Difficult Conversations

New training helps clinicians deliver empathy after harm events.

Sometimes, a bit of make-believe can help people discover what’s most real and true.
That was Christine Hettinger-Hunt’s experience at a training session on how to communicate after a harm event. Hunt is the Chief Operating Officer at San Luis Valley Hospital in Alamosa, CO, and last spring she was part of an innovative pilot training course developed by Constellation. Aimed at health care organization leaders, the training involved a series of role-playing exercises that included curveballs reflective of real-life situations.
Constellation had previously produced instructional webinars on fraught communications scenarios, covering everything from the dos and don’ts of what to say to the importance of body language. These webinars led to the new training modality, which aimed to provide a more interactive, hands-on experience to participants.
“It shows how we put this information into use, because while we can tell you what needs to happen, without practice it’s really difficult to do,” says Traci Poore, senior risk consultant for Constellation. “After the webinars, we wanted to bring the training to our customers, the ones who might call to have us walk them through what to do after a harm event. We thought, ‘Wouldn’t it be great to create a tool to train leadership, who could then train staff on how to have these communications?’”
The training lays out familiar scenarios: An elderly patient falls from a bed in a senior living residence and breaks a hip; both his wife and adult children need to be informed. Or, a child is given the wrong medication and her hospital stay is extended, which must be communicated to her parents.
The latter scenario was the scene that Hettinger-Hunt drew with her fellow “actors”—all risk managers. Hettinger-Hunt herself played the mother receiving the frightening news. She started with the script, but as the story unfolded she found herself relating to the characters and threw in a curveball of her own.
“There was this one cue, and I ad-libbed something,” she says. “Nothing related to the health care system, but an emotional response toward the father. It was along the lines of, ‘Well, you’re never home! You’re not there to make these decisions!’”
In coming up with the surprise line, she showed how people’s backgrounds, emotions and emotional baggage often enter events and interactions during crisis situations.
“What I realized was, as providers, we always have to sort that stuff out,” Hettinger-Hunt says.
In other words, clinicians don’t just manage information— they manage emotions as well.
In discussing the scene with colleagues, Hettinger-Hunt recalls the risk managers’ advice. “They said, ‘You have to focus, stay focused and refocus everyone else’s attention on what’s going on.’”
In acting, Hettinger-Hunt created something that felt real— something “everybody could relate to,” as she recalls it. And that led to a memorable lesson on how hard it can be to help people absorb difficult communication, with the onus being on health practitioners to make sure understanding happens.

Facts and Feelings
It’s natural for families to feel confused, scared or angry after a harm event. Care teams feel those emotions, too. There can be a tendency to shut down out of fear of legal repercussions or simply a sense of being overwhelmed. But if patients, residents and families are not getting answers, they may feel care teams are hiding something, Poore says. Care teams, too, may lose trust in their colleagues if issues aren’t addressed quickly, honestly and with empathy for all parties.
“Sometimes we just glaze over the emotional experience and want to focus on medical facts and on getting the person better, when there is a whole other component that needs to be addressed,” Poore says.
Fear over litigation can also have the effect of making clinicians feel they shouldn’t speak or apologize. But Poore makes an important point that’s reiterated in the training. “There is no detriment to being compassionate and empathetic in these situations,” she says. “The medical facts are the medical facts. You cannot change them. We should tell the truth. If a medical error occurred, we need to address the medical error and apologize, and let the patient and family know that steps are being taken to minimize the chance of this happening in the future.”
Apologizing is key, she says. Sometimes, medical professionals whose training emphasizes facts, logic and science want to lean on pure information as they talk with patients and families. But after a harm event, what most people really want to hear, Poore says, are the magic words “I’m sorry.” Saying it can begin to rebuild trust, not only with patients, residents and families, but also among care team members. It affirms to them that transparency and honesty are valued in the organization.
This approach represents a philosophical shift reflected in Constellation’s HEAL program. (HEAL stands for Honor, Empower, Act and Learn.) Instead of the old approach of “deny and defend,” this new approach relies on open, honest, empathetic communication, and on working together across the care team and with patients, residents and families to resolve issues and solve problems.
The program’s success is being seen in the numbers: the number of claims filed drops where HEAL processes have been implemented. And if judged by how patients, residents, families and care team members have responded, it has also been a success.
The new HEAL program training program provides the opportunity to practice delivering difficult information with care and compassion. Those skills will do even more to build trust and maintain relationships among everyone involved when harm events occur. There’s nothing make-believe about that.

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