Roll Calls: All Ears

Roll Calls Series

5

All Ears Engage & Understand

Engage & Understand • Listen for feelings and facts. • Practise emphatic listening. • Ask appropriate questions. • Appropriate body language includes eye contact, nod of the head and an alert body posture.

S2 Notes

TTSH service standards: Engage and Understand Explain each standard. Remember the 4 behaviors related to Engage and Understand by using images as depicted in the slide. Each image is representative of a behavior and builds on one another. Additional Notes: a) Feelings words include “I feel..”, I was uncomfortable… confused… angry… delighted … happy …” Facts are conveyed by “thinking words”, e.g. “I think… I expect… I see… I need… “ b) Emphatic listening involves paraphrasing and repeating to check for understanding. c) Ask appropriate questions politely to make decisions such as what , when, who, why and how. d) Use the appropriate body language to express interest such as leaning forward, eye contact, appropriate arm placement and so forth.

All Ears • • • •

Work in pairs. Tell a familiar story. One word by one person, at a time. No interruption.

S3 Notes

TTSH service standards: Engage and Understand Activity : Experience Listening Barriers Working as a pair, tell a familiar story , e.g. The Three Bears. Each person can only say one word at a time. For example, if the first person says, “Once,” the next person would say “Upon.” Continue this method until you complete the story or until time is up. The only rule is that you cannot speak for the other person. Give no more than 2 mins. Ask : • Was this task easy or difficult? • What listening barriers did you experience? Answers may include the following : We did not understand each other. We were too focused on what the next word should be. We were distracted by all of the other people talking. State : In this activity, it may have been difficult for you to complete the story – to communicate – because you were telling the story from your frame of reference, focusing on what you were going to say and on how the story should go. True understanding and effective communication occur only when you seek first to understand others by listening to them from their point of view and not from your frame of reference. To provide good service we need to engage and understand.

Engage & Understand Case Study (Generic) Hear Me Out “I brought my wife to TTSH to see a Doctor. I parked my car outside the ED white tent. I was stopped by a security guard who refused to let me or wife alight. I explained that my wife was very ill and needed to see a Doctor urgently. The male Indian security guard did not accept my explanation. My wife subsequently got off the car and proceeded to register. Halfway, she fainted. The security guard did not render any help. His female colleague who was standing beside him also did not help. A nurse came to help subsequently. I was shown the middle finger by the male security guard after I parked my car. I ignored him and proceeded to register my wife. During registration, I was again shown the middle finger.

S4 NOTES Engage & Understand Case Study

1. • • • •

Instructions Discuss the case study in groups. Identify what did we not do. How can we do to engage and understand the patient’s perspective? Once we have understood, what solutions become quickly obvious?

Possible Answers • As a staff  Recognise that this is a genuine case needing help. He’s feeling anxious, flustered.  Probably he was trying to park in a illegal parking lot – but the staff could have tried to listen to his explanation then offer solution to meet his needs. He could help by calling for valet parking for NOK etc.  Staff failed to practice empathic listening (critical in this situation as emotion is high – patient is very ill)  Use empathic listening starters (So you need to find a parking lot quickly as your wife is very ill?)  His colleague could have also extended help – get help to bring the patient quickly to ED, call valet etc.  Apparently, the staff seems to be in an unstable mood - probably due to stress or personal matters bothering him. His colleague could have stood in for him, then alerted their supervisor so that the staff could be brought away to be counseled by the supervisor).

Engage & Understand Optional Case Studies I NEED HELP (Outpatient) Patient saw doctor at XXX Clinic and was given an appointment for surgery. They went to XXX department at around 1500 hrs plus and waited till almost 1800 hrs. The staff was complaining of going home late. She just ticked the form and asked the patient to read it herself. As patient has diabetes and is illiterate, she was unsure whether the staff tick the correct columns. When the patient asked the staff to go through the form again, the staff commented that “I am very late.” She emphasised to the patient to read the forms herself – “read up, eh!” and chucked all the forms to her. The pre-admission counseling was done in a hurry. The patient told the staff that if they could not cope, do not accept anymore cases. Should tell the ward and clinic not to send patients here. The staff replied “We have already told them!”. Patient claimed that the staff was making a fuss and as to “why everybody admitting, write till pen no ink”. The patient’s daughter told the staff that they would like the patient to be admitted but staff told them there were no beds left. They claimed that the staff did not give them a chance to explain.

