Download Targeted Communications for Effective Management

(+) Dr. Baumann is Interim Chief, Department of
Emergency Medicine, Maine Medical Center, Portland,
Maine; Professor, Tufts University School of Medicine,
Boston, Massachusetts
Phase IIII
February 7-11, 2017
Targeted Communications for Effective Management
Michael R. Baumann, MD, FACEP
The ED is the topic and you’ve just been called to speak with
the CEO and two board members, or a complaining
department of medicine, or your physicians. Are you
prepared? Can you tell a compelling story and persuade them?
Can you read your audience and respond with flexibility to the
situation at hand. This important presentation will teach you
how to make important presentations by teaching skills and
allow practice in several components of presentation /
communication.
Objectives:
• Differentiate between effective and ineffective
communications.
• Create persuasive written communications, memos,
letters.
• Define the components of compelling oral
presentations.
• Respond to requests for “spontaneous” brief
presentations (including media responses).
• Develop brief formal presentations to convey an
important concept.
2/11/2017
8:00 AM-11:45 AM
SA-9
(+) No significant financial relationships to disclose.
1/3/17
ACEP ED Director’s Academy
TARGETED AND EFFECTIVE
COMMUNICATION
Michael R. Baumann, MD, FACEP
Professor of Emergency Medicine
Tufts University School of Medicine
Chair, Dept of Emergency Medicine
Maine Medical Center
Basic Human Truisms
•  We are less rationale than we think
•  We are less insightful than we think
•  We are less reasonable then we think
•  We deserve less credit than we think
•  We should share the blame for problems more
often than we think we should
Endowment Effect
Confirmation Bias
•  We value who we are, what we have, and what we
•  Without appropriate feedback, we believe everything
contribute more
•  We don’t value the contributions made by others as
much
we are doing is right and good
•  This assures continuation of behaviors that may
negatively impact good communication
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YOU HAVE TO LEARN THE
Importance of Communication
RULES OF THE GAME.
AND THEN YOU HAVE TO PLAY
BETTER THAN ANYONE ELSE.
-Albert Einstein
•  “The admitting physician wanted so much
information it was driving me crazy!”
•  “That physician is very difficult to call on the
phone.”
•  “I just wanted them to come see the patient.”
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Emergency Physician Communication 101
•  What do you mean the d-dimer came back at
5017?
Effective Communication Skills:
The Essentials
•  What does “communication” mean to you?
•  What are the essential communication skills?
•  They didn’t tell me they had a new diagnosis of
colon cancer and
•  Completed a trip to Canada 2 weeks ago before
starting chemo.
The “Real World”
Effective Communication
EFFECTIVE COMMUNICATION:
USE A CHECKLIST
•  Takes hard work and time
•  We are often rushed
•  Think of the C’s when it’s your turn to speak
•  Clear
•  Concise
•  Concrete
•  Correct
•  Coherent
•  Complete
•  Courteous
•  Takes information – sometimes lots of it
•  Requires active listening
•  Requires clear and consistent messages
•  Uses all of your senses
•  Uses many of your motor groups
•  Every neuron is “in the game if you want to be great!”
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EFFECTIVE COMMUNICATION:
CLEAR
EFFECTIVE COMMUNICATION:
CLEAR(ER)
¢ Hi Dr. Rodgers,
—  Dr. Elm who joined your group is a great asset. I’d like to talk
more about her when you have time.
¢ Hi Dr. Rodgers,
—  Dr. Elm who joined your group has been engaging our staff well,
does admits in a timely manner and is quite knowledgeable. I’d
like to talk about her doing a communication lecture for our staffs.
•  Yours, Dr. Jim
•  Yours, Dr. Jim
¢ You are Dr. Rodgers…
¢ You are Dr. Rodgers…
EFFECTIVE COMMUNICATION:
CONCISE
EFFECTIVE COMMUNICATION:
CONCRETE
•  This is not optional - Read this email in it's entirety and reply all (It only goes to Bev
•  Hi Dr. Rodgers,
•  I wanted to touch base with you about Dr. Elm who joined your
group this past month. I really think she has been engaging our
staff well, and she definitely does her admits in a timely
manner. She literally shows up five minutes after she is paged
and goes directly to the patient to start the work-up. I have also
found she is quite knowledgeable and has taught our staff a
whole host of subject matter. I’d like to talk about her doing a
communication lecture for our staffs.
and myself) as your electronic signature that you have read this.
•  •  MMC has been cited for an EMTALA violation by CMS. As part of our plan of correction
we are requiring all Emergency Services staff to review the hospital EMTALA policy .
•  •  Every patient presenting, no matter what the complaint, must be offered a medical
screening exam (MSE). A physician must accompany the Triage RN to conduct a MSE.
Triage nursing assessment does not constitute an MSE
•  •  Please review the MMC EMTALA policy at this link immediately upon receipt of this
email:
•  http://policy.mmc.org/CMS/mmc/production/Site_Published/policyweb/SiteSearch.aspx?
s=1&searchKeyword=EMTALA
• 
•  Please "reply all" upon receipt of this email to indicate that you have read and
understand the enclosed information. If you have any questions or need further
clarification, please let me know immediately.
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EFFECTIVE COMMUNICATION:
(IN)COMPLETE
EFFECTIVE COMMUNICATION:
COMPLETE
•  Hi All-
•  Hi AllThe chief medical officer will be at our 7am meeting to discuss
professionalism. Please plan to attend.
