Communication between the Surgery and the Hospital.


                          

As a Doctors Receptionist you will have a close working relationship with your local hospital(s). Working for both Doctors Surgeries and Hospitals I can say that their systems are  quite different. Not that anyone of them is right or wrong – it is just down to the type of work that they both do. But one thing that they both have in common is patients, and at the end of the day it is vital that you and their patients get the best possible treatment. So communication between your surgery and the hospital is vital for the wellbeing of your patients.

The surgery would often work closely with the outpatients department in the hospital, as well as the labs – checking up on patient results, sending in samples etc.

You at the surgery will all have come across the sample that has been sent in without the correct information on. The doctor or the receptionist has forgotten to enter the patient’s details correctly onto the specimen bottle – or perhaps the lab technician just would be unable to read the doctors handwriting although computers have come a long way in making this a lot easier to get right.

I have been “that” receptionist that receives the call from the lab saying that they cannot accept a sample as it was not labelled correctly – I  like many did not understand why the labs just could not take the details from me – after I had all the details of the patient in front of me.

The outcome of this would have resulted in the patient being called back into surgery to have another sample taken to be sent off to the labs again.

As I worked my way up to a Manager these incidents still occurred from time to time, I had receptionist complaining that they felt the hospital was being unreasonable when they offered to give over the patients details.

So, I arranged a visit to the local hospital. The first visit was to the laboratories – I brought along the supervisors from each team of Receptionists. We spent several hours with some very helpful members of the management team at the hospital and they went through the whole journey of when the sample reached the hospital via courier from us at the surgery.

It was amazing watching the process of these samples. What did surprise us was the amount of samples that they received in from each and every surgery in the local area – and some from outside the area too. This highlighted the importance of having each and every sample labelled correctly – and the awful outcome that could occur if one sample was given the wrong details.

Meeting the team at the laboratory was lovely; it was nice to put a face to the voice that for years we had only spoken to on the telephone. We both listened to each other’s points of view, and both sides admitted that there were definitely areas that they could improve on the main one better communication between the two units.

For us the biggest lesson learned was that each and every sample would be checked at the surgery before it was handed over to the courier before heading for the hospital. The Doctors were reminded regularly about the importance of completing the sample bottles correctly – and most importantly in handwriting that could easily be read by the laboratory technicians.

We discussed our visit at our next receptionists meeting. Because of the volume of receptionists that we had it was impossible for them all to visit the hospital, but it was important for them to learn from our visit. This was also something that I would discuss with every new receptionist.

A month after our visit I phoned and spoke to the member of staff that had been our guide for that afternoon and he also agreed that things had become a lot better, samples were being sent it properly  labelled, and if there were any queries it was a pleasure to phone and speak to someone who they knew. Our Supervisors also said that communication between the two units had improved a lot.

About 6 months later I organised a similar visit this time around the outpatients department. I took the supervisors along with me again, this time they were shown around the department and how the hospital dealt with a patient’s referral letter when it arrived from the surgery. Again, communication was greatly improved after this meeting.

So, much so we invited a couple of the ladies from the outpatients department to come and spend a few hours with us at the surgery, sitting with the secretaries and the receptionists seeing for themselves just how busy and hectic it was. They too found it an extremely helpful exercise.

They agreed that they never really fully appreciated how busy it was at the surgery, and again communication between the two departments was greatly improved.

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How To Avoid Workplace Anger/Violence (part 2)


Are Patients Waiting Too Long?

Research has shown that long waiting times can lead to angry/violent behaviour. So keep your patients informed, give a reason for the delay and apologise when necessary – please do not ignore the waiting patients (see blog: When The Doctor/Nurse is running late. http://t.co/Tlnpi4OD )

Does Your Patients Feel They Have A Method Of Complaint?

Provide a well-advertised complaints procedure in your Practice Leaflet. Quite often a Receptionist can deal with a complaint before it goes to Management level.

Always offer the patient a complaints form. Ensure that all your Reception team knows where the complaints forms are kept. No complaint should go to the Practice Manager without being offered a complaints form first.

Most people when offered a complaints form will decline, and even when they do except a complaints form will probably not return the completed form. But it is important that they have that choice to make.

