Effective Strategies for Managing Difficult Conversations in the Emergency Department

Learn valuable insights from the presentation by Dr. Stephen H. Anderson on managing difficult conversations in the emergency department. The talk covers various scenarios such as dealing with grief, addressing substance abuse issues, handling disagreements with colleagues, and emphasizes the importance of active listening and understanding others' perspectives. Key principles like knowing allies, promoting win-win situations, and recognizing ownership are highlighted as essential strategies for successful communication in challenging situations.

• Emergency Department
• Difficult Conversations
• Communication Strategies
• Active Listening
• Conflict Resolution

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1. Managing Difficult Conversations Social Psychology 201 for ED s Stephen H. Anderson M.D., FACEP President, WA State Chapter ACEP September 24, 2012 Presented at WSHA Safe Table - ER is for Emergencies 1

2. Seven Conversations Grieving 1) Someone is dying/ died. 2) Your child is going to have a bad outcome. Presented at WSHA Safe Table - ER is for Emergencies 2

3. Seven Conversations Sheriff/ Parenting 3) I think you have a drug/ alcohol problem. 4) I think you re here too often. 5) Why are you REALLY here? Presented at WSHA Safe Table - ER is for Emergencies 3

4. Seven Conversations Colleague/ Political 6) I disagree with you as a colleague. 7) That s not how administration foresees it. Presented at WSHA Safe Table - ER is for Emergencies 4

5. Overlying Principles There are rules/ givens. You have to listen. Presented at WSHA Safe Table - ER is for Emergencies 5

6. Principles Know your allies Know their allies. Find your support Find their support. Presented at WSHA Safe Table - ER is for Emergencies 6

7. Principles Believe in WIN- WIN. To thine own self be true. Document. Presented at WSHA Safe Table - ER is for Emergencies 7

8. There Are Rules/ Givens Some are hard Some are soft. Some are ours Some are only mine . Presented at WSHA Safe Table - ER is for Emergencies 8

9. There Are Rules/ Givens The Key Ownership Presented at WSHA Safe Table - ER is for Emergencies 9

10. You Have To Listen Conversations are two way. Find out their goals. Find out their fears. Give them enough rope Presented at WSHA Safe Table - ER is for Emergencies 10

11. Know Your Allies Rally your troops. Build your allies. Do you want to be an expert witness? Presented at WSHA Safe Table - ER is for Emergencies 11

12. Know Their Allies Introductions for EVERYONE. Note Alleged Allies not present Acknowledge as appropriate. Presented at WSHA Safe Table - ER is for Emergencies 12

13. Find Your Support Find Their Support Key to the Grieving Conversation If you re headed to war take them with you. Presented at WSHA Safe Table - ER is for Emergencies 13

14. Believe In WIN-WIN Try never to define your win, by their loss. Presented at WSHA Safe Table - ER is for Emergencies 14

15. Believe In WIN-WIN Listen Repeat back Work toward a common goal Compromise? Presented at WSHA Safe Table - ER is for Emergencies 15

16. To Thine Own Self Be True Never Lie Never Lie Never LIE! Presented at WSHA Safe Table - ER is for Emergencies 16

17. These Are Difficult Stressful Conversations! Debrief Avoid being the one with the disease Presented at WSHA Safe Table - ER is for Emergencies 17

18. Not All Conversations Will End WIN-WIN Some won t end. Have an exit strategy. Presented at WSHA Safe Table - ER is for Emergencies 18

19. Document ANY conversation with potential is worth documenting. Two documented views are better then one. They know how to document too! Presented at WSHA Safe Table - ER is for Emergencies 19

20. Someone Is Dying/ Died It s someone s job, take ownership. #1 Most Important Find your support Find their support Presented at WSHA Safe Table - ER is for Emergencies 20

21. Someone Died Focus on the closest, talk to everyone Listen Account for beliefs/ cultures Physical contact, the healing touch . Presented at WSHA Safe Table - ER is for Emergencies 21

