Teaching people skills to health care providers

[ExpatMedic0]

In light of recent events I became inspired to look into the subject of teaching people skills to healthcare providers. I found this topic interesting not only because of inspiration on this forum, but also because my minor is in Sociology. Furthermore I am currently taking a really interesting class in EMS Methodologies, as well as EMS leadership which I felt was applicable to the subject. There is of course "Bedside manner" but I wanted to dig a little deeper than that.

Do you think we teach pre-hospital health care providers adequate people skills? To be honest, I do not remember much on this subject from Paramedic or EMT class. Its quite surprising to me considering we are front line health care providers who interact with the public as a job.

How an individual chooses to represent themselves around others is an interesting and pretty complex subject. In 2013's society, individuals are born into a liquid modern world composed of social networks, online communities such as EMTLIFE, professional and personal relations, and
other groups of rank and of status. From all of these things an individual will form a social identity. This Identity can be projected online or in person.

Eriving Goffman describes the term idealization, which is a term used among all groups in society, including EMS and Nursing for example. According to this theory people will try to create an idealized picture of themselves, their families, their houses and thereby their whole living situation.
It could mean for example, having a superiority complex among professional colleagues and making it appear like you are the best and most knowledgeable.
However, Goffman gives a more modest example. In his, idealisation can is a noble family, which seems to be living an extraordinary and wealthy life. When the family have company, they bring out an excessive amount of high quality food,even though they live a humble everyday life (Goffman, 1959).

I think we all have strengths and weaknesses as health care providers and as individuals. I know one of mine is my Dyslexia, which is probably apparent from many of my forum post and also creates a burden in my academic pursuits. I could simply ignore the problem or deny I have any such problem, but this could lead to undesired consequences in my everyday life professionally and socially. Instead I work with it, I try harder, and admit when I make a mistake. There is help available and every school is taught how to deal with learning disabilities today. However, what about people with social problems? If it is a social problem, this could be difficult to address or for them to comprehend. Many professionals among us may have such issues, which could reflect a failure on behalf of health care education or even society.

According to the National Association of Emergency Medical Services Educators, People skills are "The affective domain of learning that addresses not what we know about or do to patients, but how we go about it."(NAEMSE 2012)
This is how we treat our patients, showing care and compassion to those we treat BUT wait... It's also showing respect and professionalism to our comrades, other health care team members, and co workers.

I can teach a skill or a process to anyone, for example the operation of a ventilator or the pathophysiology related to things in which you may want to use any such device for. But, Can I teach you not to be an A hole? Are we teaching our providers enough about this to engage each other and our patients?

But that does not effect patient outcomes right?..... :blink:

"Dr. Pat Croskerry, a physician and medical educator who studies and writes about how caregiver attitudes affect judgment and the quality of patient care, says “Our historical and continuing failure to acknowledge the impact of our feelings on the ways in which we interact with patients ultimately precludes optimal clinical reasoning and decision making.” (NAEMSE 2012)
I think Dr.Crokerry is correct and I would like to say it also includes other healthcare providers on our team in addition to the patients.

If you ever want to be promoted in any career, including EMS you will need to play organizational politics as well as influence others. Both of these things will require that you demonstrate different types of socially accepted behavior and play well with others. There are many different types of power but I would like to use Referent power as an example. "Referent Power is based on the user ’ s personal relationships with others."(Leadership 2012)
"The leader appeals to the follower’ s values, ideals, and aspirations, or increases self-confidence by displaying his or her feelings to appeal to the follower ’ s emotions and enthusiasm. So rational persuasion uses logic, whereas inspirational persuasion appeals to emotions and enthusiasm."
(Leadership 2012)
In a nutshell, if you act like a jerk, you will fail as a leader.

In conclusion: I think I have demonstrated some basic information related to "People skills" and how we interact with each other, and our patients. People skills are just as critical to success in EMS as anatomy. Our people skills directly effect our patients, our colleagues, and our career; subsequently our whole life. If you are (or think you are) #1 of your class or the number one medic or nurse at your organization, sit down and reflect. Regurgitating medical knowledgeable is not the only measure of success in EMS or any other industry. With out adequate people skills you will remain a worker bee your entire career or fail in other professional aspects of health care, which will reach a broader spectrum than many imagine. I believe EMS should lead by example and set the standard high for this category due to our intense interaction with the public, high level of trust, and the responsibilities we are given. Currently I do not think we are meeting those demands with our education goals and objectives, nor many of our providers.


What do you think? Do we teach providers enough about this in school?





Some Ref I used for the information for reading further, if anyone is interested:

-Foundations of Education: An EMS Approach, 2nd ed. by National Association of EMS Educators (NAEMSE), Cengage Learning 2012

- Leadership: Theory, Application, & Skill Development, 5th ed. by Robert N. Lussier, Cengage Learning 2012

-The Presentation of Self in Everyday Life 1st ed.: by Goffman, Erving, Anchor Books 1959

 

[abckidsmom]

Also one of my pet topics. No, we totally do not.

