What are the most common mistakes when de-escalating conflicts with patients?

Sometimes patients use harsh language to express themselves, and that's ok. It might be triggering for some, but we have to remember that it's not directed at us. Those words are 'chosen' to express the pain, unfairness, and worry they feel. Those words are not directed at us. Those words do not describe us, and most often when the problem is resolved or the situation is under control, they will apologise. But I think it's important to let them speak and say whatever they feel because at that specific moment, what they need is someone to listen to them and understand them. *I am in no means encouraging abusive language.*

In my personal experience when you take a patient conflict personally it clouds your ability to actually discern what is happening and puts your emotional feelings in the mix. It is difficult to correctly convey and handle escalation of situations when you feel like it’s possibly directed toward you, when in reality it isn’t. A resolution early in the discussion is best to ensure they do not leave without an answer or at least steps for what you plan to find out or put in place.

It's actually not easy for the clinician especially when burdened with work. Working in Sub-Saharan Africa makes that doubly worse when conditions are sub-par! It's always best to step back and see things from the patient's viewpoint

Think of anger as a sign that there is unaddressed pain, or fear. The patient is typically experiencing both. You may just be experiencing fear that this will escalate or that you cannot solve it, which is actually a painful thought to most physicians at some level.

Even if the patient is being disrespectful, do not interrupt. Do not spend time NOT LISTENING and preparing a response. Sometimes all it takes is listening to the patient. Try to move through all the emotions to identify the problem. Let the patient speak.

We should avoid arguing with patient, but acknowledge their feeling instead. N.B. We should not give the patient what they want only because they are angry! This will make them get use to take other people’s right by raising their voice all the time!

Truth is, this rarely gets you anywhere. Once it isn't disrespectful, abusive or threatening, they often times calm themselves down enough for you to respond, or ask you something open ended. Listening is important, but I have learnt when persons are emotionally charged you have to sometimes think "what is this person really trying to tell me". Maybe they don't feel heard, maybe they misunderstood, maybe something understandably upsetting happened. Another moment to practice empathy- it is a skill!

Never argue or interrupt patients. Once you interrupt a patient as they try to voice their concern will disrupt the flow of communication, inhibit the patient's ability to express themselves fully, and hinder the therapeutic process. Actively listen to their concerns, validate their experiences, and provide support without imposing personal judgments or interruptions.

Instead of immediately jumping in with my own perspective or solution, I try to focus on understanding the patient's feelings and concerns. Reflective listening involves paraphrasing what they have said to demonstrate that I’m actively engaged and empathetic. For example, I might say, "It sounds like you're feeling frustrated because you haven't been able to get the answers you need. Tell me more" and I give them time to talk. This approach validates the patient's experiences and encourages further exploration of their emotions, fostering a more collaborative and respectful interaction.

Never make them feel like they’re not important nor make the problem seem like oh well it’s another day. Take the problem and make sure you understand what it is and move forward from there.

We always have to show we value them in the most meaningful manner possible. Don’t commit to something you can’t deliver. A lot of times the issue stems from billing or financial hardships. Take these issues and develop into a training session with staff.

Ignoring or dismissing patients is completely disrespectful and undermines the very premise of healthcare. Patients are the experts of their own experience, not us as healthcare providers. Treating all people with respect and listening intentionally to their concerns promotes trust and a therapeutic relationship. A patient is much more likely to go along with a plan of care if they feel they are heard and respected.

Ignoring or dismissing patients' concerns is a common mistake in conflict de-escalation. This can make them feel unimportant or disregarded, exacerbating their frustration. It may also convey disinterest or avoidance, eroding trust. Patients can feel more helpless, hopeless, or angry, losing faith in you or the healthcare system. Instead, demonstrate empathy and attentiveness. Respond promptly and respectfully to their complaints or requests. Be transparent about what you can and cannot do, avoiding false promises. By showing genuine care and accountability, you foster trust and enhance patient-provider relationships. ??????

Building trust is crucial in supporting a patient throughout their care journey. If a patient feels disregarded, it negatively impacts the patient-provider relationship. Prioritizing active listening, addressing concerns promptly, and being receptive to feedback fosters trust. A foundation of trust encourages patients to communicate openly about any health changes or concerns, preventing feelings of neglect and enhancing the overall patient-provider relationship.

