual learning. N- ne is perfect, we can all imprve Versin 9 May

3 VOICE OF THE MANIKIN BRIEFING N manikin IN- SCENARIO PERSONNEL BRIEFING ED CONSULTANT Yu are Dr Khan, a Cnsultant in Emergency Medicine. Yu have been wrking lates all week and have hardly been hme r seen yur family in that time. Yu are the Clinical Directr and are finding this rle increasingly frustrating and impssible. Yu have had a particularly difficult shift including the death f a yung by and an incident invlving an aggressive patient where the plice had t cme and arrest them. Earlier tday ne f yur junirs tld yu abut a yung girl they had seen wh had taken an verdse and was threatening t kill herself if she did nt get admitted t hspital. The junir said she was therwise well and appeared fully alert and calm. Her bs were all nrmal. They were asking if they shuld refer directly t the mental health team and yu tld them that they shuld as this srt f patient was their respnsibility and shuld nt be taking up a bed in the ED, especially when the department was s busy. The junir asked if they shuld d a full assessment and yu tld them just t write referred t psychiatry in their ntes and get n with seeing ther patients. Sme time later the junir came back t say they had referred her but the Crisis Team were nt ging t cme until her paracetaml level was back. The junir said the patient was refusing t have a bld test and asked what t d next. Yu then called the Crisis team back yurself and they said they wuld cme and assess the patient. Sme time later when the patient was clse t breaching the 4 hur waiting time yu called the Crisis Team again and were tld they were ging hme nw and wuld have t hand ver t the n- call dctr. Yu asked if the dctr was experienced and was tld it was an F2. Yu decide t call the n- call senir, hping it will be the Cnsultant. Yu are put thrugh t the Registrar n call and are nt happy abut that. Yu demand t have them srt ut the situatin. Yu threaten t call the Medical Directr at hme t cmplain abut the inadequate mental health service which is ging t lead t yur department being financially penalised. Yu d nt see why the mental health services cannt be rganised sufficiently well t ensure patients d nt need t present t the ED. Yu d nt think they are prper emergency patients and feel yu are ding smene else s jb by seeing them. ADDITIONAL INFORMATION Example draft script fr scenari and suggested pause pints and prmpts fr facilitatr. Dr Khan Cnsultant Dr Byn Spr Dr Khan Dr Byn Dr Khan Finally smene answers the phne! This patient has been waiting in my emergency rm entirely inapprpriately fr ver fur hurs nw because nne f yu lt have cme t see them. They have nw breached d yu have any idea hw serius the cnsequences f that are fr us? They are nt an emergency department patient. S what are yu ging t d abut it? Well I ve nly just cme n call and I nly heard abut the patient a mment ag. Can I just take sme details? I have given all the details t yur clleagues already. I am fed up f being fbbed ff like this. This patient is taking up a bed which culd we need fr smene wh is actually sick. I am telling yu t cme and deal with this r I am ging t make a frmal cmplaint. I am srry yu feel yu have been fbbed ff but I wuld remind yu that I have nly just becme aware f this situatin althugh I will d my best t help nw. Wuld yu mind telling me a bit abut what has happened? Yur Crisis team tld me they wuldn t cme up until we had dne blds and medically cleared the patient. But the patient has refused all that s then they said they were cming t see them but they never did and when I tried t call them back just nw I hear they have all gne hme. S I need yu t cme right nw and srt this situatin ut. Our department is jammed and it is nt ur jb t deal with psychiatric patients just because yu can t prvide a service. Versin 9 May