I've been helping to teach an EMT class since January. Here and there, I pop into class and give a lecture on whatever topic, but I always include the "customer service above and beyond" footnotes on the lecture.

I get the students to role play a bad, non-trust inducing patient interaction, and then correct it with an excellent one. We talk about powerful words and spreading calm, and work really hard to help people understand that as EMS providers, we are taking people's worst days in our hands, and have the power to make them better or worse. We brainstorm strategies to help with that.

I think you're on to something, but it takes a very strong, positive minded personality who is EXTREMELY consistent in delivering excellent customer service to spread the kind of people skills you're talking about.

If I have ONE off day where I get an attitude with someone, my partners talk about it for a week or two, and use that as an example why it's not worth it for them to even try for above and beyond.

 

[abckidsmom]

Also it really takes an actual, physiological, developed brain, adult. I didn't realize how much I had needed to grow until I spent a couple of years outside of the world of EMS in the world of moms. Truly developing empathy and a feel for people I didn't understand radically changed how I do business.

 

[ExpatMedic0]

I think its a highly undervalued and under taught subject within EMS.
Providers should really think more about how they want to represent themselves and there profession and why they want to reflect those things.

It can be demonstrated in other ways, which I neglected to mention due to the fact I was trying to emphasis provider on provider relations.
However, another minor example would be a provider saying "I went on a stemi last night" vs "I cared for a person having a stemi last night." I think we are all "guilty" of minor stuff like that. I did not mention that before because I thought this topic was a little broader than simple empathy.
Some providers start to lose touch and become no better than a mechanic working on a broken car when it comes to preforming patient care. The same providers are at risk of becoming egocentric and socially disconnected from there peers. Its bad news bears for everyone and I wish it was taught more in the classroom also.

 

[shfd739]

I think alot of the newer/young providers are lacking in people/customer service skills. They grew up with MySpace then Facebook, video games and tv. Their interpersonal skills arent as developed as those of us that are older.

I have to coach my partner everyday on his interactions and tone. He comes across as uncaring, uninterested or bothered. This usually isnt the case but its hard to tell from his tone.

 

[Wheel]

I think alot of the newer/young providers are lacking in people/customer service skills. They grew up with MySpace then Facebook, video games and tv. Their interpersonal skills arent as developed as those of us that are older.

I have to coach my partner everyday on his interactions and tone. He comes across as uncaring, uninterested or bothered. This usually isnt the case but its hard to tell from his tone.

Working in retail really helped me realize how your demeanor can affect a conversation and a person's experience. I try to use this knowledge in my practice as much as possible. I find that dealing with people and managing their expectations is really important.

 

[shfd739]

Working in retail really helped me realize how your demeanor can affect a conversation and a person's experience. I try to use this knowledge in my practice as much as possible. I find that dealing with people and managing their expectations is really important.

Retail's where I learned most of mine as a 16-18 yo. I wound up running a paintball/shop field as a high schooler and learned real quick a little kindness, good service and looking after my frequent customers went a long way.

 

[Tigger]

Working in retail really helped me realize how your demeanor can affect a conversation and a person's experience. I try to use this knowledge in my practice as much as possible. I find that dealing with people and managing their expectations is really important.

That is where I learned my "bedside manner." I worked at a small garden supply and power equipment place. My boss/owner was huge on going above and beyond for everyone and it stayed with me. At the end of the day, it is just isn't much harder to treat someone with the "right" demeanor for the whole contact. Plus, at least for me it greatly improves my job satisfaction. Even if we don't make a tremendous difference with our interventions, we do make a difference in the end if we care for the patient and family's emotions properly, which starts and ends with customer service.

I want my patients to know that I care, just like I wanted my old snowblower customers to know that I cared about their needs and wouldn't lead them astray. I want my patients to trust me in that I have their best interests in mind, and acting disinterested will not help that.

I think there is a limit to what can be taught on the subject, eventually you just have to be shown what right and wrong looks like. I think I already had a good idea of how customer service worked in EMS when I started, and my first private company was, amongst its flaws, all about customer service. We had a big sign in dispatch that said "The answer is yes!" to that end. It was the expectation, and those that couldn't cut it were let go. The new hires with no experience always lasted longer than those with it because many new hires could not get used to the idea of always being early for calls or being forced to offer patients blankets on ever call. I learned that this was the only acceptable way to provide patient care, and it has stayed with me. The place I am at now still encourages such interaction but it's much smaller and staffed with fulltimers who have excellent customer service skills but do not emphasize it as much as I'd like to see.