Please remember to come to tomorrow’s staff
meeting.
EFFECTIVE COMMUNICATION:
COURTEOUS
EFFECTIVE COMMUNICATION:
COURTEOUS
•  …Asking my daughter about it is not entirely fair, as
•  Sarah dislikes confrontation and would be reluctant to
she dislikes confrontation and would be reluctant to
express her true feelings. I would like to meet with you
and Mrs. Boffa to discuss how we might remedy this
situation.
Barriers to Effective
Communication
express her true feelings if asked at school. I would
like to meet with you to discuss how we might facilitate
a faster transition for Sarah.
Barriers to Effective
Communication
•  Choice of words
•  We hear about 50% of what is said
•  Timing of the message
•  We understand 50% of what we hear
•  Non-verbal cues
•  We believe 50% of what we understand
•  Power struggles
•  We remember 50% of what we believe
•  Ineffective message delivery
•  Lack of being candid
•  Lack of trust
•  Unclear message, delivered emotionally
Walker, K, et. Al. Communication Basics LEADS curriculum, Kansas State Univ. 2002
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Necessary Skills for Effective
Communication
•  Facility with verbal communication
•  Sensitivity to nonverbal communication
•  Active / interactive listening
Fight Or Flight = Violence or Silence
•  To enhance communication, must recognize in
ourselves and others
•  A better option is to prevent or eliminate the conflict
entirely
•  Resistance disappears if there is no counter resistance
•  Adrenaline takes time to dissipate once communication
is re-established
Vascular to osh vascular
Communication: Understand yourself
•  1.
•  11.
•  2.
•  12.
•  3.
•  13.
•  4.
•  14.
•  5.
•  15.
•  6.
•  16.
•  0
Not at all
•  7.
•  17.
•  5
•  10
Sometimes
The majority of time
•  8.
•  18.
•  9.
•  19.
•  10.
•  20.
2: I have put off returning phone calls or emails because I simply didn‘t want to deal with
the person who sent them.
•  0
•  5
•  10
Not at all
Sometimes
The majority of time
1: At times I avoid situations that might bring
me into contact with people I’m having
problems with.
3: Sometimes when people bring up a touchy or
awkward issue I try to change the subject.
•  0
•  5
•  10
Not at all
Sometimes
The majority of time
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4: When it comes to dealing with awkward or
stressful subjects, sometimes I hold back rather
than give my full and candid opinion.
— 0
— 5
— 10
Not at all
Sometimes
The majority of time
6: When I’ve got something tough to bring up,
sometimes I offer weak or insincere compliments
to soften the blow.
•  0
•  5
•  10
Not at all
Sometimes
The majority of time
8: If I seem to be losing control of a conversation, I
might cut people off or change the subject in order
to bring it back to where I think it should be.
— 0
— 5
— 10
Not at all
Sometimes
The majority of time
5: Rather than tell people exactly what I think,
sometimes I rely on jokes, sarcasm, or snide
remarks to let them know I’m frustrated.
•  0
•  5
•  10
Not at all
Sometimes
The majority of time
7: I sometimes exaggerate my side of the
argument to get my point across.
•  0
•  5
Not at all
Sometimes
•  10
The majority of time
9: When others make points that seem stupid to
me, I sometimes let them know it without holding
back at all.
— 0
— 5
— 10
Not at all
Sometimes
The majority of time
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10: When I’m stunned by a comment, sometimes
I say things that others might take as forceful or
attacking—terms such as “Give me a break!” or
“That’s ridiculous!”
— 0
— 5
— 10
Not at all
Sometimes
The majority of time
12: If I really get into a heated discussion, I’ve
been known to be tough on the other person. In
fact, they might even feel a bit insulted or hurt.
— 0
— 5
— 10
Not at all
Sometimes
The majority of time
14: When things don’t go well, I’m more inclined to
see the mistakes others made than notice my own
role.
11: Sometimes when things get a bit heated I
move from arguing against others’ points to saying
things that might hurt them personally.
— 0
Not at all
— 5
— 10
Sometimes
The majority of time
13: I get frustrated sometimes at how long it takes
some groups to make decisions because too many
people are involved.
— 0
Not at all
— 5
— 10
Sometimes
The majority of time
15: When I find that I’m at cross purposes with
someone, I often keep trying to win my way rather
than looking for common ground.
— 0
Not at all
— 0
Not at all
— 5
— 10
Sometimes
The majority of time
— 5
— 10
Sometimes
The majority of time
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16: I sometimes make absolute statements like
“The fact is…” or “It’s obvious that…” to be sure
my point gets across.
— 0
Not at all
— 5
— 10
Sometimes
The majority of time
18: There are some people I’m rough on
because, to be honest, they need or deserve what
I give them.
— 0
— 5
— 10
17: At times I argue hard for my view hoping to
keep others from bringing up opinions that would
be a waste of energy to discuss anyway.
— 0
— 5
— 10
19: In the middle of a tough conversation, I often
get so caught up in arguments that I don't see how
I'm coming across to others.
Not at all
Sometimes
The majority of time
20: When I’m discussing an important topic with
others, sometimes I move from trying to make my
point to trying to win the battle.
Not at all
Sometimes
The majority of time
— 0
Not at all
— 5
— 10
Sometimes
The majority of time
•  If your score is 0 - you may take a break for this
section.
•  If your score is less than 20 you may now teach the
— 0
— 5
— 10
Not at all
Sometimes
The majority of time
class.
