607 patient biased...resolution. steps to resolve the conflict will include the steps described in...
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W hen The Patient Is BiasedThe Intersection of Com pliance, Inclusion, and Culture
Dr. Angela Row e, a pediatric em ergency m edicine doctor at a rural hospital w alks into her next patient’s room and sees a 3 year old girl, a w om an, and a m an. She sm iles and greets them .
As she typically does to begin a visit, she kneels dow n to engage the 3 year old patient w ho is cow ering on her m other’s lap. Before she is able to stretch out her hand, the patient’s dad says quietly, “I’m sorry. Please do not touch m y daughter. W e w ould prefer a different doctor.”
Dr. Row e is taken aback initially but figures there m ust be a religious or cultural reason that they prefer a different doctor. “M ay I ask w hy?”
“W e w ant a w hite doctor,” the father states calm ly.
Scenario 1
• W hat w ould you do?
• W hat conflicts arise?
• W hat risks m ight this scenario pose to the organization?
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A transgender Hm ong m an has been referred for an upcom ing procedure. W hen he calls to schedule the procedure, he m akes a request of the scheduler.
“During m y care I do not w ant to be treated by any Hm ong staff m em bers.”
“M ay I ask w hy?” the scheduler inquires.
“I am not out in m y com m unity and w ord travels fast. Can you m ake sure that no Hm ong providers see m e?”
Scenario 2
• W hat w ould you do?
• W hat conflicts arise?
• W hat risks m ight this scenario pose to the organization?
In w hat w ays is this scenario the sam e or different from scenario 1?
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So m any issues. . . So m any risks. . .
Rural Hospital Staffing
Patient Choice, Autonom y
Privacy
Em ploym ent Protections
Conditions of Participation
Fair Labor
Reputational Risk
Equitable Care
Professional Boards
Child Protection
EM TALA
Culturally Com petent Care
Professional Ethics
Plan Netw ork Sufficiency
ACA 1557
. . . and so m any m ore. . .
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At a Glance
O ur Journey
FALL 2016
SUM M ER 2017
2018
JAN 2017
FALL 2017
TEAM TALKS O N RACELearned how patient/ m em ber bias im pacts colleagues
LEADERSHIP TEAMForm ed, to benchm ark, and design strategy to support colleagues. Draft of guidelines
FO CUS G RO UPSHosted input sessions w ith team s across organization to learn effective strategies and build process
RESO URCE DESIG NPartnered w ith team s across the organization to design and refine resources for colleagues
Reach leaders and team s across the organization
TEAM TALKS &RO LLO UT
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O ur JourneyFALL2016
SUM M ER 2017
2018
JAN 2017
FALL 2017
TEAM TALKS O N RACELearned how patient/ m em ber bias im pacts colleagues
FO CUS G RO UPSHosted input sessions w ith team s across organization to learn effective strategies and build process
RESO URCE DESIG NPartnered w ith team s across the organization to design and refine resources for colleagues
Reach leaders and team s across the organization
TEAM TALKS & RO LLO UT
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LEADERSHIP TEAMForm ed, to benchm ark, and design strategy to support colleagues. Draft of guidelines
• M edical Ethics
• Patient and M em ber Experience
• Diversity and Inclusion
• Integrity and Com pliance
• Clinical O perations
• Physician Leadership
• Interpreter Services
• Com m unications
• Learning and Developm ent
Affirm Culture
Build Com petence
Establish Standards
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Should w e have a policy?
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. . . III.a. If the conflict is noticed during hours maintained by the Patient Representatives (M-F 8:00-4:30pm), a Patient representative will discuss the concerns with the patient and/or family. The Patient Representative may request assistance from the appropriate managers in the discussion and in attempts toward resolution. Steps to resolve the conflict will include the steps described in III.b., below.
If the conflict and/or steps to resolve the conflict occur during hours other than those indicated in III.a., above, the Patient Flow Supervisor then assigned to the unit on which the conflict has occurred will be responsible for those actions normally given to the Patient Representative as described in III.a., above. . . .
. . . III.a. If the conflict is noticed during hours maintained by the Patient Representatives (M-F 8:00-4:30pm), a Patient representative will discuss the concerns with the patient and/or family. The Patient Representative may request assistance from the appropriate managers in the discussion and in attempts toward resolution. Steps to resolve the conflict will include the steps described in III.b., below.
If the conflict and/or steps to resolve the conflict occur during hours other than those indicated in III.a., above, the Patient Flow Supervisor then assigned to the unit on which the conflict has occurred will be responsible for those actions normally given to the Patient Representative as described in III.a., above. . . .
Establishing StandardsVISIO N AND VALUES
Health as it could be, affordability as it m ust be, through relationships built on trust;
Excellence, Com passion, Partnership, Integrity
RIG HTSPatient Autonom y and the
right to refuse care consistent w ith one’s ow n values
Colleagues’ right to w ork in a safe environm ent that is free
from harassm ent and discrim ination
RESPO NSIBILITIESProfessional obligation to do no harm to the people w e
serve
O rganizational obligation to provide that environm ent for all colleagues and patients
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1. Clinical stability of the patient is prim ary
2. Com m unication is critical
3. Capacity of the patient or m em ber m ust be evaluated
4. Cultural and personal context are relevant
5. Caregivers and other colleagues m ust be supported
6. Personal safety is im portant
7. Legal requirem ents m ust be follow ed
• W hat does it m ean?
