The Science of communication: cooling down the complainant
George Bernard Shaw This quote is a good one to bear in mind when faced with a client who feels dissatisfied or upset with our services. Here at VDS Training we want to help you identify the communication skills that can aid you in cooling down a complainant. Remember, these skills are not about changing your personality but about ensuring you have the tools to support a successful resolution. Here are our ten top takeaways from our monthly webinar on the science of communication. Did you know that 75-85% of all veterinary malpractice claims are related to a breakdown in communication (Johnson and Ellis, cited in Adams and Kurtz, 2017)[1]. Keeping this in mind will help you to prioritise and consider the quality of communication the client receives during their experience, from phone calls at reception through to the life-saving surgery that their animal may need. How many attentive listening skills do you use? Eye contact, use of silence, and not interrupting when the client is speaking are just a few that we can employ. How often do you repeat back or summarise what the client has said to let the client know you have heard them correctly and not made any assumptions? Practises like this ensure you have captured the perceptions of the client, not just from a factual angle but from their emotional perspective too. It also allows the client to correct you if you have misheard anything they have said, and they can add in additional points that they themselves may have forgotten. Screening is the use of open-ended enquiries to deliberately check with the client that you have elicited their whole story or everything they wish to discuss Think about the value to the client when asking them to come into a more private environment. What benefits will they get? Your undivided attention and ability to listen without distraction are two good reasons. Make sure to lead the way and, like leading a horse, don’t look back as that is where the horse or client will stay if you do! But remember leading the way without eye contact only applies to someone who refuses to leave the waiting room because they want to engage you in conversation there. Many clients will follow if there is a benefit and good eye contact is made. Some emotions are easy to spot such as grief and anger. If you identify and call out the wrong emotion you can still apologise at this point and state that you can now see that the client is angry and not upset for instance. Hear and see what the client is going through and reflect this back to clarify. See some examples below: compared to When the cue or emotion is missed or not responded to, 50% of clients bring it up again and, by extending the interaction because of a missed cue, the emotion increases (Levinson et al, 2000)[2]. Consider the tone and intensity of the greeting and make sure that the client knows why they are seeing you in particular. Do they know your name and role in the practice? Help the client to understand why you are to be trusted and that your position in the practice will be helpful in resolving their complaint. Part of the introduction should involve stating to the client why you are there, using phrases such as “I am here to listen to all your concerns”. Are you making assumptions about the client’s view point? Do you start at the beginning again when meeting a complainant again to allow the full story and concerns to be relayed? Remember a summary on its own is not enough. Asking them to share their story again will enable you to address any gaps in your own and the clients understanding of the case and ensure that any explanations are relevant to their needs and concerns. This will also enhance your relationship and allow the client to be involved in decisions and plans. What are the client’s ideas, concerns, and expectations (ICE)? Keep asking if there is anything else they would like to share. Often these cues are not overt. A subtle cue could be the client looking away when a difficult section of the complaint/case is bought up. Acknowledging these cues can be a benefit. We can then park a cue, taking care to come back to it later, or respond to a cue such as “only phone me on the mobile”. However, we need to ensure that we don’t respond to a cue that needs exploring. The majority of cues would benefit from further exploration. All too often we Explain, Explore and Explain instead of Explore, Explain and Explore (EEE). When we do explain we need to relate these explanations to the client’s ideas and concerns. Make sure to check in with client when you make suggestions too. Show the client that you want to help and help them to understand that, until they tell you more about what is going on, it will be difficult for you to help them. This puts the ball back in the client’s court. There may be something else going on in the client’s mind. Try to engage with the client to establish what this might be. Possible questions include; “I am sensing you are not happy with the way forward”, or “I get the feeling we are not on the same page”, or “Do you want to tell me what’s on your mind?”