The Importance of Patient Communication


patient-communication

Finding out the reason for an unhappy patient or customer is key to putting the problem right – or at least trying to put it right. Ignoring it will not make it go away, and it won’t help good relations in the future.

Often the main reason for a unhappy person is down to lack of communication and this can often lead to outbursts of anger, frustration, arguments and a possible complaint. Whilst you are not there to take abuse, you have to have a listening ear, an open mind, and an apology if you feel that it is appropriate.

What you have to remember that people attending surgeries or clinics are often unwell, in pain, anxious, or suffering with mental issues or they may be relatives or friends of the patients concerned about their wellbeing.

Its how you deal with a complaint that will determine how far it might go.

A good example of a breakdown in communications happened to a friend of mine the other day.

My friend had to go to our local hospital for an epidural injection. She received an appointment for 11.00 am – She telephoned and asked if she could have an earlier appointment. She explained that a friend who would be taking and collecting her had another appointment early that afternoon. She explained to the clerk that she had 2 previous 8.00 appointments and she had been seen and out by 11.00. The clerk was very helpful and said she would send out another appointment, which she did. It was for 08.00 – perfect.

We arrived at 07.55 to get her booked in. We went into the admissions department to find that there were about 40 other people sitting there already, and more following in behind us. There were people standing in the corridor, as there were no more seats.

The bookings clerk came to the door and shouted *who’s next* – there seemed to be no order at all. I noted who we had walked in behind and I closely kept an eye on them and my friend followed in after they had been seen. Tempers were rising in the waiting area, and I am sure blood pressure taking a rise too. The system was in a total mess.

No apology from the clerk when my friend went in about the long wait. The clerk knew people were not happy and did all she could to avoid any eye contact. She never took her eye off the computer all the time it took to book my friend in.

We went along to the ward and a nurse took all the necessary details. She asked my friend to get ready, as she was due to go down for the injection fairly quickly. We both laughed and said that we probably would have time for a coffee afterwards before my next appointment.

My friend sat and waited, the curtains were around the bed so all we could do was sit and listen, we heard other people being booked in, and going down for their procedures – I realised that there were more than one doctor on so didn’t think too much of it.

We sat and waited a bit more, people were coming back up, getting ready and going home, there were more people arriving. A nurse came in and spoke to one patient telling them that there were two people in front of them and they would be 3rd to go down. Perhaps my friend was the first or second patient – apparently not – we were still sitting there when that patent went down. She came in and told another patient they were next to go down.

It got to 11.00 and my friend was very conscious of the time. I tried to reassure here that I could wait a bit longer, but she went out to find someone to ask what was happening. She met a nurse who I can only say was not very helpful at all.

My friend explained about me having another appointment, the nurse said that we should have come prepared to wait, this was a day ward and my friend should have expected to be there for some time.

My friend explained that she had spoken to the clerk on the telephone when booking the appointment and she didn’t mention anything about the possibility she might be there for the day and there was nothing to indicate that on her appointment letter when she received it.

My friend explained about her previous 2 visits and that she had 8.00 appointments on both those days and both times she had been seen and out by 11.00.

The nurse said that she must have been *lucky* those times.

The nurse went on to say that if she were seen fairly soon that she would be done and out within half an hour – but then went on to say – of course you still could be here for a good while yet.

Never once did the nurse offer to go and see where on the list she might be. She really did not want to be bothered. She really was not any help at all.

So, my friend worried about me getting to my next appointment told the nurse that she was sorry but she could not wait any longer – the nurse just said “well that’s entirely up to you”

My friend came back, got dressed and we left. She was extremely upset, and angry at the way the situation had been handled. I felt bad that I could not have waited any longer with her.

She is a pretty laid back woman, but of course this could have been someone that might not have that accepted the situation so lightly and of course could have caused a unpleasant situation.

What could have been done to make this situation better?

  1. When my friend phoned to rearrange her 11.00 appointment to an earlier one she explained why this was. The clerk taking the call should have explained there and then that she could not expect to be out by 11.00. If she had been told this she had a choice, she could have :
  2. made the appointment on another date, or
  3. asked someone else to take and collect her, someone that didn’t have a problem with staying all day.

