Mini Session 2A

Presenters:Amy Crowe, Kate Martin, Grace Jeremy

Making healthcare remarkable

Empathetic approaches to writing meaningful grievance lettersAmy Crowe, legal writer, patient services

Novant Health

About Novant Health

Empathetic approaches to writing meaningful grievance letters3

What we’ll cover today

Why our letters are important

The 4 foundations of a response

Putting it into practice

Empathetic approaches to writing meaningful grievance letters4

Understanding the “why”

Why are our letters important for patients?

Our patients and their loved ones

• Want to be heard

• Seek answers

• Deserve a prompt and fair resolution

• Have a right to know about their care and receive it in a way they can understand

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Why are our letters important for our organizations?

• Can rebuild trust with our patients and families

• Shows we are honest and transparent about our care and services

• Conveys compassion and personalized care and services

• Can reduce potential litigation for our organization

• Meets compliance and regulatory guidelines

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The 4 foundations of a response

Empathy Apology

Health literacy

Customer service

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Empathy

What is empathy?

Empathetic approaches to writing meaningful grievance letters

Identifying or experiencing the thoughts, feelings or attitudes of another.

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What are our patients and their loved ones feeling?

Afraid

Anxious

Vulnerable

Helpless

Confused

Frustrated

Tired

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Relating to our patients and their loved ones

Ask yourself some questions:

– What would I be feeling in the same situation?

– Why is this so important to this person?

– Why is the person upset?

– How can I see what is at the heart of this person’s concern rather than just viewing it as a complaint?

– What were the patient’s expectations? How did those differ from what actually happened?

– What do I know about this person’s life story and his/her journey?

Use some acting skills

– If you’re having a hard time feeling empathetic, “act as if…”

– It can be difficult to relate in some situations, but get creative and dig deep.

Evaluate and eliminate inherent judgments or biases

– Ex. You are aware of the patient’s previous drug addiction. You assume they only want pain medication because of this.

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The results of empathy

Empathy creates compassion

Sees the person beyond their words

Identifying their feelings helps understand how to

meet their needs and respond

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Apology

Why apologize?

Reestablishes trust

Prevents litigation

It’s the right thing to do

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How to apologize appropriately

Always• Expectations• Experience• Communication• Behavior/attitude• Waiting

Sometimes• Gaps in clinical care• Disagreements with care plan• Adherence to policies and procedures

Never• Measures were taken for safety• When you’ve done the right thing

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Example

Patient: 1. I waited forever in

the ER. 2. Nobody gave me

anything for my pain.

3. An officer got involved for no reason.

Investigation:1. Patient did have a

long wait time because the ER was very busy that night.

2. Patient specifically requested IV Dilaudid, which was not medically indicated. He was offered Tylenol but refused.

3. He was very upset about this and became physically and verbally aggressive toward staff. Public safety was called to deescalate the situation.

Response:1. I apologize you waited

longer than expected in the ER.

2. In the ER, it is often not safe to give IV pain medication because it has increased risks. The safest way to take pain medications is by mouth. We’re sorry if this was not better explained at the time.

3. Keeping everyone safe at our facilities is important. We partner with public safety to make sure we’re providing a safe environment for all. We appreciate your cooperation in this effort.

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Tips for apologizing

• Don’t overly apologize. Keep it minimal to sound sincere.

• Balance the patient’s perspective with the organization’s reputation.

• Be apologetic without using “I’m sorry” or “I apologize”.

• Ex. We’re disheartened this was your experience and will use it as an opportunity to improve.

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Health literacy

What is health literacy?

Definition: Health literacy is the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.

CMS requires our grievance letters to be written in a way that the patient or their representative understands.

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How to incorporate health literacy

Empathetic approaches to writing meaningful grievance letters

•Swelling vs. edema•Bruise vs. contusion

Use non-clinical language

•Doctor vs. physician•Short time vs. acute•Long time vs. chronic

Use lower-level vocabulary words

•Presented to the ER•Contraindicated•Received a workup

Avoid hospital lingo

•Our review was completed today, and we would like to share the results with you.

•Our review was completed today. We would like to share the results with you.

