Tactful Communication: Settling Disputes

It’s Not What You Say

We have all heard the expression “It’s not what you say, but how you say it.” That is so true in your medical practice. Whether you are relating your communication between employees, or with your patients, what you say and how you say it is vital.

Tactful communication requires a person to clearly communicate his or her message while being sensitive to the other person and that person’s feelings. “Tact” is defined as “having a keen sense of what to say or do to avoid giving offense; skill in dealing with difficult or delicate situations.”(1)

Simply put, being tactful is knowing what is appropriate, tasteful, or aesthetically pleasing and using discretion in your verbiage to others.(1) It does not mean that a person should not state his or her opinions; rather, it is presenting them in ways that are less offensive.

As a manager, there are several things you can encourage in your practice to ensure more sensitivity to the feelings of others.

Remind your employees that being rude is not an option.

Encouraging your employees to think before they speak will allow them to consider what they are saying and how their words are being received. Have them ask themselves if there is a better way to state their thoughts. Remind your employees that being rude is not an option.

Be Positive

Starting with something positive can often soften the negative comments that follow. For example, you may say, “You are so helpful with the patients and their needs, yet, when you do [fill in the blank], you seem to lose that good feeling.”

Offer suggestions that allow the employee to have something in mind and understand what you are suggesting. You may preface your comments with, “Perhaps if you were to do X, the end result would be more positive.” Your terminology and verbiage has a big effect on the outcome of your conversation with your employee. Putting a “positive” spin can often protect against hurt feelings.

The same holds true for your employees when dealing with one another and with patients.

Deflect the Negative

Deflecting negative comments as soon as they start actually encourages a positive, constructive conversation. At the same time, if negativity persists, it is important not to get pulled into the drama or gossip:

• Let the person speaking know you are not interested in the topic or the gossip.

• Change the subject if at all possible.

• Remind the person that you do not gossip, especially in the office.

Both your employees and your patients want to feel they have your full attention during certain conversations.

It is important to choose the time and place to have certain conversations. When you need to have a potentially negative conversation, it is essential to be away from other people. Find a private area at a time the person is likely to be more receptive to your comments. Not all topics are appropriate all the time, and it is never a good idea to have a sensitive discussion in public.

Your body language is as important as your words. Be aware of how you are sitting or standing or what you are doing when having conversations. For example, tapping your foot indicates impatience, and doing this during a conversation would not convey the care you want to show that person. Both your employees and your patients want to feel they have your full attention during certain conversations. Let them think that they do.

Watching what you are saying is just as important from a personal standpoint as from a professional one. Don’t share personal information that you don’t want spread around the office. Never assume someone will keep your private thoughts private.

Professionalism is another aspect of communication. Your dress and how you act convey information as clearly as what you say. Therefore, it is important to relay attributes of professionalism in all aspects of your position.

Develop the Skill of Good Listening

Be an attentive listener. People want to be heard. By repeating what they say, you verify that you understood their position in a conversation. By simply saying, “Let me see if I understand what you are saying,” you convey to others that you are listening to them. This does not mean that you agree with what they are saying, merely that you heard them and are validating their feelings.

Be respectful of others. When you treat others with respect, it is easier to gain respect. Kindness, empathy, and tact go hand in hand. It is also necessary to be respectful of other cultures and beliefs. Our words can be interpreted in many ways. We need to think about what the listener will hear from us and determine whether we will succeed in having them understand our viewpoint.

Assertiveness and building a rapport with others are necessary components of being tactful. For that reason, saying something positive before saying something negative can help diffuse a potentially difficult situation.

Most important of all is discretion. It is possible you may find yourself needing to correct or criticize an employee for something he or she has done. Do so in a quiet, peaceful, and private place. No one should be privy to your dealings with another employee. Every employee is entitled to your discretion. Use good judgment when speaking to others.

The same thing holds true for communication with a patient. HIPAA requires confidentiality and privacy with regard to a patient’s care. This includes areas of billing and collection. Even without the HIPAA laws, a patient should be entitled to privacy.

Patients and patient care should never be discussed outside of the practice. Exercising discretion and knowing what should and should not be said are important components of being tactful.

Many situations are difficult from the outset. A tactful approach can alleviate some of the difficulty in handling such situations, and how a difficult situation is handled may determine its outcome. Being tactful enables you to defuse a situation while considering the other person’s feelings and preserving the relationship.

This is especially true with regard to handling patients. A patient who becomes upset should immediately be removed from the presence of other patients. This protects others from hearing that patient’s complaints and possibly finding fault when they wouldn’t normally have done so. Removing a patient to another area also offers the patient privacy.

Show the patient you care by listening to his or her complaints. Ask the patient what you can do to help fix the situation. Use key phrases such as, “I understand your frustration,” or “let me see if I understand what you are saying.”

Isaac Newton once said, “Tact is the art of making a point without making an enemy.”(2)

Tact involves not only fixing the situation, but monitoring the outcome to ensure that the patient feels that the situation was resolved to his satisfaction. A follow-up telephone call to the patient shows him or her you are vested in improving the difficult situation, and also that you care.