I NEED UPDATES (Inpatient) “After my spouse operation was done, she was sent to the recovery ward for observation. I was waiting for any news of her operation condition. Nobody told me anything about her until 3.45pm when I went back to Ward XX to enquire. Then someone from the recovery ward called me and said that my wife was still at the recovery ward and would be moved to the high dependency ward for further observation. Do not understand why nobody take the initiative to contact the patient’s family member to update the condition. Please consider the anxiety and worries it may cause to the patient family member”.

I NEED CARE (AHS) Patient came for CT scan on 26 Dec 08 and was rescheduled to 13 Jan 09 as steroid was not prescribed for his asthma. He was mis-quoted for the CT charges and finally agreed to the charges as quoted. CT scan was done on 13 Jan 09. He came for review 2 weeks later and during consultation, doctor found out that the images was blank, hence no report to share with the patient. Patient claimed that his doctor advised him to rest for 6 months or wait for another year before repeating another scan. He said that he did not know how to move on as he was too upset. He queried who would compensate him for the time, work, transport and flight back to Singapore. He claimed that he was concern about his health and he made it a point to come for review. He queried meanwhile who would be responsible for his medical condition should there be any abnormalities.

S5 NOTES Engage & Understand Optional Case Studies 1. • • • •

Instructions Discuss the case study in groups. Identify what did we not do. How could we have managed the situation better if we have engaged and listened? Recognise that patient has a genuine need.

Notes for Outpatient Case Study  Staff failed to practice empathic listening (critical in this situation as emotion is high – waited for 3 hrs)  Use empathic listening starters (You seem to be a little uncomfortable, would you like me to go through the form with you again?). There was no effort from the staff to improve communication even though patient has been waiting for more than 3 hrs. Should have sensed the worried look and tone of the patient – patient has diabetes and was unsure if the staff tick the correct columns. Should not express frustration in front of patient – “why everybody admitting, write till pen no ink” Notes for Inpatient Case Study  Staff failed to provide updates to the next of kin regarding the patient’s condition.  No effort from the staff to improve our communication process with patients, more so when the patient would be moved to high dependency ward. The stress level would be high when the next of kin was told that patient would be moved to HD ward when there was no updates earlier on. Notes for AHS Case Study  Recognise that this is a genuine case needing help - Patient’s emotion would be high – flew back to Singapore specially for the CT scan and to see a doctor as he was very concerned about his health  This is a case whereby the faults lie with us – CT scan without images (Quality of work is questionable)  Staff to provide service recovery to pacify him . Offer to arrange another scan for him. Have it reported and have the consultation on the same day . Seek permission to waive the charges.

Engage & Understand Follow-Up Activity Apple of Patient’s Eye For staff who turn challenges into opportunities to delight the patients and families, compliment the staff at the next roll call. Offer a small basket of apples. Psychological Air Activity

Our Pin-ups Pin up compliments on the notice board. Mark out behaviors that reflect engagement and understanding with stars. Put a photo of the person/team that’s complimented.

Demonstrate the need by people to be understood with this activity: 1.Ask staff to pinch nose and close mouth (hold their breath) for 30 seconds. 2.Once they start holding their breath, tell them you’re going to share important information on listening e.g. “empathy is a type of listening that requires heart, full attention and respect. It is reflecting content and feeling. It’s necessary when you need to diffuse an emotional situation...” 3.Ask staff if they could concentrate. Most will not be able to. 4.Teaching point: when we don’t listen to someone who needs to be understood, we are not giving them “psychological air”. The chances is they will not be able to hear us even if we have important things to say. We need to let their feelings “air out” first.