 

[Marques951]

That is where I learned my "bedside manner." I worked at a small garden supply and power equipment place. My boss/owner was huge on going above and beyond for everyone and it stayed with me. At the end of the day, it is just isn't much harder to treat someone with the "right" demeanor for the whole contact. Plus, at least for me it greatly improves my job satisfaction. Even if we don't make a tremendous difference with our interventions, we do make a difference in the end if we care for the patient and family's emotions properly, which starts and ends with customer service.

I want my patients to know that I care, just like I wanted my old snowblower customers to know that I cared about their needs and wouldn't lead them astray. I want my patients to trust me in that I have their best interests in mind, and acting disinterested will not help that.

I think there is a limit to what can be taught on the subject, eventually you just have to be shown what right and wrong looks like. I think I already had a good idea of how customer service worked in EMS when I started, and my first private company was, amongst its flaws, all about customer service. We had a big sign in dispatch that said "The answer is yes!" to that end. It was the expectation, and those that couldn't cut it were let go. The new hires with no experience always lasted longer than those with it because many new hires could not get used to the idea of always being early for calls or being forced to offer patients blankets on ever call. I learned that this was the only acceptable way to provide patient care, and it has stayed with me. The place I am at now still encourages such interaction but it's much smaller and staffed with fulltimers who have excellent customer service skills but do not emphasize it as much as I'd like to see.

I agree with everything you said. I think working in customer service and actually caring about that job helps you care for others and have the proper people skills you need when dealing with the public as an EMS provider.

 

[ExpatMedic0]

How do you think we could justify adding hours to an EMT, Paramedic, or RN program to teach these things, or are they things that should be taught outside of school or in another environment? I am just curious what some thoughts are

 

[Household6]

If I have ONE off day where I get an attitude with someone, my partners talk about it for a week or two, and use that as an example why it's not worth it for them to even try for above and beyond.

Yeah, it's reflective on everyone.. Including the PR of your company. We've been warned many times that if our Preceptor gets a phone call from a patient about the way they were treated or disrespected, we'd better be ready for an ugly *** chewing.

We spend so much time on interaction skills, I love it. I totally dig my Preceptors' hints and help on learning to be nice. Especially interaction with geriatric patients. It's kind of a shame that there's people out there who have to be taught how to be polite and kind.

There was a nurse in the ER department on Tuesday night, I really wanted to ask her if she was always that condescending to her patients or if she had something stuck up her *** today.. But I didn't... Maybe I should have.

 

[Akulahawk]

Is it possible to teach "people skills" to providers? Not exactly. You can model appropriate behaviors and inappropriate behaviors. You can describe that and test on that... but like compassion, you can't exactly teach those things.

You can force someone to offer a blanket... but if it's offered with complete disdain, it won't be received all that well.

 

[Ecgg]

I think medical ethics or ethics class in general (looking at Kants, Mill, Rawls, Daniels, Thomson's "Violinist" etc. major theories) would offer a good overview and perspective on many issues. Then it's up to individual provider to "buy in" and adhere.

Although with such limited time allotted to EMS education a good argument could be made that there are other things that are more important.

 

[medictinysc]

It's in our job description

Our job's as EMT's, Intermediate's, and even Paramedic's is to bring chaos to order. So it is in our job description to be polite, courteous, and calming. For example, hypathetlically speaking 81 yoa Female patient. Who has frequent falls, calls again just after you fall asleep in the lazy boy, and of course its lights and siren for "unknown medical problem" you gather your supplies. We all carry everything we might need into the scene right? You go to the door, knock, announce, and ****** crickets, nothing. We knock, and knock, and knock. faintly we hear help. We call for deputies to make entry, they arrive not emergent due to the call history. They beat down the door and you find your patient lying on the carpet apologizing for falling again. Stating I don't need to go to the hospital I just need up.

How do you say? Do you chastise the patient for asking for help or getting a sitter? Do you demand that the patient cannot refuse this time. or do you kindly help her up, ask if she's ok and explain again the refusal process making sure to document vitals, and mental status. You call her neighbor and begin helping them fix the door before clearing>

What do you do?

 

[EMDispatch]

EMS, and another public safety position is a service industry. Being snotty during interactions may not come back to bite you, but it always could. Hell, you don't even have to be snotty, it just has to be a perceived slight by the individual that you were in contact with.

A point to consider is the recent Amanda Berry incident out of Cleveland. For those not aware, the 911 calltaker is now under fire for how the call was handled. This is due to a perceived slight on the part of the general public, and those involved on the incident. There's even a ridiculous facebook demanding their termination. From a technical standpoint, she didn't do anything wrong. She could have possibly remained on the line until PD arrived, still that may not have been allowable under their protocols. Had the dispatcher employed a little more empathetic tone and manner, I doubt there would be a problem right now. The fact is a little empathy and explanation go a long way.