When a person is tactful, it shows character and professionalism. It allows a person to be known for their positive manner and their integrity. Choosing what to say, when to say it, where to say it, and how to approach the subject makes you think before you speak, with the end result of a more successful encounter.

Handling Employee Disputes

Tact also plays a role in handling employee disputes. There is always the question of how and when a manager or supervisor should get involved. There is no clear-cut answer to this issue. Managers should first encourage staff to work out their differences on their own. Allow them the opportunity to meet with one another to find a reasonable solution to their conflict. If that does not work, then a manager should become involved. Looking at the specific situation, the conflict, and the time that has elapsed will help determine how involved superiors should be in employee disputes.

As a manager, it is important to hear both sides of the disagreement. Staying objective is a must. Meet with the employees who are involved in the conflict together and separately, depending on what the situation warrants.

Look at how the conflict affects other employees and patients. Then help the staff to resolve the conflict in the best way possible. Staff should never be allowed to be disrespectful to one another or to patients. If necessary, the staff member may need to be “written up” and incur consequences for his or her behavior.

A policy must be in place to protect the practice. Be clear and specific on your practice’s policy for resolving conflict. Be clear on when a manager or supervisor should become involved. State the consequences to employees of workplace conflicts if they are not resolved quickly and efficiently.

Would you “write up” an employee for certain behaviors? Would you send an employee home if the conflict can’t be resolved? If you do send the employee home, for how long would it be? Would it be with or without pay? The policy needs to fit your practice culture and it needs to be enforced.

When resolving a conflict, it is important to be considerate of all people involved. Follow up to determine if, in fact, the conflict truly is resolved. The worst thing that could happen would be a backlash or repercussions from an unresolved conflict.

Give Feedback

As a manager, it is often necessary to give feedback to staff. This should be done in a positive, respectful manner. Cite specific examples of what you have heard and how it might be interpreted in a negative way. Then cite an example of how rephrasing the comment or action might be seen in a more positive light.

On occasion, there may be a conflict or disagreement between a patient and an employee or even a provider in your practice. It is essential to determine what the conflict is and whether it is possible to resolve the conflict to the patient’s satisfaction. In many cases, hearing the patient’s concerns makes a mutually agreeable resolution possible.

If such a resolution is impossible, it will be necessary to determine whether the patient is a good fit for the practice. The patient may choose to go elsewhere, or the practice may ask the patient to find another physician.

Dismissing a Patient

In those cases where a practice asks a patient to leave the practice, the method of dismissing the patient should be discreet. A letter should be sent by certified mail to the patient giving him or her 30 days’ notice that he or she is being asked to find other care. Suggest that the patient find a new physician by utilizing local hospital referral systems, county health care agencies, and the patient’s own insurance company’s physician lists. Offer to send the patient’s records to the new physician at no cost to the patient.

A patient may never be dismissed during an acute phase of treatment. Always feel free to contact your attorney or malpractice carrier should you have any questions about dismissing a patient appropriately.

Dismissing a patient is always a last resort and is done only when the practice feels that they can no longer treat the patient. There are many reasons why a practice may want to release a patient, including the following:

• Noncompliance with treatment or care recommended by the physician;

• Nonpayment of bills for care rendered; or

• Rude or abusive treatment of staff.

A patient should never be allowed to be rude or disrespectful to staff. Tact works both ways, and patients as well as staff must behave appropriately. It is necessary to keep in mind, of course, that often when a patient or family member is in pain, is stressed, or has just received bad news, he or she may appear to be rude. Practices need to differentiate whether the patient’s behavior is due to something that an employee did or due to the situation. It is easier to be forgiving if the patient is reacting to the situation.

Conclusion

Tactful communication is all about diplomacy. It involves understanding other people and being sensitive to their feelings. Learning what to say or what to avoid saying to prevent giving offense will lead to better handling of delicate situations.

Coaching your staff to be more diplomatic and positive will go a long way in improving the morale of your practice and the treatment of your patients. Encourage your staff to develop a sense of what is appropriate behavior and verbiage. Encourage respect and understanding of the differences of others. Sensitivity is an important part of patient care.

Improve communication in your office by improving the verbal and body language and behavior of your employees. This will encourage staff to be more tactful with one another and with your patients. As always, it is the patient who will benefit from this.

As Dr. Seuss once said, “Step with care and great tact and remember that life’s a great balancing act.”(3)

References

1. Tact. Dictionary.com . http://dictionary.reference.com/browse/tact?s=t . Accessed October 1, 2015.

2. Isaac Newton quotes. BrainyQuote.com . www.brainyquote.com/quotes/quotes/i/isaacnewto377678.html . Accessed October 1, 2015.

3. Dr. Seuss quotes. BrainyQuote.com . www.brainyquote.com/quotes/quotes/d/drseuss597903.html . Accessed October 1, 2015.