 

  1. The admissions clerk never once apologised for the delay when booking her in. She was asked to be there for 8.00 which she was and was kept waiting an hour standing in a corridor when no chair – a simple “sorry to keep you waiting” would have been simple thing to say but very effective. Often by doing this it defuses the situation, it is very hard to be angry at someone that is being helpful and pleasant.

 

  1. The clerk was working on her own trying to book people in; perhaps she should have been given extra help at this busy time. Was this being fair to her – expecting her to deal with such a great volume of people? And of course having to deal with angry patients.
  2. People were starting off their admission to hospital getting uptight, angry and the possibility of their blood pressure being high. Not fair to put that extra pressure on a patient.

 

  1. Why wasn’t my friend kept informed of when she was going to be seen, especially when we could hear other patients being told when they were going down. Was one nurse dealing with patients differently to another? Were doctor’s lists being dealt with differently to others? If so that simply isn’t good enough. Everyone deserved to be treated the same.

 

  1. The nurse could have been a bit more understanding; instead of trying to help my friend she was completely defensive every time my friend tried to say something. Had the nurse taken the time to go and find out where on the list my friend was (and if she was next or the one after she would have stayed) but it was clear to my friend the nurse was not going to do that.

I feel that this whole situation from start to finish resulted in a lack of communication and could have been handled so much better at various stages from the booking, admission and the appointment.

 

What do you think?

untitled99

 

© 2011-2017 Reception Training all rights reserved
Advertisements

Straight from the heart


 

imagesCATMPJJAToday is Fathers Day and what I would give to be able to telephone my dad and wish him a lovely day – something I did every year and took for granted. Sadly my dad died last year and I never got to be with him in time – to have that one last conversation with him. To tell him how much so many people loved him, to tell him what strength he was to me and to tell him simply that I loved him – but I know he knew that anyway.

This blog is a bit different from normal. It is straight from the heart and its one of those stories that left me and my family but more so my lovely dad badly let down by the system that I believe is one of the best in the world – but can show perhaps without the right communication how things can go so badly wrong.

I had a lovely Saturday afternoon, we had been celebrating a friends baby shower and there was lots of laughter and fun, the afternoon had ended and the clearing up underway. My daughter telephoned me to say that she had spoken to my dad (her beloved granddad) and he had commented that he felt unwell – he had been backwards and forwards to the doctors for some weeks with a chest infection and put on various different medications.

My dad asked my daughter to phone a doctor for him – this had alarm bells ringing, my dad would NEVER make a full and in all his life he had never ever phoned a doctor outside of surgery hours, and had never had a home visit. He was of the “old school” he never complained.

My daughter asked if I would phone and speak to him, she knew that I had a good understanding of how the out of hours worked and felt that I would be the best person to speak to someone.

Unfortunately I was not in the UK on this occasion and was phoning from another country. I telephoned my dad and it was pretty obvious he was very poorly he also was very confused – he asked if I could phone the doctor and his wishes were that no one called him as he felt he was not able to have a conversation with someone at this stage. He was confused and he was in pain. He sounded really poorly.

I have a brother and unfortunately we were unable to contact him – but we left a message.

At 17.30 I telephoned the out of hours service. I explained to the operator it was my dad’s wishes that I spoke to them, as my dad was too poorly to speak to anyone. I explained that he was confused in a lot of pain and had not passed urine since the day before. I gave a list of my dad’s medication to the operator. I offered my telephone number to the operator and he said as it was an international telephone number he was unable to take it – this concerned me as I was the point of contact – I offered it again and he again said that he was not able to take the number.

I gave every single bit of information that the operator would have needed to assess the call appropriately. I know if my dad had made that call he would have not given all the facts.

After speaking to the operator and all the details taken into consideration it was confirmed that my dad would need an ambulance. As the operator couldn’t take my telephone number he actually put me through directly in touch with the ambulance service. I explained the circumstances and my concerns that my dad was confused, along and in a lot of pain. They confirmed that an ambulance would be called.