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SILENCE OR VIOLENCE
SILENCE OR VIOLENCE
•  Personal examples
•  Personal examples
•  Violence >>> Silence
•  Violence >>> Silence
Nsurg patronizing OSH hosps
Hosps to peds pgy1 - violence
Verbal Communication
VERBAL
COMMUNICATION
•  I already know how to talk…
Effective Communication:
Verbal Communication
•  What are the most important factors necessary to
effectively communicate verbally?
•  What irritates you when it comes to verbal
communication?
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Effective Communication:
Verbal Communication
•  Be honest
•  State your position openly
•  Speak carefully, but state what you think
•  If you disagree with someone, tell them, clearly and
carefully
•  Avoid “some would argue” or “others think”
•  Use “I” statements focused on your thoughts
•  Take responsibility for your thoughts and opinions
•  Avoid “you” statements
•  “you think we should…”
•  “Some people feel”
Effective Communication:
Verbal Communication
•  Be clear and consistent
•  No should mean no, and yes should mean yes
•  If you change your mind, explain why you changed it
•  Do not say one thing to one person and another thing
to another
•  Avoid sidebar conversations
•  RED FLAGS:
•  “Don’t repeat this, but…”
•  “I am only telling you…”
Effective Communication:
Verbal Communication
Effective Communication:
Verbal Communication
•  Speak clearly and at the appropriate volume
•  Too loud = controlling
•  Too soft = uncertainty
•  Solicit views and suggestions
•  Don’t control the discussion
•  Do not mumble, speak down or degrade
•  Do not act out those feelings
•  State your feelings
•  Do not whine or get weepy
•  Be validating, speak in the positive
•  Do not get pressured speech
•  Violates multiple communication rules
•  Do not react to others emotions
•  Attempt to understand why they are expressing them
•  Silence can be OK
•  Do not ramble, come to the point
•  Decide on specific follow-up actions and specific dates
Effective Communication:
Verbal Communication
Verbal Communication : SBAR
•  Do not be rude or use foul language
•  Structured technique
•  Professional behavior is much more effective
•  Conveys a great deal of information
•  Do not burn bridges
•  Succinct and Brief
•  Do not say anything you will regret later
•  People don’t forget these things easily
•  Standardizes different communication styles that come
from
•  Can you recall recent examples where you
communicated in a way you regretted?
•  Gender
•  Background
•  Training
•  Profession
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Verbal Communication : SBAR
Verbal Communication : SBAR
•  SBAR communication is a model for clinical
•  Situation – What’s going on with the patient right
communications
now?
•  Method of communication with military origins
•  Identify yourself
•  Beginning to gain traction in healthcare
•  Identify the patient
•  Enhances safety by standardizing what is conveyed
•  State the problem concisely
Verbal Communication : SBAR
Verbal Communication : SBAR
•  Background – What’s the background? How did we get
•  Assessment – What do I think the issue is? Why am I
to this point?
concerned?
•  Review the chart
•  Provide your observations
•  Anticipate questions
•  Provide your evaluation of patient’s current state
•  State the relevant medical issues
Verbal Communication : SBAR
VERBAL COMMUNICATION
•  Recommendation – What should we do to respond to
the situation?
•  Suggest what should be done to meet patient’s immediate needs
•  What is the most important skill you could develop for
effective verbal communication?
MMC ED to hosps - Please admit
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ACTIVE LISTENING
WHAT IS ACTIVE LISTENING??
•  When was the last time you were speaking to someone
and you wondered if they were still listening?
Listening:
A
CRITICAL communication skill
•  You will need to know how to manage when
•  They are not listening to you
•  You are not listening to them
•  Studies show we remember ¼ to ½ of what we hear.
SOMETIMES IT’S EASY
TO TELL WHEN YOU ARE NOT
ACTIVE LISTENING:
•  Looking at watch or smartphone
•  Deciding where to go for dinner
•  Texting
•  Wondering if I will finish early so you can workout
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SOMETIMES IT’S HARD TO
TELL WHEN YOU ARE NOT
ACTIVE LISTENING:
Effective / Active Listening
•  Thinking about what you are going to say next
•  Open minded
•  Forming counter arguments or rebuttals
•  Empathetic
•  Interrupting the speaker
•  Respond / be interested
•  Discussing a point with someone at your table
•  Pay attention to what is being said or inferred
Effective / Active Listening
Effective listening : LISTEN
•  Fight distractions
•  L – Look
•  Look at them , eye contact
•  Pay attention
•  Avoid side conversations in a group setting
•  Watch for non-verbal cues
•  Body language
•  Facial expression
•  Judge the content
•  Not the messenger or delivery
•  I – Inquire
•  Open probing questions, what, why, how, who
•  What do you mean when you say…
•  S – Summarize
•  Recap
•  What you are saying is…
•  Confirms you are trying to hear accurately
EFFECTIVE LISTENING: LISTEN
EFFECTIVE LISTENING: LISTEN
•  T – Take notes
•  Keeps focus
•  Mentally repeating their words also keeps focus
•  N – Neutralize your feelings
•  Stay objective, avoid bias
•  Listen to the message
•  E – Encourage
•  Smile and other open facial expressions
•  Nod occasionally
•  Use silence or small verbal cues to encourage them to say more
•  Don’t be distracted by how you feel toward the person
•  Don’t be distracted by their emotions
•  Yes, uh-huh, really
•  Open stance and arm positions
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Active Listening: Paraphrase
Active Listening: Paraphrase
•  Restate what the speaker has said
•  Allows you to fully comprehend
•  Demonstrates you have heard what they said
•  Allows speaker to hear their words from your perspective
•  Lets them know you are listening
•  Allows the speaker to clarify or correct
•  Paraphrase to assure you’re getting the right
information
•  What I’m hearing is…
•  Sounds like you are saying…
•  I may not be understanding you correctly and I find myself
taking what you said personally, so what I heard was…
Active Listening examples
Active Listening examples
Active Listening : Summary
Nonverbal Communication
•  Shows you value them
•  What is it?