Are You Or Your Staff Helpful and Courteous?

An abrupt or indifferent receptionist and lack of information can often lead to frayed tempers.

Do You Think Your Receptionist Makes Things Worse?

First rule; do not get yourself into an argument. An argument may cause anger to escalate into aggression and perhaps violence. Have you as a team discussed ways to prevent or defuse such situations? Ensure that all staff have clear guidelines – this will help them deal with such a situation.

Is the Waiting Room a Calm and Comfortable Place?

Consider ways of reducing boredom, up to date magazines. Toys for the in the play area. Posters and Notices on the wall. Plenty of seating. Make it comfortable.

A local A&E Department recently spent a large amount of money re designing and updating their A&E Department and found that this reduced the vandalism by a considerable amount. Both patients and staff found it a more relaxing environment to be in.

Can Your Staff Recognise The Warning Signs?

Staff need to be aware of this at all times. If dealing with a patient who is known to be hostile, make sure you are in a position to summon help or make an escape if necessary. Bring it to the attention of others if necessary.

Does your Practice have panic buttons? Ensure that all Locums and new staff are aware of where they are situated.

Are You Aware Of Stranger Danger?

Be extra cautious if an unknown temporary resident is fitted in at the end of surgery. Warn the doctor/nurse that the last patient is a temporary patient. It has been known that a few patients are looking for drugs will book a late appointment and not complete the temporary residents form out correctly which means that the Practice has no relevant information on the patient. This is not to say that every temporary resident is like this – but there are the odd few out there.

Is Information Shared?

Everyone working in the practice needs to know which patients might pose a risk. This will apply to doctors working at another surgery for the out of hours. Especially inform all other surgeries if you have a temporary resident causing any problems. If you have a violent patient you should inform your local PCT/Health Authority.

Can The Waiting Room Be Seen and Controlled By the Receptionist?

Try to ensure that there are no nooks and crannies where people are sitting out of sight. If someone is getting agitated or poorly the Receptionist should be able to notice the signs and deal with it appropriately.

Are You Providing Weapons?

Do you equip your surgery and waiting room with items that can easily be used as weapons or missiles?

  • Paper opener
  • China Cups
  • Heavy objects such as stapler, paperweights
  • Metal toys in the children’s area
  • Sharp objects

Always ensure that potential items are out of reach.

What Should You Do If the Patient Becomes Aggressive?

  • KEEP CALM
  • Avoid direct confrontation and try to defuse the situation. Listen and show you are listening to their point of view – do not argue.

Can You Defend Yourself?

  • Avoid physical contact.
  • Call on others for support
  • Quite often if there is more than one person in front of the aggressive person they will calm down a lot quicker. If you hear a patient getting aggressive at the front desk, just go over to the receptionist dealing with the patient and just stand and observe, do not say anything, often this is enough to calm the person down.
  • If the Receptionist cannot deal with the situation then you might need to step in and take over.

People who are most effective in dealing with aggression understand something about the psychology of people. They understand why make people tick and recognise that human beings have basic animal instincts, which often come to the fore when they feel threatened or feel frightened or angry.

The options that our animal instincts provide are either FLIGHT or FIGHT.

Many things may affect which option we choose but some things which will increase the likelihood of choosing FIGHT are:

  • Feeling our personal space is being invaded
  • Feel physically threatened
  • Feel that our exit path is blocked.

One of the most effective ways of diffusing this natural response is to deliberately signal that you are not going to respond in an aggressive way. This may not be easy when you are probably feeling threatened yourself, but the following actions will help to signal non-aggression to others.

Give the other person space – If you increase the distance between you and the aggressor it will lessen the feeling that their personal space is being invaded and reduce the feeling of physical threat and open up their exit path. It also gives you a greater range of options should the situation suddenly change.

Relax your own posture – you can reduce your own aggressive signs by dropping your shoulders, adopting an open stance and allowing your arms to drop. Such action will probably feel unnatural given the situation but it will quickly reduce the aggressor’s feeling of being intimidated.