The next hour was a nightmare – worried that I had no news – still no contact from my brother so I telephoned my dad house to find that he was still there and no ambulance had been. The only reassuring thing was my brother had just arrived so at least he had someone there with him.

Concerned that no ambulance had arrived I contacted the out of hours again. I was told that the ambulance had been cancelled – yes cancelled!

Concerned that Dad had been confused perhaps someone had phoned him and he might have told them not to bother – that is something dad might have done if he thought that he was causing a fuss – but speaking to my brother no one at Dad’s had phoned or no one had cancelled the ambulance.

My brother told me that he would take my dad straight away to A&E himself in the car.

Had my dad gone in an ambulance he would have gone straight through – but my brother had to find a car parking space, walk my poorly dad into A&E and wait until the drunks and people with colds were booked in before them – it took over half an hour waiting to be checked in – and as you can imagine a while before he was seen – my dad was finally admitted the doctors told my brother that they would keep him in for a few days.

Sadly my dad died the next evening.

When we got back to my dads house in the early house of the morning the answer machine was flashing – the message was received after 19.00 saying it was the ambulance service calling – and apologised for the delay in the ambulance and if anything has changed please call us back on 999 – thank you. I was confused at this stage to say the least.

I contacted and the ambulance on the Monday to find out what had happened – how my dad was sadly let down by the system. The gentleman dealing with the call was extremely helpful and he assured me he would look into it for me.

I then telephoned the out of hours and asked them why the ambulance had been called – to which I was told because of patient confidentiality I would have to get written permission from the patient before they could release any information. For goodness sake the patient was dead! How on earth was I suppose to do that? I did find that very upsetting. This took me a while to get sorted – there was every chance that they were not going to discuss this with me – but I got there after several stern words.

As you can imagine there was a lot of correspondence backwards and forwards – taking forever to get answers.

The out of hours was blaming the ambulance service for not prioritising the call appropriately and the ambulance was blaming the out of hours – it took a long time to finally find out what had happened. But we finally got to find out what had actually happened.

The out of hours said in their letter that the ambulance service categorisation process resulted in an inappropriate C2 response that on review they acknowledge should have been a C1 priority for a 20 minutes response. The ambulance service also stated this in their letter – but also followed it up with it was one of their busiest nights and went on back that up with figures on calls throughout that day.

As for the cancellation of the ambulance it was confirmed that the reason the call was cancelled was due to the fact that the operator had inaccurately quoted the wrong call number he quoted 3392 instead of 3329. As this point the demographic details should have been confirmed by both parties to ensure the correct call log was being looked at. In this case it did not happen. The call number given to the ambulance service actually related to another call transferred by the out of hours service. The call log that the ambulance service operator was looking at was told that this patient had in fact contacted the out of hours requesting the ambulance to be cancelled. So my dad’s ambulance was cancelled and the gentleman that phoned to cancel the ambulance more than likely still got a visit from the ambulance service.

So, errors all round – would it have saved my dad’s life if the ambulance had arrived – and within the 20 minutes target? We will never know but what was more upsetting is the fact that if my brother had not been able to get to him when he did, and I had not phoned back thinking he was being taken to hospital he would have been waiting for the ambulance and perhaps have collapsed at home when he was on his own, because my dad would not have complained or wanted to have been a nuisance in any way.

When talking to the out of hours service I did share my concerns that they had nor wanted to take my telephone number – the only point of contact they had. The woman who I was dealing with at the out of hours did say that from this incident they would be looking at reviewing their system and every call would have the facility to take a contact telephone number. For me this should have been such an easy process and should have been put in place right from the start.

For me if ever I took a call from a patient, or someone calling on behalf of a patient my first priority would always be to get a contact telephone number. To me this is basic communication.

I sadly still see on the news and read in the papers that this out of hours service that I dealt with are always in the news for all the wrong reasons. Why are they still getting it wrong?

So for my today Fathers Day it’s always a sad reminder that this beautiful man – my dad is no longer here.