•  Seek greater understanding of what they are trying to
•  What are some examples?
say
•  Builds relationships
•  Learn invaluable points in the process
•  Benefits the speaker and the listener
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Non verbal communication
•  Many studies show the non
verbal cues communicate
more
•  What you say is overpowered
by how you act and appear
•  Why are you angry? E.g.
Nonverbal communication
Effective Nonverbal Communication
•  Posture
•  Actions
•  Tone of voice
•  Facial expression
•  Gestures
•  Use of space
•  Make eye contact
•  Conveys interest
•  Makes you look more trustworthy and sincere
•  Do not stare
•  Watch your body language
•  Open stance, arms at sides creates air of openness
•  Gestures should be open
•  Standing / sitting straight conveys alertness
•  Slouching in your chair minimizes communication
Effective Nonverbal Communication
Effective Nonverbal Communication
•  Watch your facial expressions
•  Smiling, nodding facilitate communication
•  Frowning, shaking your head can close the door on
communication
•  Never “eye roll”
•  Things to avoid:
•  Hunch your shoulders
•  Fold your arms
•  Turn away from the person to whom you are talking
•  Point your finger at the other person
•  “I’d love to work Saturday”
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Non Verbal Communication
Non Verbal Communciation
•  Examples
•  Questions
(NON) VERBAL COMMUNICATION :
SUMMARY POINTS
•  Set the stage in meetings
•  Get everyone in on the agenda early
•  Keep focused on the goals
•  Get everyone on a common acceptable platform
BEFORE getting to specifics
•  All patients get good care
(NON) VERBAL COMMUNICATION :
SUMMARY POINTS
•  Make sure you have complete info before speaking
•  I am not sure I have enough info to see how this will work…
•  Check assumptions at the door
•  Everyone makes assumptions (including you)
•  Clarify and paraphrase
•  I get the impression you feel this…
•  I think the problem lies here, but I sense you think differently…
•  Better reimbursement for the group
(NON) VERBAL COMMUNICATION :
SUMMARY POINTS
(NON) VERBAL COMMUNICATION :
SUMMARY POINTS
•  Inquire without advocating
•  Often spend too much time trying to convince others we are
right rather than listening
•  It’s not personal 99% of the time
•  Try to understand their point of view
•  Ask yourself why a reasonable, rational person would say or act
•  Inquire
•  Explain to me the details of your idea
•  I don’t get it, can you try again…
in that manner
•  Watch non verbal cues and mood
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(NON) VERBAL COMMUNICATION :
SUMMARY POINTS
(NON) VERBAL COMMUNICATION :
SUMMARY POINTS
•  It’s OK not to know everything
•  I don’t know
•  I want to make sure I understand what you are saying
•  Respond to emotions with inquiry, not silence or
•  You seem angry, so I feel we are not communicating
violence
•  You seem upset, is everything alright?
•  I understand why you are frustrated…
– paraphrase
well
•  We don’t seem to be getting anywhere, can we agree on
this…
•  I understand your point, what has worked in other
instances…
(NON) VERBAL COMMUNICATION
WRITTEN
COMMUNICATION
EFFECTIVE WRITTEN
COMMUNICATION
Electronic mail
•  Email
•  72 percent of Americans use the Internet
•  88 percent of internet users use email
•  In business, these percentages are for all practical purposes 100
percent.
•  Letters
•  Announcements
•  Posters
•  30 billion emails sent in 2004
•  97 billion emails sent in 2010
Worldwide Email Usage 2007-2011 Forecast: (IDC #206038)
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EFFECTIVE EMAILS
EFFECTIVE WRITTEN
COMMUNICATION
•  All communication points previously discussed apply
•  Remember the 7 C’s
•  Non verbal cues are severely limited
•  Try and keep email communication to topics that are not
controversial
•  Give an early warning of the subject
•  Subject line in email
•  First few sentences in a letter
•  Be respectful and concise
•  Edit and spell check all written communications
•  Misspellings can distract from your message
•  Spell checkers miss similar words
EFFECTIVE EMAILS: BASIC TIPS
EFFECTIVE EMAILS: BASIC TIPS
•  Subject line is the HEADLINE in a newspaper
•  Grabs your attention
•  Should know at a glance what the email is about
•  Repeat or weekly emails should have the date
•  Reply requested emails should have the respond date
•  Make a single point per email
•  Can reply to each within it’s time frame
•  Quick replies can be answered immediately if sent single
•  Related points can be combined
•  Consider putting them into separate or numbered paragraphs
•  Emails that are for info only can have multiple points
•  Again consider paragraphs
•  Friday notes example
EFFECTIVE EMAILS: BASIC TIPS
EFFECTIVE EMAILS: BASIC TIPS
•  Work emails should not be too informal
•  They last forever
•  They may be printed
•  They may be forwarded
•  Emails are never confidential
•  Think before you write
•  “Draft” controversial emails in word
•  Save as draft is second best option
•  Be a good email responder
•  Check email regularly
•  Acknowledge receipt if the response is delayed
•  Specify if you need a response
•  Include any call to action you desire
•  Be sure to include full contact info for them to respond
•  Often sent before ready
•  Don’t hit send if you have:
•  Any uneasiness about the message
•  Any anger about the message
•  Don’t use emails for discipline
•  Effective for task reminders: e.g. - complete your charts
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EFFECTIVE EMAILS: BASIC TIPS
Case Studies: Electronic Mail
•  Use BCC for emails to large groups
•  Rarely use “reply all”
•  Know the entire email thread before forwarding
Case #1
Case #2
From a member of the ED staff to everyone else in the
ED:
From a member of the medical staff to you, copied to all
of his partners:
“…I can’t believe we are allowing this to happen…
this is completely unacceptable… who is running
this department anyway…?”