Avoid sudden movements – remember that heightened emotion will make an individual jumpy and ready to defend, and that quick or sudden movement might trigger an instinctive reaction.

Reduce eye contact – Sustained eye contact is a very aggressive signal in these types of encounters. You should avoid gazing intently into the aggressor’s eyes.

The above four behaviours will reduce the potential for aggressive situations to turn into violent confrontation. However, they do not, on their own, resolve the encounters successfully. Successfully resolution can be achieved by:

  • CALMING the individual and then building
  • RAPPORT with him/her to finally achieve
  • CONTROL over the situation

This sequence is very specific. Successful control of a situation cannot be achieved by trying to achieve rapport with a person who is still very wound up by the incident itself. You must calm the person down before he or she will be receptive to your attempts to build a rapport.

CALMING

A common mistake, which is made at this stage, is trying to deal with the reason why the person is being aggressive. In fact you should try to deal with the emotions that the person is bringing into the situation. Trying to deal with the reasons why before you calm the emotions will only service to increase the tensions and set off an escalation of the incident.

It is vital that you as the person seeking to control the situation are fully in control of your own emotions and reactions. This is not easy because you are not immune to the situation and you may be feeling fear, excitement or anger. But your ability to control your own emotions, particularly your anger will have a vital impact.

Many incidents involving aggressive people take place in public places where the aggressor has an “audience” and it will help the situation a lot if you make the encounter a one to one situation where the aggressor will not be able to “play to the audience”. Most of all, do not put the aggressor in a situation where he or she will be seen as losing face to the audience.

In the early part of this stage, what you say in your efforts to calm the individual is probably less important than how you actually say it. How well you communicate non-verbally will be very important in sending calming messages to your aggressor.

There are several non-verbal behaviours which can help to signal non-aggression and encourage the aggressor to calm down

  • Move slowly – sudden, quick or unpredictable movements can sign aggression particularly to someone who is already tense and feeling threatened.
  • Allow space – respect the aggressor’s “personal space”. Moving into a person’s personal space is very intimidating and almost threatening.
  • Reduce aggressive signals – finger pointing, sustained eye contact, arms folded, hands on hips are all gestures which heighten tension rather than reduce it.
  • Deliberately adopt  “friendly” gestures – extending your arms with the palm of your hands outwards, dropping your shoulders, gentle voice tone, an open interview stance and your head to one side rather than full on – these will help to signal to the aggressor that you do not seek to be aggressive.

When you have managed to calm the aggressor to a point when you feel they are able to listen to you, then you can move into the next stage of building rapport.

RAPPORT

This is really about winning the aggressor’s trust. If you are to gain effective control of the situation then it is crucial that the aggressor feels that he or she can trust you. This will involve showing empathy towards the aggressor.

This means letting the person know that you can appreciate his or her view of the world and the particular situation they are in. This is distinct from sympathy and agreeing that their view is the right one. Showing empathy can be achieved by simply reflecting back to the person what they have said.

Be careful not to use emotive words or phrases which emphasises failure of loss of face like:

“That was a pretty stupid way of carrying on wasn’t it?”

Show the individual that you are a person too. This may involve giving a little bit of yourself away to encourage the aggressor to talk and to be more open.

By this stage you should be dealing with a much more rational person who is amenable to reason and is listening to what you are saying. If you are not – then you need to continue with the “calming” skills until the person is able to be more rational.

 

Remember: Patients are not always right but they ARE important. Show them they are important by the way you treat them.

 

 

 

Helping Patients With Learning Disabilities


People with learning disabilities are a small proportion of the population; however evidence suggests they have greater health needs, in relation to hearing and visual disabilities, hypertension, chronic bronchitis, epilepsy, cerebral palsy, gross obesity, spinal deformities, skin disorders and mental health.

Patient can often feel intimidated and often feel confused and may be happy to let their carer speak for them.

They might often see the Doctor or Nurse but leave the room without having communicated what the reason was for attending the Surgery. In addition to these problems many people with learning disabilities may not be able to understand written instruction which can cause them some distress.

