“Together Performing at a Higher Standard”
The Florida ESRD Network

Your Role in the Patient Experience:
• How to build professional relationships with patients while maintaining boundaries
• Customer service and effective communications skills
• Interactive communication scenarios
• Staff–to-Staff teambuilding communication
Vascular Access – The Patient Chronicles:
• Common physical, emotional, and psychological challenges patients face when migrating from a catheter to a permanent vascular access
(VA)
• Engaging patients in discussions regarding VA and infection control
• VA Assessment – What complications look like, what staff will see with stenosis
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• Quality care starts and ends with you
• Your jobs require building good working relationships, working in a team-oriented environment, and providing outstanding clinical care
• You build meaningful and sometimes personal relationships with the patients because you have the most one-on-one time with them
• Patient and facility feedback
• There is always room for improvement
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We’re all Friends
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Joe Karan, Network 7 Patient Subject Matter Expert
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Dorothy Craft, RN, CDN
LET’S TALK ABOUT CUSTOMER
SERVICE AND PROFESSIONALISM
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494.60 Physical Environment
• Building/furnishings/equipment – must be safe and functional
• All equipment operated according to manufacturer’s guidelines
• Patient care environnent sufficient to prevent cross contamination and accommodate emergency equipment
• Comfortable temperature
• Accommodations for patient privacy
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494.70: Patients’ Rights
• Informed within the first six treatments
• Informed regarding:
 Right to participate in care
 Advance directives
 Treatment modalities
 Facility policies regarding patient care and isolation
 How to file a grievance
 The facility’s discharge and transfer policies including involuntary discharges
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• Information that is easy to understand
• Care that is respectful
• Involved in decisions about care
• Privacy and confidentiality
• Make a complaint and receive a response
• Clear information about facility policies including discharge and transfer policies
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In-Center Hemodialysis Consumer Assessment of
Healthcare Providers and Systems Survey (ICH
CAHPS)
• Not a Consumer Satisfaction Survey
• Administered once in 2014 and semiannually in
2015 and subsequent years
• Results reported to CMS as part of the Quality
Incentive Program (QIP)
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• In the last 3 months, how often did you feel the dialysis center staff really cared about you as a person?
• In the last 3 months, how often did dialysis center staff make you as comfortable as possible during dialysis?
• In the last 3 months, did you feel comfortable asking the dialysis center staff everything you wanted about dialysis care?
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• In the last 3 months, how often did dialysis center staff insert your needles with as little pain as possible?
• In the last 3 months, how often did dialysis center staff check you as closely as you wanted while you were on the dialysis machine?
• In the last 3 months, how often did dialysis center staff behave in a professional manner?
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• The ability to identify with and understand another’s situation, feelings, and motives
• Put yourself in the patient’s shoes
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Source: 5-Diamond Patient Safety Program, “Professionalism in the
Dialysis Setting.” www.5diamondpatientsafety.org
.
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• Describes a certain type of behavior in the workplace
• Is based on our values and understanding of our professional roles
• Is evidenced in our behavior and judged through:
 Our image
 Our communication
 Our competence
 Our demeanor
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A professional is:
• Trustworthy
• Competent
• Empathetic
• Respectful
• Caring
• Culturally aware
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• Sharing that shifts focus from the patient to the staff member
• Disclosing personal problems/employee concerns
• Losing the ability to respond objectively
• Giving/receiving gifts
• Showing favoritism
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• Flirtation
• Inappropriate dress/language
• Ordering/parenting
• Having the last word
• Threatening termination
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Ask yourself these questions:
• Would this be allowed in another medical setting?
• How does this activity assist the patient in care of his or her ESRD?
• Can this be documented in the medical record?
• Are you willing to do this for all patients?
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• Encouraging patient self ‐ determination
• Providing informed consent
• Competence
• Not taking unfair advantage of any relationship
• Avoiding dual relationships
• Respecting privacy/confidentiality
• Empowering patients rather than creating dependency
• Not taking things personally
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• Know yourself: What pushes your buttons?
• Recognize your limits: What is your tolerance level?
• Anticipate situations and have a plan: Positive outlets and coping skills.
• Understand that our response can either escalate or deescalate the situation.
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• Maintaining professionalism, boundaries, and showing respect for patients’ care builds trust
• Having trust in staff leads patients to engage more in their care
• Together this leads to better outcomes for patient and facility
• Utilizing new patient orientation, plan of care meetings, and patient education to engage patients
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• Think about your own experiences.
• What would your patients say about your facility’s customer service?
• Does staff at your facility welcome and engage every patient the same way?
• Are concerns addressed quickly?
• Is the customer always right?
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• Conflicts or complaints are rarely isolated incidents.
• All staff can look for indicators that the patient is unhappy.
• Try to take personal feelings out of the equation.
 This is not about you!