22. Someone Died Goals To Express 1) We did everything appropriate. 2) Address pain & suffering. 3) Now we are here to help you & others. Presented at WSHA Safe Table - ER is for Emergencies 22

23. Someone Is Dying Don t lie Don t steal hope Be realistic Presented at WSHA Safe Table - ER is for Emergencies 23

24. Someone Is Dying Listen ( Is the PATIENT speaking through an advanced directive?) Find your support/ Find their support Start the conversation Geography/ proximity Presented at WSHA Safe Table - ER is for Emergencies 24

25. Your Child Is Going To Have A Bad Outcome Find your support/ Find their support Don t steal hope Be honest in that moment Presented at WSHA Safe Table - ER is for Emergencies 25

26. Bad Outcome Negative attitude leads to negative outcomes Blame is for later Presented at WSHA Safe Table - ER is for Emergencies 26

27. Bad Outcome Child s safety first When do you include the child in the conversation? Presented at WSHA Safe Table - ER is for Emergencies 27

28. I Think You Have A Drug/ Alcohol Problem Society/ Legislature/ Peers now tell us We MUST have these conversations THIS is the pivotal time. Presented at WSHA Safe Table - ER is for Emergencies 28

29. Drug & Alcohol Problems The Principles There are rules/ guidelines Listen first Your allies/ their allies Their support might turn out to be your best ally! WIN-WIN Be true to yourself Presented at WSHA Safe Table - ER is for Emergencies 29

30. Drug & Alcohol Tools to Help Old Records EDIE WA state Prescription Monitoring Program Educate patients that these exist Presented at WSHA Safe Table - ER is for Emergencies 30

31. I Think Youre Here Too Often PRC Patient s Requiring Co-ordination Presented at WSHA Safe Table - ER is for Emergencies 31

32. Youre Here Too Often New WA Hospital Requirements Identify PRC clients upfront Notify their PCP of visit Discharge patient with instructions along: the right patient-to the right place-at the right time Shouldn t be a punitive discussion Presented at WSHA Safe Table - ER is for Emergencies 32

33. Youre Here Too Often You re Unique, but Educate The Econ Lecture Presented at WSHA Safe Table - ER is for Emergencies 33

34. Why Are You REALLY Here? Constructively focuses the scatter. Gives an opening to the REAL difficult conversation. NEVER demean the answer Presented at WSHA Safe Table - ER is for Emergencies 34

35. I Disagree With You As A Colleague Fatal Error VS. Difference Of Opinion Fatal Error Success comes through education first Presented at WSHA Safe Table - ER is for Emergencies 35

36. Difference of Opinion With A Colleague Praise in Public/ Debate in Private Ask yourself going in: What s my goal? Am I a team builder? How can I make this WIN-WIN? Focus on the patient Presented at WSHA Safe Table - ER is for Emergencies 36

37. Difference Of Opinion With A Colleague Listen Agree on the easy, Work toward the hard. Set the stage for The Next Time If necessary, use the chain of command. Presented at WSHA Safe Table - ER is for Emergencies 37

38. Thats Not How Administration Foresees It 38 Presented at WSHA Safe Table - ER is for Emergencies

39. Administrations Viewpoint The Golden Rule Do unto others, as you would have others do unto you. 1) 2) Those with the gold, make the rules. Every pathway has an economic angle. Presented at WSHA Safe Table - ER is for Emergencies 39

40. Administrations Viewpoint What brought you to the table? 1) What do they need from you? 2) What motivates you? Principles Priorities Presented at WSHA Safe Table - ER is for Emergencies 40

41. Administrations Viewpoint Great leaders get input from great followers Presented at WSHA Safe Table - ER is for Emergencies 41

42. Managing Difficult Conversations There are rules/ givens You have to listen Know your allies/ know their allies Find your support/ find their support Believe in WIN-WIN To thine own self be true Document Presented at WSHA Safe Table - ER is for Emergencies 42