Areas to be Considered

Communication

  • Use clear short sentences
  • Check the patient’s comprehension of the conversation by asking questions that will clarify that they have understood.
  • Give clear information. It might be necessary to explain in more detail because of the patient’s level of understanding.
  • If it helps the patient write instructions down.
  • When asking the patient asks a question please give them time to reply.
  • Direct the question at the patient rather than just to their Carer.
  • Use good body language and eye contact at all times.
  • Make them feel at ease.
  • Do not rush them.
  • Give them your full attention.
  • Most of all give them time.

Appointments

  • Consider booking a longer appointment to give both the GP and the patient time to communicate.
  • People with learning disabilities may become anxious in a crowded and noisy waiting room, so appointments booked at quieter times of the day might ease anxiety.
  • Some people with learning disabilities may find it difficult while waiting for their appointment; this may be overcome by booking at the beginning of the appointment list.
  • Continuity is important to people with learning disabilities – if they gel well with a certain Doctor or Nurse wherever possible please try to book them with that Doctor/Nurse.
  • Always give an appointment card for their next appointment; please do not give it verbally.

Know Your Patients

A good receptionist will know her patients – and will understand the patients especially those with special needs. She will know exactly the needs of the patient and will endeavour to do her utmost to ensure that the patient has a good experience when coming to the Surgery and this begins at the front desk.

 

 

Sending out Letters to Patients


I had a frantic phone call one Friday evening from a good friend – she was in a right panic. She had received a letter from her Surgery (not the one that I worked at) asking her to make an appointment to see the Doctor regarding her recent smear test.

She didn’t know what to do; she had in previous years had abnormal smear results and of course was now thinking the worse.

I tried my best to console her – but she had made her mind up – she convinced herself that the Doctor was calling her in to tell her she had cancer.

As you can imagine she had a very stressful and sleepless weekend.

Monday morning came and she rang the Surgery – at first she was told that there were not appointments that day – but she insisted on seeing the Doctor.

Her appointment was for 11.00 – she was at the surgery at 10.00 – she sat and waited – she was called in to see the Doctor for him to tell her that the smear had not been taken correctly and it would need to be repeated. That was it – it needed to be repeated – more than likely the nurse may  not have taken it correctly.

To say she was over the moon was an understatement. But the worry she went through that weekend was awful.

So, it got me thinking – how many other people received letters at the weekend that could cause worry and concerns – having to wait until Monday morning before speaking to a Health Care Professional? Probably quite a few I should imagine.

So, I spoke to the Partners at our next staff meeting and we all agreed that such letters that were not urgent and could cause concern to patients or their families would be posted on a Monday, Tuesday or Wednesday, hopefully arriving before the weekend and if the patient was concerned at all they could phone or make an appointment to speak to or see a Doctor

If there was an urgent letter that needed to go out on either the Thursday or Friday and the Doctors felt it might cause some concerns one of the Doctors would phone and explain the letter was on its way and if the patient had any concerns they would try to answer their questions.

True Story

I recently spoke to a mum who young son was having various tests done at her local hospital. She received a telephone call from the consultant at 7.30 on a Friday evening asking her how her son was – he asked her if he had got any worse, he asked if he had been with any cattle she was a bit alarmed at the call. He asked her to bring him in again on the Monday for some more blood tests. She admitted that she was a bit concerned – more blood test – but put it to the back of her mind for the weekend. Her and her son had a fun packed weekend which she said was one of the best.

She went with her mum to see the Consultant on the Monday they he gave them the devastating news that her son had cancer – the consultant had known that on the Friday when he spoke to her.

This consultant had given this thought – he wanted to spare her the heartache for a few more days – he knew by telling her the news on the Friday that her world would come crashing down – he knew she was on her own at the time – he spared that until he had her face to face and could go through the options and treatment for her little boy. This is something she is eternally grateful to that Consultant for.

It’s not what we do but how we do it that can have such a bit impact on people.

 

Does your Practice send out recall letters on a Friday so the patients will receive them on a Saturday?

Dealing With A Difficult Call


Being on the front line you will often come across difficult people. It might be face to face or over the telephone. But the most important thing is you keep your cool. Do not rise to any argument . By keeping your cool it often results in the person apologising for their bad behaviour.