• W hy is it im portant?
• W ould it apply in your organization?
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O ur Journey
FALL 2016
SUM M ER 2017
2018
JAN 2017
FALL 2017
TEAM TALKS O N RACELearned how patient/ m em ber bias im pacts colleagues
LEADERSHIP TEAMForm ed, to benchm ark, and design strategy to support colleagues. Draft of guidelines
FO CUS G RO UPSHosted input sessions w ith team s across organization to learn effective strategies and build process
RESO URCE DESIG NPartnered w ith team s across the organization to design and refine resources for colleagues
RO LLO UTReach leaders and team s across the organization
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Building Com petency
Colleagues across the organization experience com m ents or requests in favor of or against a staff m em ber based on identity (ex: Race, Ethnicity, Religion, Age, G ender, Language, LG BTQ Identification)
Everyone know s our organizational stance on patient and m em ber
bias
Everyone know s w hat to do w hen caring for a patient or m em ber w ho show s bias
Anyone w ho experiences patient or m em ber bias feels
supported and valued
Before: Prepare
During: Respond
After: Support
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Building Com petency
Colleagues across the organization experience com m ents or requests in favor of or against a staff m em ber based on identity (ex: Race, Ethnicity, Religion, Age, G ender, Language, LG BTQ Identification)
Everyone know s our organizational stance on patient and m em ber
bias
Everyone know s w hat to do w hen caring for a
patient or m em ber w ho show s bias
Anyone w ho experiences patient or m em ber bias feels
supported and valued
Before: Prepare
During: Respond
After: Support
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Dr. Angela Row e, a pediatric em ergency m edicine doctor at a rural hospital w alks into her next patient’s room and sees a 3 year old little girl, a w om an, and a m an. She sm iles and greets them .
As she typically does to begin a visit, she kneels dow n to engage the 3 year old patient w ho is cow ering on her m other’s lap. Before she is able to stretch out her hand, the patient’s dad says quietly, “I’m sorry. Please do not touch m y daughter. W e w ould prefer a different doctor.”
Dr. Row e is taken aback initially but figures there m ust be a religious or cultural reason that they prefer a different doctor. “M ay I ask w hy?”
“W e w ant a w hite doctor,” the father states calm ly.
Trying It O ut
• W hat principles apply?
• W hat w ould the process look like?
• How should this colleague be supported?
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Prepare in advance
• Review the standards
• Talk to your team
• Create a plan
De-escalate and stay or Disengage
and Leave
• I’m here to help care for you
• Let m e find som eone w ho can address your concerns.
• Do you m ind if I place you on a brief hold?
Peer/Leader Support
•Listen and engage others as needed
• W hat is m ost im portant to you?
• I’d like to talk to the patient, is that ok w ith you?
Talk to the Patient
• I understand you have concerns about your care.
• This is the staff/ doctor available to care for you. W e are unable to m eet your request. W hat w ould you like to do?
Reporting and Follow Up
• Depending on severity –w orkplace violence
• Letter to patient/m em ber
Support the colleague
• I’m sorry that happened
• You are valued. Did the resolution feel that w ay to you?
• W e are here to support you
Building Com petencyBEFO RE DURING AFTER
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“Indirect” case: “That receptionist w as so loud w hen she checked m e in for m y appointm ent – just like every other loud Latina w om an. She violated m y privacy.”
“Direct” case: “Your accent is too heavy. I’m tired of trying to understand you. Let m e talk w ith som eone else.”
N ow It’s the
Com pliance
Team ’s Turn
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• W hat principles apply?
• W hat w ould the process look like?
• How should this colleague be supported?
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Affirm ing Culture
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O ur Journey
FALL 2016
SUM M ER 2017
2018
JAN 2017
FALL 2017
TEAM TALKS O N RACELearned how patient/ m em ber bias im pacts colleagues
LEADERSHIP TEAMForm ed, to benchm ark, and design strategy to support colleagues. Draft of guidelines
FO CUS G RO UPSHosted input sessions w ith team s across organization to learn effective strategies and build process
RESO URCE DESIG NPartnered w ith team s across the organization to design and refine resources for colleagues
Reach leaders and team s across the organization
TEAM TALKS &RO LLO UT
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O utcom es
• Spring 2018 Team Talks
• Toolkit of resources
• Train the Trainer (over 700 em ployees)
• Huddles
• O ngoing m anagem ent and partnership
• Sharing learnings externally
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O ther com pliance and diversity/inclusion partnerships:
• N on Discrim ination in Health Care (ACA 1557 and ADA 504)
• Em ployee Investigations
• Privacy
• Retaliation Allegations
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Q uestions? 25