Many healthcare facilities are making the shift from fee-for-service care to value-based care, optimizing the utilization of a team of medical professionals to care for patients, and inevitably increasing the potential for interpersonal conflict. Last week we discussed this seemingly negative aspect of team-based care and reframed it as a positive opportunity for improvement, provided an effective plan is in place to facilitate a healthy resolution. This week we’re continuing our discussion on conflict, specifically targeting how to effectively de-escalate conflict between a healthcare professional and the patient.
If you’ve been in healthcare for any amount of time, you’ve almost certainly had an encounter with an emotionally charged patient. You’ve probably seen firsthand how a simple point of frustration or disagreement can escalate quickly, potentially even leading to litigation in worst-case scenarios. A large part of the healthcare professional’s job is compassionately caring for patients under potentially sensitive and delicate circumstances. Today we’ll look at several practical strategies to help de-escalate conflict among patients when emotions are running high.
The Skill of Identifying Emotions
Hands down, the first step to dealing with emotionally charged patients is being able to recognize their state of frustration and/or anger even when they do not verbally express what they’re feeling. Authors of the Geeky Medics article, “Dealing With Angry Patients and Relatives,” write, “It is very important that we first identify that the person we are talking to is angry. The skill of identifying emotions is very useful when communicating with patients and relatives. Once the emotion is identified we can then start to respond accordingly with empathy, reassurance, or an apology, depending on what the patient is feeling and what events have occurred.” (1) Note the following behaviors as signs of potential anger:
- Loud speech or shouting
- Swearing/verbal abuse
- Oversensitivity to what is being said
- Aggressive posturing, not wanting to sit down
- Walking/threatening to walk away
- Pacing up and down
- A rise in the pitch of voice
- Change in eye contact (e.g. suddenly looking down)
These are behaviors that can be easily identified, yet there are also more subtle signs of anger such as giving one-word answers, seething, and sudden quietness. Being able to properly perceive and interpret patients’ behaviors is the first step in de-escalating the situation.
Conflict De-Escalation Techniques
Although not specifically targeted towards a healthcare context, I believe the tips included in 360 Training’s blog, “Conflict De-Escalation Techniques and How to Use Them,” translate nicely to caring for patients. (2) I’ll use the term “patient” interchangeably with “customer.”
Tip #1 – Stay Calm:
This may be the most important step in de-escalating conflict with a patient. Control your own emotion. Matching their anger in your reaction will only worsen things. Remain calm and be prepared to listen.
Tip #2 – Don’t Blame Anyone:
Now is not the time to recite company policy and in doing so, can amplify the patient’s anger. Avoid “you” statements that naturally point the finger at the patient. I’d like to note that it only serves to weaken the integrity of the entire healthcare team and/or facility when you blame another staff member. This creates distrust within the patient.
Tip #3 – Get to the Bottom of the Problem:
Express a genuine desire to partner with them to solve the issue by using statements such as, “Let’s try to work this out together.” Also, be sure to ask questions, communicating to the patient that you care and are invested in solving the problem to the best of your ability.
Tip #4 – Admit Mistakes:
Don’t hesitate to apologize if you make a mistake. This can go a long way with the patient – maintaining rapport and instilling trust. Be sure to let the patient know you will remedy the problem and make sure it doesn’t happen again.
Tip #5 – Break the News Gently:
If the patient is at fault, break the news gently and in a way they can clearly see, then help guide them to the solution. The 360 Training blog states, “Repeat what they told you was the problem. For an angry customer: ‘You said this shirt shrank when you washed it’ – so they agree. Then, explain what happened – ‘This shirt is silk. It says here on the label to dry clean only. If you put it in the washer and dryer, it will shrink.’ (2)
Tip #6 – Strive to Fix the Issue:
It’s important to be able to identify if the patient is just wanting to vent or if he/she is wanting you to provide a solution to a problem. If you are able to solve the problem, do so. This Medical Justice article, authored by a physician, states, “Listen to the patient’s explanation. If his explanation is reasonable, consider accommodating him.” (3)
Tip #7 – Thank the Person!:
360 Training sums it up nicely, “Imagine their surprise when you thank someone for taking the time to bring an issue to your attention. People want to be heard and the easiest thing you can do is acknowledge their problems and their feelings. Also, if possible get their feedback for how they would solve the problem and mention what kind of follow-up you plan to do.” (2)
Katy Konkel provides two additional tips that are unique to the healthcare industry in her article, “How to Deal With an Angry Patient.” She first advises her readers to not take patient frustration personally, explaining that anger is often a secondary emotion. She writes, “While it may seem like a patient is lashing out at you personally, the reality is that they are most likely having an emotional response to a situation that does not even involve you. You just happened to be in the wrong place at the wrong time…By reminding yourself that the patient’s emotions are misplaced, you can circumvent feelings of being attacked and needing to respond aggressively.” (4)
In addition, healthcare providers have a unique responsibility to gain patients’ trust by helping them feel heard and genuinely cared for. Expressing empathy is one of the best ways to do this, as well as diffuse heightened emotion. Konkel writes, “Acknowledge their experience and how it is affecting them. Ask your patient if they would like your help. First and foremost, patients want to know that they are heard and understood.” (4)
The physician’s office can often be an emotionally difficult place for patients. Each touch-point of the patient’s experience has the potential for frustration, ranging from; long wait times, an unexpected diagnosis, minimal time spent with the healthcare provider, curt check-out personnel, and of course, surprised charges and billing. It’s crucial the entire staff of a healthcare facility is equipped on how to respectfully and efficiently de-escalate emotionally charged patients.
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Jerry L. Stone