Being overly rigid can lead to service users feeling controlled or coerced, fostering a sense of restriction that may provoke rebellion, defiance, or hostility. This rigidity can signal an unwillingness to compromise or an inflexible enforcement of rules without considering the service user's individual needs or preferences, potentially undermining trust and challenging my credibility. Conversely, being too lenient can leave service users feeling unguided or neglected, suggesting a lack of confidence or assertiveness on my part.

One of the best ways I’ve found to de-escalate a conflict is to say, “I understand that you're feeling frustrated with the current situation, and I want to work together to find a solution that meets both your needs and the healthcare protocols. Let's talk through the options and see how we can best navigate this issue together. I know that the Healthcare System has a lot of guidelines in place that may be difficult, but I am I'm committed to ensuring that your concerns are heard and addressed to the best of our ability. So, let’s explore some possible options that might better accommodate your preferences while still maintaining the integrity of your care plan. Okay?” That usually works well as the focus becomes on possible solutions.

Do not become the scapegoat. Do not take the responsibilities of trying to fix it, take responsibility of explaining processes.

Know the culture at your institution. Know the rules under which you provide care. Rigidity/ leniency can result in confusing messages to the patient and escalate a situation. Make clear, obtainable goals and expectations.

El error de ser demasiado rígido puede llevar a una falta de empatía y comprensión hacia las necesidades individuales de los pacientes, mientras que ser demasiado indulgente podría comprometer la calidad del cuidado al no establecer límites necesarios para la salud y seguridad del paciente. Es crucial encontrar un equilibrio adecuado.

If you have said or promised something. Be sure to deliver. Always follow up and follow through on actionable items, on things that would be mutually beneficial. Never promise something that you cannot deliver on.

Making sure that moving forward you are including the patient in what decisions are being made keeping them informed on what they have to do and above all owls if you’ve given your word, make sure you keep it

Saying you understand what the patient is going through. Better to say "I don't fully understand what you are going through or what you are experiencing, but I am here for you, if you want me to be, to help you through it." Unless you are in the patient's shoes, do not say you understand. Not giving the patient long enough to respond to a question. Acute fight or flight silences the reasonable brain. Give them time. Give the patient options to get to the same treatment goal. "I have your blood pressure medication for you. Would you like to take it with applesauce or yogurt?"

As a Board-Certified Patient Advocate, my role is to be a steadfast ally. Empathy and genuine concern are my guiding principles. I make it a point to schedule time into my day to follow up on difficult cases and acknowledge their concerns. I'll start by saying, "I know you’ve been going through a difficult time and wanted to check in on you and see how you were doing." At that point, I just stop and listen, acknowledge their feelings & hear their concerns, giving them a safe space to talk. From there I try to provide practical assistance and support, additional resources, or clarifying information. I let them know they are being heard and they're not alone. Sometimes that’s what they need the most.

Absolutely. If you make a promise you better make sure you follow through. Make promises you can keep don't just placate people. That is an infuriating practice.

Do not engage in any patient experience dissatisfaction publicly/on social media for a few reasons: (1) sometimes these aren’t even real patients; they are bots preying on people as clickbait; (2) these are private conversations, and any conflict resolution should be handled offline through appropriate channels. It gets tempting to address a comment on social media, but an appropriate response is: “I would be happy to discuss this further offline.” Airing dirty laundry publicly only leads to misinformation, miscommunication, and reputational damage.

Attempts to justify or explain a wrong doing is so disrespectful to patients. Also blame games to other departments not OK as an explanation for why they have suffered. At the end of the day if the hospital and its staff have got it wrong and the patient has suffered as a result, then humility, truth, acknowledgement and endevours to never let it happen to another patient is what a patient needs to hear. Transparency and honesty are very healing and healthy for all.

Never start the conversation with “I’m sorry you feel like that” This infers that the person is making a mountain out of a molehill.

Literally when a patient is in a state of agitation, they can't listen. Their brain is highjacked by all sort of functions in a desperate attempt to deal with the situation. Usually some sort of Flight - Fight - Freeze - Faint reaction. Understanding this, one can easily understand that the patient needs to feel safe. This can be accomplished by active listening, meeting them where they are, and stay with them to hold the feelings together.

@Patrick Akrivos Absolutely! When patients are in a state of agitation, their ability to listen is compromised as their brain prioritizes survival instincts like flight, fight, freeze, or faint responses. Recognizing this, it's crucial to prioritize creating a sense of safety. Active listening and meeting them where they are emotionally can help them feel understood and supported. Staying present and holding space for their feelings can foster a calming environment, allowing for better communication and resolution. ???? #PatientCare #EmotionalSupport