Case #3
#1: From hospital administration:
“I would like to publically congratulate Dr. _____ for
accepting this position…”
#2: A recipient of the note inadvertently hits “reply to all”
with the following one-liner:
“I can’t believe this moron got the job!!!”
“…can’t you ER docs ever get this right? This is
ridiculous… you guys have no idea what you are
doing… I am tired of cleaning up your mess…”
Case #4
Sent by one of your residents to the hospital President at
3:30 A.M.:
“…Dear Administrator: … I can’t believe I am
forced to drink this crappy coffee when I am on
call! Why have you allowed this to go on for so
long?… I have some suggestions for you… please
let me know when this is fixed…!!!”
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Mitigating others emails
•  Similar to voice communication
•  Know when to take it offline
•  “This seems important and it seems people have strong feelings.
We will discuss at next faculty/staff meeting.”
•  “How about if we set up a group to explore the issue. Please
send suggestions for members to ...”
•  Act decisively (quickly)
Discussion?
Effective email communication
EXAMPLE : FRIDAY NOTES
•  Yes email:
•  See the new orderset to make it easier to order CTs.
•  Friday notes
•  Welcome Dr. X to the department
•  Attached is a lecture offering you may enjoy
•  Please see the attached email about the Maine ACEP
•  Characteristics
•  Immediately accepted
•  Not controversial
meeting in Portland on Dec 7th and RSVP to Maureen
•  Reminder for attendings, the LLSA is scheduled
immediately preceding the MEACEP meeting
•  Please remember to put a sticker on your airway QI
forms
Effective email communication
Effective email communication
•  Not email:
•  Any message that is extremely important
•  Any message that is confidential
•  Any negotiation or back and forth conversation
•  Not email:
•  The hospital has a new policy of no moonlighting
•  The compensation program has been cut by 10%
•  The CME budget has been cut by 10%
•  The Overtime budget has been cut by 10%
•  Everyone has to do more shifts
•  The shifts are going to be 9 hours
•  Especially if you don’t know the person
•  Bad news, Criticism, Complaints
•  You need an immediate response
•  You don’t want a permanent record
•  Participants are nearby- benefit of nonverbal
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NOT EMAIL : EXAMPLE FROM
QUALITY OFFICER
EFFECTIVE EMAIL: SUMMARY
POINTS
•  Dear Dr Rogers,
•  Always read before you send
•  I know you have reported 100% compliance on OR
checklists, but since you had a wrong side surgery
recently, I sent students into the OR to observe and
here are the results…
•  Never use email to pick/continue a fight
•  Sleep on the really hot ones
•  Less is more
•  If you need to be critical, try to start every note by
pointing out something positive
•  Received the most scathing reply from the surgeon in
chief he has ever received
•  Not in email, multiple other learning points
EFFECTIVE EMAIL: SUMMARY
POINTS
EFFECTIVE EMAIL: SUMMARY POINTS
TROUBLE WAITING TO HAPPEN
•  Do not overuse Reply to All
Don’t send important emails when you are:
•  Assume everyone will see your note
•  Be careful with confidential information
•  Rushed or distracted
•  Do not send or forward emails containing
•  Pissed off
inflammatory, offensive, racist or obscene remarks
•  NO Jokes, cartoons, pictures
•  DO NOT USE CAPITALS!!
•  Really tired
•  Have alcohol on board
LETTERS
LETTERS : EXAMPLE
•  Introduce yourself and your role
I would like to thank you for taking the time to speak with me today
regarding care you received on July 5, 1767. I truly apologize if you felt
there was a lack of communication during your visit, and that you felt we
did not meet your expectations. We take feedback very seriously and use
it in working with staff to improve customer service.
•  Address the concerns/main issues
•  Remain respectful
•  Come to closure
•  Avoid requiring further communication if not intended
Thank you again for speaking with me.
Sincerely,
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LETTERS : EXAMPLE
•  Dear
You were seen in the Maine Medical Center Emergency Department on
August 14, 2005. X-rays performed in the Emergency Department are
routinely reviewed. Upon review of your CT there was another
interpretation added to your chart. This finding may require follow-up
with a physician. I would like to discuss this CT interpretation with
you, but have been unable to reach you at the phone number you
provided. Please call me at your earliest convenience so we can discuss
your CT. If you have already received the CT interpretation and are
seeing a physician, please call me to let me know you have received the
information. Thank you for your time.