4 Facilitatr Suggestins Dr Byn Dr Khan Dr Byn Dr Khan Dr Byn Facilitatr Suggestins Scenari cnclusins STOP (if bserving simulated scenari) What d peple feel right nw? Hw wuld yu respnd t this? Hw can we recgnise and manage ur emtins? I am srry abut what has happened with yur patient. There must have been sme kind f misunderstanding. Let me just take a cuple f details. What prblems is the patient actually presenting with? She arrived saying she had taken an verdse but has refused blds. There is nthing mre we can d fr her. S is she depressed? D yu think she has capacity? I have n idea. It is nt the jb f either myself r my junirs t be psychiatrists. We shuld nt be ding yur jb. Well actually all dctrs shuld be able t d a mental state examinatin and make an assessment f capacity, it s nt just the rle f the psychiatrist. STOP We are ging t pause the scene there and discuss What d peple feel abut that cnversatin? What gd cmmunicatin techniques were illustrated? What have yu seen in the scenari that yu think yu culd use mre f in yur wn practice? In ne versin f the scenari, whatever the dctr says t the cnsultant is nt enugh t de- escalate him and eventually he just hangs up the phne. This leaves the trainee feeling cheated as they were nt given the pprtunity t reslve the situatin. In anther versin f the scenari the trainees cmmunicatin skills eventually manage t reduce the tensin in the cnversatin and the cnsultant appears calmer and mre reasnable. They frm a sensible plan tgether and part amicably with thanks fr understanding n bth sides. Versin 9 May

5 CONDUCT OF SCENARIO INITIAL SETTINGS Telephne cnversatin between ED Cnsultant and Psychiatry Registrar ED Cnsultant directs anger abut actins f clleagues twards psychiatry trainee EVENT 1 Expected Actins: Trainees are expected t shw high levels f empathy and gd cmmunicatins skills. Trainee tries t manage cnversatin. They may: Explain their rle Explain the limitatins f the service Try t empathise EVENT 2 ED Cnsultant remains angry at trainee, demanding that they deal with the situatin. Expected Actins/Cnsequences: Depending n the skill f the trainee the respnse may be quite different. LOW DIFFICULTY NORMAL DIFFICULTY HIGH DIFFICULTY Cnsultant is angry but de- escalates after they vent their frustratin. Afterwards prviding the Registrar is plite and prfessinal Cnsultant is reasnable Cnsultant is very angry and makes inflammatry unprfessinal statements. Can be de- escalated nly with effective cmmunicatin skills Cnsultant extremely angry, impssible t de- escalate. Abusive and unprfessinal and eventually hangs up the phne Reslutin: Aim t end cnversatin with amicable reslutin withut cmprmising rle. Cnsultant may terminate cnversatin by hanging up if nt satisfied. Versin 9 May

6 DEBRIEFING Faculty: When ffering feedback t trainees r inviting feedback frm their clleagues cnsider: Clear bjective bservatin what they did Make cncern clear t learner why this is nt ideal Active listening shw yu are interested in the learner and their experience. Dn t be tempted t keep talking abut them, imparting yur wisdm. The real learning cmes frm the learner. Side with them, physically and metaphrically, t examine what they did and explre it tgether. Be curius abut why they did smething Quickly mve t generalising the learning t thers r they will switch ff Facilitatr can hardly say anything, unless the learners miss smething key Applicatin t practice Managing cnflict and anger n the phne Cnsider: Aplgise sincerely (but dn t accept the blame unless it really is yur fault) Be diplmatic, appear t be interested in reslving the issue Be prfessinal at all times, dn t rise t the bait r becme emtinal. Dn t get defensive r int an argument Allw them t vent, just listen Use empathy say yu can see why there are upset Thank them fr their respnse Thanks fr being s hnest/flagging up the prblem t me Watch ut fr escalatin change in speed r tne f vice, ging quiet Try t ffer slutins Be aware hw yu cme acrss. Impressins matters. Mst f usual impressin is frmed frm bdy language which yu dn t have available here, Try t cnvey enthusiasm, a genuine desire t help and cheerfulness, where apprpriate Summarise and check yu have understd the infrmatin Dn t hang up Make sure yu get their name and cntact details Finish ff psitively, ideally by summarising the actin plan. Sme peple feel the annymity f the phne means they can be as rude as they like as they aren t face t face with a human. Try t cunter this by intrducing a human element like mentining yur kids r saying smething like I am nt persnally respnsible fr this situatin but I will help t srt it ut with yu Use repetitin. Stick t yur guns POINTS FOR FURTHER DISCUSSION Pitfalls Trainees may be drawn int acceding t an unreasnable request such as t g and assess the patient right nw when they d nt think this is clinically indicated r part f their rle. Trainees may be drawn int criticising their clleagues r the service they perate within Trainees may becme verly defensive and refuse t cmprmise at all Versin 9 May