Here are a few tips on how to deal with a difficult call.

  • Always smile as you speak and the caller can hear the warmth of your tone.
  • NEVER be sarcastic
  • Let the caller let off steam, then find out how to help them – try not to interrupt.
  • Be patient and offer apologies wherever possible.
  • Ask short specific questions to obtain facts – never judge.
  • Always take the name of the caller, the nature of the call and a contact telephone number. If in the event that you get cut off you can call the caller back – it won’t look like you have hung up.
  • If recording a complaint always date, time and add your name and enter the nature of the complaint.
  • If the caller wants to register a complaint arrange for them to receive a complaints form.
  • Log the complaint (do you know if your organisation has a procedure for this?).  Does another department need to be aware of the complaint?
  • Inform a senior member of your reception team – give him/her a brief summary of what happened. He/she should then speak to the appropriate person often a complaint will come straight through to Management and if they are aware of the complaint it makes it easier to deal with.

DO NOT TAKE THE CALL PERSONALLY – USUALLY A DIFFICULT CALL IS DIRECTED AT THE FIRST PERSON AVAILABLE.

Passing A Verbal Message or Telephone Call


When putting a telephone call through to another person you must remember to do the following:

  • Always ask the caller’s name
  • Ask the callers company / nature of their call.
  • Take their telephone number if you feel that there might be a delay in putting the call through – that way if you get cut off you have a contact name and number.

When you put the call through to the person the call is for it is important to prepare them for the call by letting them know who it is on the phone and the nature of the call.

There is nothing worse that a person receiving a call from reception and just being told “there is a call for you” and the call is put straight through. The person receiving the call doesn’t know if the call is a member of staff, a customer, or a rep or a company just touting for business.  This always gets the call off to a bad start. .

The caller starts a conversation believing that the person taking the call is aware of whom they are because they have already given their details to the receptionist, they presume the receptionist has done her job and passed on this information to the person taking the call. There is nothing more embarrassing than half way through a call the person taking the call has to ask whom they are speaking to – and it is very unprofessional. Not a good impression to give!!

If you are phoning through to let someone know there is a visitor in reception remember to say that they are in reception. Often the receptionist will phone and say I have a Mr Jones to speak to you – they put the phone down and you get a dead line but you presume you have been cut off – and wait on them phoning back – but what really has happened is the receptionist means that Mr Jones is waiting in reception.

                                             REMEMBER: FIRST IMPRESSION

A caller will always judge your organisation by the service that they receive. A telephone call is quite often the first point of contact they will have with your organisation.

 GET IT RIGHT

Taking A Telephone Message


When taking a message ALWAYS have a pen and paper/notebook ready. You don’t know how long the message is going to be, don’t presume you will remember it. (have a look at blog: Chinese Whispers http://t.co/7oge2fxK )

You will probably need to take down a telephone number and a contact name and possibly a message.

If you are taking a message that you need to pass to another person you must remember:

ALWAYS USE A PROPER NOTE PAD OR MESSAGE BOOK

  • Do not use a “sticky pad” – they are too small and often get stuck to another piece of correspondence – causing the message getting lost or not getting to the correct person.

DATE THE MESSAGE WHEN IT WAS TAKEN

  • Often a message is not read on the day it was taken.

TIME THE MESSAGE WAS TAKEN

  • This is also  very important. A time can quite often be significant and give a wider meaning to the message to the person who is receiving the message especially if the message if read some time after it was taken. 

 WHO THE MESSAGE IS FOR

  • Quite often the message might be for a specific person or the whole team.  You may need to put: or the attention of Alison Smith – Reception Team Leader Or For the attention of The Reception Team.

WHO THE MESSAGE IS FROM

  • Always take a name and contact number from the caller. Never presume that the person the message is for will have the contacts number.

SIGN THE MESSAGE

  • It is important to let the person know who has left the message. If they have a question regarding the message they know whom to contact if they have a query regarding the message.

 The six steps above are not only helpful, they are courteous and in a court of law very important.

and please Remember! A message you take could be used in a court hearing and used in evidence. The evidence would include the date the message was taken, the time it was taken and who took the message.