EFFECTIVE
FEEDBACK
•  Sincerely
EFFECTIVE FEEDBACK
•  Sandwich technique
•  Recognize qualities and areas performed well
•  Deliver honest and sincere feedback
•  Close with review of good qualities you hope to see continue
•  Non verbal communication is key
•  Neutral facial expression and body language
EFFECTIVE FEEDBACK
•  Location is important
•  As soon as reasonable
•  Make sure you have all of the data
•  Private location
•  Temperament is key
•  Angry or frustrated on either person’s part defeats this
EFFECTIVE FEEDBACK :
EXAMPLES
•  You are a wonderful advocate for your patients and
they seem to really connect with you.
•  I have noticed your productivity is below the rest of the
group. Perhaps we could come up with a few
techniques where you could match the group
productivity and still preserve your personal touch.
•  Remember to pick what’s important for feedback
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EFFECTIVE FEEDBACK
•  Your point is completely valid and I appreciate you
sharing it with me.
•  The outside auditors measure us on compliance to their
standardized guidelines and it is very important that
we adopt a standardized approach.
•  I think we should evaluate the evidence and if the
standard approach has no reason not to adopt, we
should follow it.
Average RVU/shift_FY YTD cumulative
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Eval Time v Mean
LOS V Mean
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Effective Feedback
Avg Pt/shift Cumulative YTD Fy_blinded
35
30
25
20
15
10
5
0
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F
N
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SPECIAL
COMMUNICATIONS
SPECIAL COMMUNICATIONS:
MEDIA
SPECIAL COMMUNICATIONS:
MEDIA
SPECIAL COMMUNICATIONS:
MEDIA
•  Understand their agenda
•  Reporters have a deadline
•  If you don’t respond they will ask the ED director across town
•  Prepare ahead of time
•  Most medical issues are seasonal, and repeat yearly
•  Can prepare, much like a lecture, and save for each year.
•  Know exactly what they are discussing and what their
•  Common topics in Maine
•  Heat Illness
•  Ozone
•  Cold Illness
•  Carbon Monoxide
•  Flu season
take on the matter is
•  Especially important if called by the editor of a paper or the Op
Ed (opinions) division
•  Not so important if talking on usual health issues
•  Don’t do any interviews without prep
•  If they show up unannounced, reschedule
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SPECIAL COMMUNICATIONS:
MEDIA
MEDIA
GENERAL POINTS IN THE MOMENT
•  Broadcast media
•  Work on your key message
•  The average “sound bite” is currently 7 seconds
•  You don’t have long to get your point across
•  Stay focused
•  Hone it down to short, clear, direct phrases
•  Print media
•  Think through your response very carefully
•  Especially with opinion editors who may have an agenda they
are trying to print that is different than you realize
•  Make it a “quotable quote”
•  Even if time is short, take a moment and come up with
your sound bite
•  If you have the choice, choose a background that is good
advertising (outside in front of hospital signage works
well)
SPECIAL COMMUNICATIONS:
MEDIA
SPECIAL COMMUNICATIONS:
MEDIA
•  Dress well
•  Lean forward slightly toward the camera
•  Solid, dark colors
•  Look at the interviewer
•  A white coat may be appropriate
•  Keeps your eyes from wandering; looks shifty
•  Warm up your voice
•  Do not look directly at the camera
•  Speak with energy
•  Never shake your head “no”
•  A higher volume, range, tone and pitch than normal
•  Never frown
SPECIAL COMMUNICATIONS:
MEDIA
SPECIAL COMMUNICATIONS:
MEDIA
•  Plant your feet, and use slow, deliberate
•  Memorize your key points
•  Movements
•  No more than 3-5
•  Keep your cool; stay calm
•  Write them down
•  Breathe
•  Try to keep referring to them in your interview
•  Don’t get flustered if you are peppered with questions
•  Never say “No comment”
•  Speak more slowly than your interviewer
•  To the audience, no comment = guilty
•  Avoid saying “I think”
•  Not sound-bite worthy
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SPECIAL COMMUNICATIONS:
MEDIA
MEDIA : SPEAKING POINTS
EXAMPLES
•  Keep hydrated
•  Have 3-5 key messages:
•  Avoid caffeine, milk or alcohol
•  Try not to lick your lips
•  Visualize a great interview
•  Heck, it works for athletes… why not you?
•  Afterward, do a post-mortem
•  Review, evaluate and improve
•  Practice!
•  It’s important to always wear a helmet when riding a
bike or motorcycle, skiing, or engaging in any activity
that could result in a serious head injury.
•  You don’t have to be traveling fast, or fall far to
experience a serious head injury.
•  Helmets should be worn by both children and adults.
MEDIA : WORKING YOUR
MESSAGE EXAMPLES
•  Question: In this age of increasing health care, is this
the best use of hospital funds?
MEDIA : WORKING YOUR
MESSAGE EXAMPLES
•  Question: Why expand the Emergency Department?
•  Answer: The number one reason we’re expanding our
•  Answer: This is really about enhancing patient care …
•  Answer: The real story today is providing better patient
Emergency Department is …
•  Answer: The community needs this for three reasons ….
care ….
•  MEDIA : SPEAK IN POSITIVE
PHRASES
MEDIA : SPEAK IN POSITIVE
PHRASES
•  Question: What did the X-rays show?
•  “I am not a crook” - Richard Nixon
•  What if he had said :
•  “I am an honest man” instead…
•  Incorrect
•  We didn’t have time to take a full set of X-rays.
•  Correct
•  We’ll take a full set of X-rays once we’re able to stabilize the
patient.