7 After a difficult phne call: Make ntes. These will serve t remind yu f the details in the event f a cmplaint r if yu want t raise the issue yurself Pre- empt a cmplaint by raising the issue first. Either call the Cnsultant r senir duty persn r write an accunt t send t the apprpriate senir persn as sn as yu can. If yu think anther healthcare wrker has acted unprfessinally cnsider recrding the details and reprting it t their manager. DEBRIEFING RESOURCES Versin 9 May

8 PSYCHIATRY SCENARIO 13 - HANDOUT INFORMATION FOR PARTICIPANTS The telephne can be a particularly difficult medium fr cmmunicatin. This scenari allws trainees t experience a difficult telephne cnversatin with a senir clleague as the basis fr an educatinal sessin explring cnflict reslutin, de- escalatin, liaising effectively with senir clleagues and managing emtins. The sessin can als include linked cncepts such as hw t manage cmplaints. KEY POINTS Be reassured that everyne has difficult cnversatins like this in their careers Appreciate sme f the basic advice fr managing difficult phne cnversatins Have mre cnfidence in dealing with these situatins RELEVANCE TO THE CURRICULUM Curriculum ILO 4 Assess and Manage Risk ILO 9 Wrk effectively with clleagues ILO 17 Act in a prfessinal manner at all times Details Demnstrate expertise in applying the principles f crisis interventin in emergency situatins Make care plans in urgent situatins where infrmatin may be incmplete Cmpetently manage a service, r a part f the service, alngside cnsultant trainer Shw cmpetence in supervised autnmus wrking Use effective negtiatin skills Manage divergent pinins n patient treatment r interventin Manage cmplaints made abut services Maintain gd prfessinal attitudes and behaviur when respnding t situatins f ambiguity and uncertainty Supprt and advise clleagues in dealing with cmplex prfessinal interactins Recgnise wn limitatins WORKPLACE- BASED ASSESSMENTS Trainees rarely have the pprtunity t be assessed managing a difficult phne cnversatin s simulatin is a useful tl. FURTHER RESOURCES RCPsych On Dealing with Difficult Clleagues 2010 RCPsych Curriculum 2010 (updated 2012) Versin 9 May

9 PARTICIPANT REFLECTION What have yu learned frm this experience? (Please try and list 3 things) Hw will yur practice nw change? What ther actins will yu nw take t meet any identified learning needs? Versin 9 May

10 PARTICIPANT FEEDBACK Date f training sessin:... Prfessin and grade:... What rle(s) did yu play in the scenari? (Please tick) Primary/Initial Participant Secndary Participant (e.g. Call fr Help respnder) Other health care prfessinal (e.g. nurse/odp) Other rle (please specify):... Observer I fund this scenari useful Strngly Agree Agree Neither agree nr disagree Disagree Strngly Disagree I understand mre abut the scenari subject I have mre cnfidence t deal with this scenari The material cvered was relevant t me Please write dwn ne thing yu have learned tday, and that yu will use in yur clinical practice. Hw culd this scenari be imprved fr future participants? This is especially imprtant if yu have ticked anything in the disagree/strngly disagree bx. Versin 9 May

11 FACULTY DEBRIEF TO BE COMPLETED BY FACULTY TEAM What went particularly well during this scenari? What did nt g well, r as well as planned? Why didn t it g well? Hw culd the scenari be imprved fr future participants? Versin 9 May