Patient Dilemmas

reduces work load

increased employee engagement

using focusing skils to get emotional and personal conetxt of the patient Ex: signs and symptoms

EMOTIONAL INTELLIGENCE: •Self-awareness•Management of emotions•Empathy•“people skills”•motivation

safter, better, cheaper

improves quality of patient care

80% of diagnosis can be made from taking history and actively listening

leads to an enjoyable work place

using non focusing skills to recieve non-verbal feedbacks

What is the strongest predictor of patient non-adherence?

Grit: take on challenges and work is difficult

associated risks, benefits, and tradeoffs

Death or brain damage still occurs from hypoxemia after esophageal intubation

"the prevention of harm to patients"

pateints experience more clarity

Analysis of closed malpractice claims

get over yourself; you are not God's gift to the world

clear goals

risks perceptions

“I don’t think you should ever tell somebody that their mother is dying standing in a hall corridor.”

helps pts factor their goals/values into choices

ego up ego down

clinical expertise + pts. prefernece, lifestyle, and goals

improves accuracy

risks vs. benfits of treatment

TRIGGERS: •Being put down•Unreasonable expectations•Verbal abuse

"If you can't explain it simply, youdon't understand it well enough"- Albert Einstein

Prevention is a standard in healthcare.

Electrocardiography, pulse oximetry, and Capnography

•Who is and will be involved in care•Progress and results•Discharge plan

"Well she sat down and looked right at me, she reached out to me a couple of times to reassure me"

Involved patients ask more questions and keeps physicians involved in ways to sustain that collaborative relationship

• Cost of drugs• Forgetfulness• Side effects• Not covered by insurance

being able to speak up without threats

enhances patient safety

HOW? Consider a protocol driven code of conduct

The environment must be neutral and feel safe.

“a subsequent study found that 65% of entry-level nurse errors were related to poor clinical decision-making… related to

Anesthesiologists tend to be risk averse and interested in

humbling and painful at times

happend in high performing teams

know your strengths/weaknesses

it takes more than one person to change healthcare

"Warren, you can always tell someone to go to h*ll"

expected benefits

What % of patients fail to adhere to treatment recommendations? What % fail to pick up first-time prescriptions?

“indistinguishable from the delivery of quality health care.”

OSHA and FDA

high rates of burnout,depression, and anxiety

gather information: determine the nature of the problem

adds hope and fears to the equation

Behavioral, cognitive, and emotional skills can be acquired.

Dont listen to those who say you cant make a difference

Trust between patient and physician can greatly affect patient outcomes

everyone teaches and everyone learns

Anesthesia care became more complex and technological and expanded

must take care of clinicians

Strong leaders were willing to admit that (blank) was imperfect, needed to be studied, and interventions implemented.

safter, better, cheaper

helps pts align their goals with those risks and benefits

“Practice Parameters”

“My dad was always aware of this was that they’re rushed.”

effectiveness and quality

Non-verbal/demeanorVerbalActive ListeningPhysical Location KNOW THE HOW'S

A patient’s beliefs (religion) can influence

helps pts understand the risk and benefits of their alternatives

helps pts understand the pros and cons of their alternatives

Emotional skills require self-awareness.

increases patient satisfactory

“Let’s just say his bedside manner and his openness were conducive to asking questions and getting really responses.”

reduces length of stay

assume postivie intent

Ethnicity, age, and gender are examples that physicians tailor to improve

I’m not quite sure how to explain this but definitely more of an empathetic approach and again part of that is listening

develop and maintain a theraputic relationship

increased efficiency, saves money

Laryngeal Mask Airways/Fiber optic Laryngoscopy

TRIGGERS: •Lack of communication•Colleagues that don’t “pull their weight”•Unfair criticism •Silly rules •Sexism

inevitable and that both positive and negative consequences may occur

assist pts in making choices that promote their goals and reflect their autonomous rights to decide

everyone is hear for betterment of the patient

The results are likely to be better with active engagement rather than avoidance.

carry out patient education and implementation of treatment plans

Four R's: Recognize, Respond with Respect,Resolve and manage, Reflect

•Taking people for granted•Failing to keep promises•Failing to take responsibility•Failing to practice what one preaches

Anesthesiologists have been leaders in applying techniques and lessons from human factors.

people must be motivated to address

“Critical Incident” technique borrowed from Aviation

Key to understanding other people: •What makes them “tick”•What motivates them•How to work with them

improves proivder satisfaction

•Asthma• Catastrophic brain •injuries• Cervical spine injuries• Diabetes• Exertional heat stroke

patient's failure to follow the recommendations of his or her physician or other healthcare provider

•Cognitive factors•Interpersonal factors•Patient involvement and participation •Patient’s attitudes•Cultural variations

Clinicians still practice when fatigue, illness, or stress prevent them from performing optimally

patient may comprehend what is being said, but they may not understand the medical instructions or information

Frequently and Timely

two way exchange of information between provider and patient

different perspectives are healthy

perception by patient that they are focus of time spent and are accurately heard

most difficult