Use simple sentences

•Summarize instead of list in detail•Say it in as little words as possible•Generalize instead of restating verbatim

Reduce wordiness

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Reading level of your letter

Empathetic approaches to writing meaningful grievance letters

Goals for reading levels:

• Patient education materials – 3rd grade

• Grievance letters – 6th to 8th grade

• Realistically with grievance letters – below 10th grade

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Customer service

Two narratives

Questions we ask about our customer service

• Did we do the right thing?

• If not, how can we make it right for the patient/loved one?

• What is the appropriate response?

• How do we reestablish trust with this patient/loved one?

Questions patients/loved ones ask about their experience

• What happened while I was in the hospital?

• Why aren’t they trying to help me?

• How are they going to make this right with me?

• Why should I have to pay for care I disagree with?

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Balancing competing interests

• If there were opportunities for creating a better experience for the patient or their loved ones, what are your options?

• Service recovery

• Bill adjustment

• Compensation

• Meeting with the patient

• What is the patient/loved one asking for?• Identify the “ask” and address it.

• If denying a patient/loved ones’ “ask”, explain why.• Vaguely stating that a patient’s care was appropriate is not answering their

questions.

• Leaving the patient/loved ones without answers to their questions about their care does not reestablish trust.

• Our letters are a way to improve the customer relationship.

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Rebuilding trust and brand loyalty

Your letters can rebuild trust

Honesty & transparency

Giving dignity to the patient and their loved ones

Explain instead of blame

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Putting it into practice

Choosing language that matters

Acknowledge without having to understand

• “I can only imagine…”

• “I’m sure that was…”

• “I imagine this must have been…”

• “From what you’ve shared, it must have been…”

• *Only use words of emotion that the patient has provided. Don’t project emotion onto them.*

Add a personal touch

• If a patient has died, always start the letter with condolences.

• When referencing a loved one, use his or her first name if known.

• Congratulate mothers on the birth of their babies.

• The more personal we can make the letters, the more our patients feel we listened and see them as an individual.

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Choosing language that matters (cont.)

Sensitive language and word choice

Developing approved language for common responses

• Pain management

• Rude/dismissive behavior

• Wait times or delays

• Instructions and processes

Empathetic approaches to writing meaningful grievance letters

This… Instead of that…

“declined” “refused”

“Could not find support for…” or “no documentation to support”

“could not substantiate”

“patients with diabetes” “diabetic patients”

Explain (acknowledge) Don’t blame (accusing or perception)

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Gentle approaches and soft tone

Empathetic approaches to writing meaningful grievance letters

Redirecting emphasis

Use sentence structure (syntax) to soften your

approach

Patient says he didn’t receive a bath for 7

days. Documentation shows bath was refused when nurses attempted.

Instead of “You declined baths.” say

“Our offers for a bath were declined.”

Active voice

Use when the patient alleges we did not do

something that we should have.

Patient says her nurse didn’t respond to the call

bell for an hour when requesting more pain

medication.

Your nurse gave your pain medications as ordered.

The unit secretary responded to your call bell

and explained that your nurse would return when your next dose was due.

Passive voice

Use when the patient alleges we did

something that we shouldn’t have.

Patient claims we gave her the wrong

medication.

Your medication was changed by our doctor

based on your condition. The

medication you received was correct.

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There’s a person at the end of your letter

Keep in mind…

• We’re all human.

• You’re a person, and they’re a person.

• There is a story behind every concern.

• Feelings are real, and perception is reality.

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Q&A

References and addendum

References

"empathy". Dictionary.com Unabridged. Random House, Inc. 7 Mar. 2018. <Dictionary.com http://www.dictionary.com/browse/empathy>.

U.S. Department of Health and Human Services. 2000. Healthy People 2010. Washington, DC: U.S. Government Printing Office. Originally developed for Ratzan SC, Parker RM. 2000. Introduction. In National Library of Medicine Current Bibliographies in Medicine: Health Literacy. Selden CR, Zorn M, Ratzan SC, Parker RM, Editors. NLM Pub. No. CBM 2000-1. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services.

Susan Keane Baker and Leslie Bank. “I’m Sorry to Hear That…”: Real-Life Responses to Patients’ 101 Most Common Complaints About Healthcare.

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Steps for determine reading level

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Steps for determine reading level

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Steps for determine reading level

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Steps for determine reading level

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