. It is important not to ask multiple questions and, once you have asked the client, it is important to give them some time and space. Usually there is a reason why someone is continuing to raise their voice. Commenting on their behaviour or asking them to calm down will only inflame the situation. Check in with yourself, are you using of ‘I’m feeling…’ rather than ‘you are…’, is there something you are doing or saying that is contributing to their emotional state? Research has also shown that using 'OK' can be a signal that the vet wants the floor. Next time you meet a client like this, try to think about unintended interruptions and body language, and wait patiently when the client takes a breath. Often, we interrupt without realising. A subtle hand gesture, for example, can be taken as a cue for the client to stop talking. Similarly, the tone of encouraging comments such as 'uh-huh', 'em', and 'go on', can be interpreted incorrectly and interrupt the client’s flow. If there is more information to follow, an interjection at this stage can be interpreted as an interruption. As we will discuss later in this article, the environment can also have an impact on a client’s emotional state. Think; is there an audience? Is the client seated? Finally, don’t come back with explanation or solutions. Always find out all the client’s concerns and ensure the response relates those concerns rather than making assumptions. An apology early on can really help, for example, 'I am sorry you feel I have not met your needs'. Evidence shows sitting down works best and not getting up if they get up again. Personal safety is imperative though. A designated room set up for discussions of this nature would be ideal but probably not practical in most practices. Aim to be at the same level as them and avoid barriers such as desks or consulting tables. Ultimately, attending one of our practical sessions with simulated clients where we look at your own personal challenging situations can help provide you with practical tools to try out as soon as you leave the session. A specially trained facilitator and our simulated clients will feedback to you on the effectiveness of the skills that you personally use. There will also be time to redo the scenario. You can find our list of workshops across the country here and we look forward to seeing you there! Paul J. Meyer [1] Adams, C. and Kurtz, S. (2017). Skills for Communicating in Veterinary Medicine. UK: Otmoor Publishing. [2]Levinson et al (2000). A study of patient clues and physician responses in primary care and surgical settings. JAMA.248(8):1021-7. Adams and Kurtz (2017) state that this statistic is likely to hold true in veterinary medicine. 'The single biggest problem with communication is the illusion that it has taken place'
1 Communication breakdowns are a common reason for complaints and malpractice claims
2 Are you really an attentive listener or are you just waiting for your turn to speak?
3 Are you getting all of the story?
. The use of ‘anything else’ sums this up. It is important to keep questions as open-ended as possible. Specific questions such as “is there anything else about the operation you wish to add?”, for example, may restrict the client to only talking about the operation when in fact their major concern is something else.'So you're annoyed that we dispensed the wrong tablets for Clover's repeat prescription and this happened on two occasions; you also felt that the vet didn't listen to you and you're still concerned that Sue hasn't got to the bottom of Clover's diarrhoea. Is there anything else?'
4 How do you stop an unwanted show in your waiting room?
5 Use the triple As! Don't be afraid of the apology
6 How good are you at identifying their emotions?
'I understand'
'I understand how difficult it is for you to make this decision'
'I can see that your'e worried about Rex's ears'
'I get the feeling that you would like to explore these options further'/'I get the feeling I've not explained the options clearly'
'It sounds like you are concerned about what this growth might mean for Raymond'
'I can see that you're extremely frustrated that you've been ringing in everyday and no-one has updated you with the bill'
7 What constitutes a good introduction if you are having a meeting with the complainant?
8 Working with a client's starting point and not your own
9 Responding to the cues is vital to cut through the ice!
10 What if the following happens?
What about if the client does not want to talk?
What about if a client is getting very angry and screaming and shouting?
as This will save time in the long run. It is important to provide any information in bite sized pieces without using jargon. Keep checking with client what their thoughts are throughout and, when you have agreed a mutually acceptable plan, it is important to confirm the client’s understanding. What happens when you are the most senior vet and the complaint is directed at you?
Does the physical environment help, such as sitting down in a a room different to a consult room if possible?
'Communication - the human connection - is the key to personal and career success'
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VDS Training are passionate about developing all members of the veterinary team, to help you overcome the personal and professional challenges you face on a daily basis, and to build practical skills and techniques to make a real difference to you and your life.