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MEDIA : SPEAK IN POSITIVE
PHRASES
MEDIA : SMALL, SIMPLE SOUND BITES
•  Question: The patient says Dr. Jones is a quack.
•  Incorrect
•  Dr. Jones is not a quack.
•  Correct
•  My experience is that Dr. Jones is a very good physician.
“The Emergency Department is seeing a large number of
patients with issues related to the heat, and this serves
as a good reminder that when we have a heat wave
people drink plenty of fluids, limit vigorous outdoors
activities, and seek out an air conditioned place to cool
off, especially if you’re elderly.”
Remember the 7 second sound bite…
http://www.wcsh6.com/video/3853414851001/1/MaineMedical-Center-put-Ebola-response-plan-to-the-test
MEDIA : SMALL, SIMPLE SOUND BITES
•  Our Emergency Department is treating a significant
number of patients for heat-related symptoms. Most are
generally mild.
•  It’s important for people to drink plenty of fluids, avoid
vigorous activities during the hottest part of the day,
and seek out an air conditioned place to cool off.
•  The elderly are especially susceptible to heat-related
issues, so they should be especially cautious. If you have
elderly relatives or neighbors, remember to check in on
them regularly.
MEDIA : FOCUS ON YOUR MESSAGE
•  Q: Is the Emergency Department a high stress area?
•  Incorrect
MEDIA : FOCUS ON YOUR MESSAGE
•  Do you have long waiting lines in the Emergency
Department?
•  Incorrect
•  No, we don’t have long waits in our Emergency Department
•  Correct
•  As you would expect, patients with the most urgent conditions
are treated first. Our goal is to see every patient as soon as
possible.
MEDIA : FOCUS ON YOUR MESSAGE
•  Q: We’re received reports that you were grossly
understaffed last night. How many doctors were
working?
•  Yes, the stress in the Emergency Department can be quite high.
•  Incorrect
•  Correct
•  There’s a lot that goes on in an Emergency Department, and our
staff is trained to handle whatever comes our way, from a broken
leg to a heart attack.
•  I don’t know that number.
•  Correct
•  I don’t have that information at my fingertips, but will get it for
you. What I can tell you right now is that we had a greater than
normal volume of patients due to …
•  Avoid “I don’t know” statements – they seem evasive
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MEDIA : FOCUS ON YOUR MESSAGE
•  Q: Patient John Smith claims your staff misdiagnosed
his condition?
MEDIA : FOCUS ON YOUR MESSAGE
•  Don’t give them another story…
•  Incorrect
•  Incorrect
•  I’m not going to comment on that.
•  Correct
•  Because of patient privacy policies, I can’t speak about a specific
patient or treatment, but we are aware of Mr. Smith’s concerns
and are looking into the matter.
MEDIA : WORD YOUR ANSWER TO STAND ALONE
•  We had a resident who had trouble intubating patients, so he
spent some time practicing at our simulation center and is now
proficient.
•  Correct
•  If a resident wants to sharpen his or her skills in a particular
area, we have a simulation center that provides an opportunity
to become proficient in skills ranging from suturing to
diagnosing heartbeats .
MEDIA: FINAL TIPS
•  Q: Do you recommend calling 9-1-1 whenever someone
has chest pains?
•  Incorrect
•  Yes, they should call 9-1-1 immediately
•  Think high level
•  Big picture
•  Don’t worry about details
•  Correct
•  If someone is experiencing chest pains, they should call 9-1-1-
immediately.
Emergency Medicine Midlevels - Situation
Emergency Medicine Midlevels - Background
•  Current staffing in ED unable to accommodate increasing
•  Volume changes and new programs have stressed
demands for patient care in both volume and acuity as
well as resident/student coverage.
•  Midlevel staffing designed without replacement factor
once coverage for resident conferences built in.
current abilities
•  Despite participation in multiple care management processes
•  Clinical decision unit opened “slow” with no additional
provider staffing
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ED volume
February 2010- February 2012
ED Left without being seen
February 2010- February 2012
4.0%
6150
3.5%
5950
3.0%
5750
2.5%
5550
Series1
2.0%
5350
1.5%
5150
1.0%
4950
0.5%
4750
1
2
3
4
5
6
7
8
9
10
11
12
13
14
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20
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1
24
ED Clinical Decision Unit
Patients
Drop Page Fields Here
February 2010-February 2012
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
Emergency Medicine Midlevels - Assessment
CDU Patients by Month
140
Count of Encounter
120
100
80
Drop Series Fields Here
Total
60
•  Demand is increasing
•  Patient volume continues to climb
•  Patient acuity continues to climb
•  Observation patient volume showing third year growth
•  Walkout rate starting to rise
•  Safety issues - Coverage on Tuesday mornings for resident
conference becoming inadequate with volume increases
40
20
2012-02
2012-01
2011-12
2011-11
2011-10
2011-09
2011-08
2011-07
2011-06
2011-05
2011-04
2011-03
2011-02
2011-01
2010-12
2010-11
2010-10
2010-09
2010-08
2010-07
2010-06
2010-05
2010-04
2010-03
0
YrMo
Emergency Medicine Midlevels Recommendation
Emergency Medicine Midlevels
•  Add 3.2 FTE as soon as hiring allows
•  Revise schedule to add 12 hours of coverage
•  Improves care for observation patients
•  Allows re-establishment of a fast track for minor emergencies
(Huron recommendation)
•  Anticipated outcomes
•  Reduce Left Without Being Seen rate significantly with
fast track
•  Reduce door to provider times for all patients
•  Fast track will improve bed availability
•  Reduce patient complaints related to ED wait
•  Increase provider and patient satisfaction by
decreasing interruptions during patient encounters
•  Provide safer coverage for current patient volume and
acuity
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SPECIAL COMMUNICATIONS :
DISRUPTIVE PHYSICIAN
Questions
•  Review proforma provided by Finance
•  Questions?