For a second example, when our agency first started to employ EMD questioning, there was a significant number of complaints about how people felt dispatch was being delayed. The dispatchers at the time added the line "I'm going to ask you a few more questions to help the paramedics, while another dispatcher alerts them." Surprisingly, to many of them, it worked and complaints became virtually non-existant.

The basic necessary people skills can be taught in the classroom. You can encourage active listening in every scenario, and get providers used to explaining the nature of their interventions to the patient, or mock family members. It would take minimal additional effort, and would in my opinion have a profound effect. As it was in my EMT course, we were given lessons on communication and interaction with elderly and special needs patients. They were quick, but highly effective at helping us understand some different strategies and etiquette to employ.

There should also be CE focused on the patient interactions. Plenty of programs are offered specifically on special needs populations, but more should be put in place for standard interactions. It would be nice to see more ability to get some CE credits for public programs and community involvement; public health screenings, educational presentations. Things along those lines could go a long way to break up the monotony of standard patient interactions and maybe even give some haggard providers a fresh lease on why they do their job.

 

[ExpatMedic0]

I am glad someone from dispatch responded, I was waiting to hear from that point of view.

 

[EMDispatch]

I am glad someone from dispatch responded, I was waiting to hear from that point of view.

2 other quick thoughts I forgot about the first post:

1. We get customer serviced hammered in our heads 24/7, 365. We even get QA'd on our people skills, and customer service. I imagine it would be hard, but it would be nice to see some review done for field providers on the same. Not a constant thing, but occasional follow ups with patients or family members about interactions.

2. This falls into the people skills category: Everyone needs at least a basic lesson on PIO activities and how to handle civilian and media observers. Preferably once a year at a minimum. Youtube would be a much less damning place for public safety employees, if that happened.

 

[ExpatMedic0]

Once upon a time I worked in a very busy urban system. I would often do 12 cases in 12 hours. My circadian rhythm was all screwed up, my pay was not so great, my vacation was even worse, and my personal life had hit an all time low. I did not enjoy coming to work anymore and I was "burned out", to a crisp.

Luckily I took a vacation and made a transfer. Soon thereafter things began to improve but I realized my own people skills had diminished. After my vacation I made it a point to improve my people skills and after every single person I transported, I always made it a point to shake there hand and say something positive or goodluck before I left.(unless they where unconscious of course) It not only helped remind me that I was human, but that my patients deserved more than just a "flesh mechanic" as Russ would say.
This one simple act, which only took mere seconds, was huge. A simple goodbye and goodluck triggered a moment of connection that not only helped my patients but also myself.

 

[abckidsmom]

Once upon a time I worked in a very busy urban system. I would often do 12 cases in 12 hours. My circadian rhythm was all screwed up, my pay was not so great, my vacation was even worse, and my personal life had hit an all time low. I did not enjoy coming to work anymore and I was "burned out", to a crisp.

Luckily I took a vacation and made a transfer. Soon thereafter things began to improve but I realized my own people skills had diminished. After my vacation I made it a point to improve my people skills and after every single person I transported, I always made it a point to shake there hand and say something positive or goodluck before I left.(unless they where unconscious of course) It not only helped remind me that I was human, but that my patients deserved more than just a "flesh mechanic" as Russ would say.
This one simple act, which only took mere seconds, was huge. A simple goodbye and goodluck triggered a moment of connection that not only helped my patients but also myself.

This is really fantastic, and something simple to add to an interaction that wouldn't be a big deal.

 

[Akulahawk]

Once upon a time I worked in a very busy urban system. I would often do 12 cases in 12 hours. My circadian rhythm was all screwed up, my pay was not so great, my vacation was even worse, and my personal life had hit an all time low. I did not enjoy coming to work anymore and I was "burned out", to a crisp.

Luckily I took a vacation and made a transfer. Soon thereafter things began to improve but I realized my own people skills had diminished. After my vacation I made it a point to improve my people skills and after every single person I transported, I always made it a point to shake there hand and say something positive or goodluck before I left.(unless they where unconscious of course) It not only helped remind me that I was human, but that my patients deserved more than just a "flesh mechanic" as Russ would say.
This one simple act, which only took mere seconds, was huge. A simple goodbye and goodluck triggered a moment of connection that not only helped my patients but also myself.

While not exactly in the same boat (burnout), I found that I foster a good connection with my patients simply by greeting them in the morning, giving a handshake with a square look in the eye. At the end of (my) day with them, I thank them for putting up with me, for allowing me to be involved in their care, and that I wish them well. They see you as human and caring and you're reminded that you're human too.

I did similar things when I was on the ambulance so many years ago. While I can do many things TO someone, whenever possible I'm doing things WITH them and simply being human with them is what gets them to trust you and do things TO them that they might not otherwise allow.