A Mediator's Toolkit for Navigating Difficult Clinical Conversations presented at GHOL Nyon Please Message To Request Copy of this Presentation for Download

1. A MEDIATOR’S TOOLKIT FOR
NAVIGATING DIFFICULT
CLINICAL CONVERSATIONS
Groupement Hospitalier de l'Ouest Lémanique, Nyon
June 3, 2014
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations

2. Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
Case

3. Reactive Devaluation
• Slow Down
• Repeat what we hear
• Acknowledge common ground
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
MEDIATOR’S TOOLKIT
Case

4. Take A Deep Breath
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
MEDIATOR’S TOOLKIT
Case

5. Objectives
• What are common sources of conflict?
• What tools can be applied when you
encounter a conflict?
MEDIATOR’S TOOLKIT
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
Toolkit

6. Call Dr. Pepper
for
H - E - L - P
Humanize
Engage
Listen
Partner
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
MEDIATOR’S TOOLKIT
Toolkit
Dr. PepperSalty Belle

7. Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
“If you don't know the kind
of person I am
and I don't know the kind of
person you are
a pattern that others made
may prevail in the world.”
- A Ritual to Read to Each Other
William Stafford
Humanize
HUMANIZE

8. Emergency!
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
Humanize
HUMANIZE

9. Time
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
HUMANIZE
Humanize

10. Social Structure
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
HUMANIZE
Humanize

11. Social Structure
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
HUMANIZE
Humanize

12. Power
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
HUMANIZE
CC 3.0 Huddle by Andrew McKinley
Meeting by Sergi Delgado (The Noun Project)
Humanize

13. Power
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
HUMANIZE
Humanize

14. Communication Style
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
HUMANIZE
Humanize

15. Communication Style
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
HUMANIZE
Humanize

16. Information & Decisions
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
HUMANIZE
Icon CC 3.0 Signpost by ZachVanDeHey from The Noun Project
Humanize

17. Information & Decisions
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
HUMANIZE
Humanize

18. Common Sources of Conflict
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
HUMANIZE
• Know your profile
• Understand the “other” person’s view
• Acknowledge the spectrum to find common ground
Humanize

19. !
Figure 1. Ethics in a Pluralistic Society
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
HUMANIZE
Humanize
Being ethical (aka “right”) in a pluralistic society
is another spectrum of difference to mediate
CC-BY 3.0 Kate Michi Ettinger

20. Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
ENGAGE
“If you don't know the kind
of person I am
and I don't know the kind of
person you are
a pattern that others made
may prevail in the world.”
- A Ritual to Read to Each Other
William Stafford
Engage
OSTRICH

21. “Toto,
I don’t think
we’re in
Kansas
anymore”
- Dorothy in the
Wizard of Oz
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
ENGAGE
Engage

22. “We would
like to
welcome
you to
Munchkinland”
- The Lollipop Kids
welcome Dorothy
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
ENGAGE
Engage

23. “Tell me about Mama”
- Nancy N. Dubler
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
ENGAGE
Engage

24. Conversational Justice
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
ENGAGE
Engage

25. Strategies to Engage
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
ENGAGE
• Anchor conversations with the Patient’s Narrative
• Be hospitable in our “foreign” place
• Give pt & family a role, purpose & belonging
• Conversational Justice
Engage

26. Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
LISTEN
“If you don't
know the kind of
person I am
and I don't know
the kind of
person you are
a pattern that
others made
may prevail in
the world.”
- A Ritual to Read to
Each Other
William Stafford
Listen
Photo: Practical Sanskrit

27. Listening for Layers
Data/Facts
Emotions
Values
Concerns/Needs
Identity
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
LISTEN
Listen
CC Wikimedia

28. Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
LISTEN
Listen

29. • Listen for Layers
• Listen to Understand
• Reflective Listening
• Acknowledge &Validate
• Ask-Tell-Ask
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
LISTEN
Listen

30. MultipleViewpoints Matrix
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
LISTEN
Listen

31. Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
PARTNERS
“If you don't know the kind
of person I am
and I don't know the kind
of person you are
a pattern that others made
may prevail in the world.”
- A Ritual to Read to Each Other
William Stafford
Partner

32. Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
PARTNERS
Thomas Kilman Conflict Modes
Avoidance Accommodating
Compromise
Competitive Collaborative
ASSERTINGONE’SNEEDS
CONSIDERING OTHERS‘ NEEDS
Partner

33. Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
PARTNERS
Whirlpool by Eli Ratner;Thomas Kilman Conflict Modes
Avoidance Accommodating
Compromise
Competitive Collaborative
ASSERTINGCLINICALGOALS
HONORING PATIENT PREFERENCES
Partner

34. Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
PARTNERS
Whirlpool CC by Eli Ratner & PD Images from The Noun Project
Avoidance Accommodating
Compromise
Competitive Collaborative
Partner
ASSERTINGCLINICALGOALS
HONORING PATIENT PREFERENCES
TIME

35. Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
PARTNERS
Partner
Graphics: Laura Thierry; 7
Coats: Kate Michi Ettinger

36. Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
PARTNERS
Partner
Graphics: Laura Thierry; 7
Coats: Kate Michi Ettinger

37. Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
PARTNERS
Partner

38. Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
PARTNERS
Partner
Graphics: Laura Thierry; 7
Coats: Kate Michi Ettinger

39. What are common sources of conflict?
• Time
• Social Structure
• Power
• Communication Style
• Information & Decisions
MEDIATOR’S TOOLKIT
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
onclusion

40. What tools can be applied to conflict?
• Humanize
• Engage
• Listen
• Partner
MEDIATOR’S TOOLKIT
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
onclusion

41. MEDIATOR’S TOOLKIT
Kate Michi Ettinger, JD
@k8ethics
muralinstitute.org
A Mediator’s Toolkit for Navigating Difficult Clinical Conversations
HUMANIZE
PEACE IN EVERY STEP, VEN. THICH NHAT HANH
NON VIOLENT COMMUNICATION, MARSHALL ROSENBERG
GETTINGTO YES, ROBERT FISHER AND WILLIAM URY.
DIFFICULT CONVERSATIONS, DOUGLAS STONE, BRUCE PATTON,
SHEILA HEEN
COMMUNITY BOARDS OF SAN FRANCISCO MEDIATION TRAINING.
EMPATHIC LISTENING (STEVE ROSENBERG'S MEDIATION TRAINING)
ASK-TELL-ASK
Bibliography
BIBLIOGRAPHY
ENGAGE
LISTEN
PARTNER
THINKING, FAST AND SLOW. DANIEL KAHNEMAN.
CONTINUUM OF CONFLICT ADAPTED FROM: AVRUCH K, CULTURE &
CONFLICT RESOLUTION, UNITED STATES INSTITUTE OF PEACE PRESS, 1998.
CHEW PK, THE CONFLICT & CULTURE READER, NYU PRESS 2001. LEBARON
M, BRIDGING CULTURAL CONFLICTS, JOSSEY-BASS PRESS, 2003. "MAPPING
CULTURES: STRATEGIES FOR EFFECTIVE INTERCULTURAL NEGOTIATIONS" IN
SECOND TRACTK/CITIZENS' DIPLOMACY, EDITED BY J. DAVIES AND E.
KAUFMAN. LANHAM, MD: ROWMAN & LITTLEFIELD PUBLISHERS, INC.:
149-160. MOORE, C.W. AND PETER WOODROW. 2002. AS WELL AS MYERS-
BRIGGS LITERATURE.
BIOETHICS MEDIATION: SHAPING SHARED SOLUTIONS. NANCY DUBLER
AND CAROL FRIEDMAN.
SCARF: A BRAIN-BASED MODEL FOR COLLABORATING WITH
AND INFLUENCING OTHERS, NEUROLEADERSHIP JOURNAL BY DAVID ROCK.
PUBLIC CONVERSATIONS PROJECT: PUBLICCONVERSATIONS.ORG
PACE E BENE: PACEEBENE.ORG
THOMAS KILMAN CONFLICT MODES
SIX HATS, EDUARDO DE BONO