 

Certain Factors Can Affect Workplace Anger/Violence (part 1)


 As a Receptionist you will be the front of house. You will meet and greet patients throughout the day. Often you will come across patients (or their carers) that perhaps are annoyed, angry and on the rare occasion violent.

Dealing with such difficult situations can be daunting and somewhat frightening – especially for the new members of staff but there are things that can be taken into consideration by understanding

Frustration

This can often occur when people experience long delays, lack of attention or simply just not getting what they want.

Resentment

Some people resent those in a position of authority – and a Receptionist can often be seen as being in authority i.e. those given out the appointments, some people can see the Receptionist as being undermining or talking down to them. Often if people are negative they will see every situation as a negative one too. As a Receptionist it is your role to try to turn a negative into a positive.

Personal Reasons

We often do not know the personal circumstances in people’s lives. This could be

  • Illness
  • Pain
  • Fear
  • Insecurity
  • Mental Health issues
  • Bereavement
  • Addictions (substance and drug abuse)

Previous Anger/Violence Might Have Paid Off  

  • Think they will get an immediate response.
  • Lack of patience
  • Yelling works
  • Expectations

Lack of Communication

  • Patients not knowing what is happening
  • Not been given a full explanation
  • Being ignored (or thinking that they are)
  • Staff offhand and not helpful
  • Ignorance of the system

Environment

  • Noisy / untidy cramped rooms
  • Potential weapons to hand
  • Reception area non confidential
  • Bad Atmosphere

Lack of Training

  • Without proper staff training staff may not have the confidence or skills needed to keep the patients happy or the surgery running smoothly.

Poor Systems

  • No available appointments
  • Telephones not being answered
  • Wrong information given
  • Disorganised reception area
  • Notes / results missing or not available for appointment
  • Lack of trained staff.

How can the Risks be reduced?

  •  A safe working environment
  • Well designed working areas  
  • Effective Practice     
  • Good Communication between Management/Staff/Patients      
  • Proper Training  
  • Forward planning.

A Safe working Environment

It is important that the Reception desk is secure. Make sure that you take every step to prevent aggressors reaching over and grabbing items from the reception desk

  • Prescriptions (it has been known for prescriptions to be taken from a Reception area)
  • Patients notes
  • Money (often just been taken from a previous patient)
  • Letter opener (this could be used as a dangerous weapon

Wherever possible try to take the aggressive/upset patient away from the front desk. Take them away from the “audience” and away from other patients that might feel threatened by their behaviour.

Security Features / Physical Layout

Wherever possible have your waiting area in sight of the Reception Area then if there is an incident that occurs you are able to deal with it before it gets out of hand.

  • Panic button in Reception – directed to your local police station
  • Panic button in consulting rooms communicating with reception and/or local police station

All panic buttons should be checked on a regular basis i.e. weekly and logged that has been done so.

If you feel that a situation does not warrant pressing the panic button you could have a special ‘code word’. As a Practice you could agree on a certain word and use this in case of you needing backup in Reception. For example you could phone your Practice Manager or  duty Doctor and ask  “could you bring me the red file” this would alert them that you needed assistance.

Sometimes just having another person there – in the background can help in a situation and the angry person will quite often back down.

Well Designed Working Areas

This can be achieved by

  • Providing a comfortable area where staff can take a well-earned break.
  • Providing comfortable meeting areas.
  • Encouraging staff participation in keeping the workplace tidy.

Proper Training

This would allow staff to

  • Understand the causes of anger/violence in the workplace
  • Recognise the warning signs of an angry/violent situation
  • Help prevent anger/violence
  • Be less afraid and better able to solve difficult situations
  • Avoid taking certain situations personally.

A Plan For Action

This can provide details about:

  • Who is responsible for decisions at your surgery
  • What action needs to be taken in such a situation
  • When (and if necessary) to call the police.
  • What action is needed AFTER the situation has occurred – i.e completing out an incident form (see blog: The Incident Report Form http://wp.me/p1zPRQ-6o )

It is best to have a plan of action put in place to cover different situations. Talk things through at your team meetings.

PLAN AHEAD!