SPECIAL COMMUNICATIONS :
DISRUPTIVE PHYSICIAN
•  Upon exiting the room she thanks the physician for
waiting.
•  He looks her in the eye and quietly says…
??
Which approach would you take at this
point?
A. Do nothing?
Well
&$@#
you!
•  The following day the case makes it to your desk by
6:45 A.M.
B. Confront him directly
C. Report him to his Chief?
D. Report him to the VPMA?
E. Report him to HR?
SPECIAL COMMUNICATIONS :
DISRUPTIVE PHYSICIAN
The Disruptive Physician
•  More common than you might think
•  Essential to address immediately
•  Inaction virtually assures a replay
Gawande A. When Good Doctors Go Bad. The New
Yorker. August 7, 2000; 60-69.
Do you have a Disruptive Physician Policy?
JJ I can’t hold
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SPECIAL COMMUNICATIONS
TARGETED COMMUNICATIONS:
SUMMARY
•  99% of the time it isn’t personal
•  Do your homework
•  Know your issues – better than anyone else
•  Study
•  Listen… actively
TARGETED COMMUNICATIONS:
SUMMARY
TARGETED COMMUNICATIONS:
SUMMARY
•  Get experts to brief you and guide you on what you
•  Show up on time… or even a little Early
•  Don’t think you know everything
•  Don’t act like you know everything
•  Don’t be afraid to ask questions
•  Be comfortable with what you don’t know
don’t know
•  Don’t forget your internal experts – if going to an ultrasound
meeting
•  Bring the US champion
•  Never burn a bridge if you can avoid it
•  Keep your friends close and your enemies closer
•  Reputations follow us throughout our lives, so how you
treat others will be remembered
TARGETED COMMUNICATIONS
•  Thank you for your attention!!
•  Contact Info:
Michael Baumann, MD
Department of Emergency Medicine
Maine Medical Center
22 Bramhall St
Portland, ME 04102
207-662-7010
[email protected]
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CASE A
CASE B
•  The ED is full.
•  You get a call from the medical director of
•  Patients are in hallway beds.
•  There is a 2 hour wait to be seen.
•  You get a call from one of the hospitalists who is
managing an elderly patient with HTN on the
floor. The patient develops epistaxis and there is
no equipment on the floor. “Can I bring the
patient to the ED real quick?”
inpatient psychiatry, who is in your ED with
another psychiatrist Dr Y who is a patient.
•  Dr. Y has an extremely painful condition and he
asks you to help because they haven’t been seen
yet.
•  They acknowledge the ED is busy, but mention if
they approached the current ED attending “that
guy wouldn’t do anything they asked.”
CASE C
•  The ED attending from the prior case approaches you
and asks why you are seeing patients?
•  You describe the scenario and he goes on to tell you
angrily he hates “VIP medicine” because they subvert
our systems and things get missed.
CASE E
You are working the night shift and the ED is packed
with patients. A nurse reminds you [for the third time]
that the patient with acute renal colic in Room 17 is in
pain again and needs more pain medicine. Your curt
response… “I’ll get to it!” is just a couple of octaves
louder than usual and she frowns ever so slightly.
CASE F
CASE G
You are working the night shift and the ED is packed
with patients. Dr. Baumann, one of your ‘less speedy’
interns walks in to the nursing station to join the team
for the night. One of the staff mumbles… “Oh no, it’s
going to be a long night again!” just loud enough for
everyone to hear.
You are working the night shift and the ED is packed
with patients. The paramedics bring in a well-known
alcoholic sprawled out on the stretcher. One of your
over tired residents publicly laments… “Hey look…
another drunk dirt bag for us to take care of!”
Most of the staff chuckle in approval.
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CASE H
During your first few months on the job as a ED
attending you inadvertently become a “spectator”
of a case one of your partners is managing. He
makes a few clinical decisions that really surprise
you and the patient has an important
complication as a result.
Being brand new to the practice, you are not quite
sure what to do…
CASE STUDY (I): SMARTER THAN
THOU
•  Patients are often referred to your dept for studies after
being seen by their physician or an outside facility.
•  You announce at dept meeting that there are “too
many instances of smarter than thou” or “second
guessing” behavior
•  A respected physician exclaims “so we are supposed to
do every test the outside physician thinks”
CASE J
CASE K
•  For years your faculty has been paid a fixed salary with
In the face of escalating ED length of stay a group of
your nurses propose that a new set of Triage Protocols
be adopted. These dictate triage nurse-driven test and
treatment orders for patients with:
yearly 2% adjustments
•  In the past salary was not linked to either clinical or
academic performance
•  A hospital wide initiative will soon mandate that all
physicians adopt performance-based compensation
strategies
•  As a new Chief, you see pros and cons…
•  Chest pain
•  Abdominal pain
•  Acute painful conditions
•  A host of other diagnoses…
CASE L
•  The neurosurgeons are refusing to admit any cases that
are non-operative
•  Old patient with small subdural
•  Intraparenchymal bleed with seizure
•  The hospitalists are refusing to admit these cases
because they are busy
•  The patient is in the ED
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