• Address complaints immediately.
 Do not wait until the “right moment.”
 Things tend to escalate the longer they go without resolution.
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• Try to determine the “real” cause of the conflict:
 Is there a problem that effects multiple patients or only one?
 Is there a win/win solution?
• With a little effort most issues can be resolved:
 Scheduling
 Medication
 Attitudes
 Access skills
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Staff-to-Patient
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After reading the scenarios that follow we will discuss the questions below.
• What rule of professionalism or code of conduct was broken?
• What boundaries (if any) were crossed?
• What should have happened?
• If you were the staff member in this scenario, how would you have handled it?
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A patient told the facility manager that he refused to have a certain technician cannulate him because the technician has been talking, non-stop, about a terrible divorce and custody battle that she is going through. He describes her in a constant state of impatience and anger. He refuses to let her work with him because he is afraid that she won’t concentrate on his arm. He’s afraid that she will ultimately cause him pain because she is not focused on her job or her patients.
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• What rule of professionalism or code of conduct was broken?
• What boundaries (if any) were crossed?
• What should have happened?
• If you were the staff member in this scenario, how would you have handled it?
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A dialysis patient often sees technicians at the dialysis facility move from one patient to another without washing their hands or changing gloves. One morning the patient’s machine started beeping and a technician walked over from another patient area and hit a button on his machine to reset the alarm without changing his/her gloves. The patient stated to the technician
“You did not wash your hands or change your gloves before you touched my machine!” The technician stated back to the patient, “Don’t worry about it, I know what I am doing, it’s not that big of a deal.”
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• What rule of professionalism or code of conduct was broken?
• What boundaries (if any) were crossed?
• What should have happened?
• If you were the staff member in this scenario, how would you have handled it?
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A retired colonel stated to the facility manager that a new technician was being very disrespectful.
When asked what the technician had done to be disrespectful, he stated, “She calls me hon, honey, sweetie pie, and cutie. She even called me a baby because I complained about how bad I was feeling. I’m a Colonel in the United States Army! I served in two wars! She should be calling me
Colonel Jones, Mr. Jones or Sir!”
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• What rule of professionalism or code of conduct was broken?
• What boundaries (if any) were crossed?
• What should have happened?
• If you were the staff member in this scenario, how would you have handled it?
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A dialysis facility dietitian has been trying to explain to a patient the importance of monitoring potassium. The patient begins yelling at the dietitian, “I’ve given up everything I love!
Tomatoes, strawberries, and bananas. I don’t have any potassium in me. I’m sick and tired of being harassed by you. You’re one to talk! Look at you,
Miss Fatty Pants! Who are you to tell me how to diet?” The dietitian then yells at the patient, “If you don’t shut up right now, you’ll never be able to come back here!”
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• What rule of professionalism or code of conduct was broken?
• What boundaries (if any) were crossed?
• What should have happened?
• If you were the staff member in this scenario, how would you have handled it?
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A patient refuses to allow any technician, except for his absolute favorite, to cannulate him. It was discovered that the technician had told the patient,
“I’m the best technician here and the only one you need. I’ll take the best care of you and make sure nothing bad happens to you while you are on the unit.” Now this technician has moved to another dialysis unit across town. The patient is furious and scared. He’s demanding to know, “Where has my girlfriend gone?”
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• What rule of professionalism or code of conduct was broken?
• What boundaries (if any) were crossed?
• What should have happened?
• If you were the staff member in this scenario, how would you have handled it?
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Staff-to-Staff
COMMUNICATION STRATEGIES FOR
TEAM BUILDING
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What is the most important reason to support and assist other staff?
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• Give immediate assistance when possible.
• Provide examples within a non-parental, nonjudgmental, “What I’ve learned,” or
“What helped me,” framework.
• Use the opportunity to reinforce both staff and patient teaching, so that everyone learns at the same time.
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Why do people bully others?
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• Reduce criticism and inspire confidence.
• Mentor using a “walk through” technique.
• Allow for questions, feedback, and learning curves.
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• How important are you?
• What really happens when you discourage communication?
• The “day after” conversation
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Two final thoughts as we close this portion of the workshop:
It is so awesome; you get to do this every day.
Your words have the power to change things.
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Christina Beale, RN, CNN
Lifeline Vascular Access
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Helen Rose, MSW,LCSW
HRose@nw7.esrd.net
Beverly Whittet, RN,CDN
BWhittet@nw7.esrd.net
Mary Fenderson, RN, CNN,MSHSA
MFenderson@nw7.esrd.net
Phone: 813-383-1530
Fax: 813-354-1514 www.fmqai.com
This material was prepared by ESRD Network 7, under contract with the Centers for Medicare & Medicaid Services
(CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy nor imply endorsement by the U.S. Government. FL-ESRD-Aim1-11142014-01
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