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Ep. 19: Write a Report Like You Train
5 Plays4 years ago
Today, Brine Hamilton is joined by Joel Lashley, the author of Vistelar’s book titled Confidence in Conflict for Healthcare Professionals. Joel has worked in public safety for over 30 years, including 18 years of service in the health care setting. He also co-developed a program for managing the challenging behaviors of children, adolescents, and adults with autism and other cognitive disabilities for police officers, corrections officers, and healthcare providers.
Their discussion dives into the topic of how good report writing and good training go hand in hand.
Some of the takeaways include:
How under-reporting in healthcare settings leads to less safe environments of care
- The elements of writing a complete report
- Why good training leads to better, timely and more complete reports
- How a well written incident report can be used to justify one actions when questioned by those in authority
- How The Persuasion Sequence can be used as a simple roadmap for writing a great report
Recommended
Transcript
Introduction and Podcast Overview
00:00:02
Speaker
Welcome to another episode of the Competence in Conflict podcast, your destination for learning how to prevent and better manage conflict in both your professional and personal lives.
00:00:12
Speaker
As you may remember, in the last episode, I mentioned that we finally had the last snowfall here in Milwaukee.
00:00:19
Speaker
Well, I was wrong.
00:00:21
Speaker
So April 21st,
00:00:23
Speaker
We had a snowfall that caused whiteout conditions and resulted in 20 car crashes in the area, and one being a 48-car pileup.
00:00:34
Speaker
This is April 21st, right?
00:00:37
Speaker
So every year I fall in the trap thinking that this year is going to be different, and every year I'm proven wrong.
Virtual Training Transition for U.S. Army Corps
00:00:45
Speaker
Anyway, despite the weather here at Vistar, we've had a lot of exciting things going on.
00:00:49
Speaker
One of the more interesting initiatives is we've been training instructors at the U.S. Army Corps of Engineers using our new virtual format.
00:01:00
Speaker
So this is a train-the-trainer program.
00:01:01
Speaker
It's a 16-hour course being taught in four-hour blocks.
00:01:05
Speaker
And we've been working with the Corps for years, but we've always used on-site training.
00:01:10
Speaker
And as you can probably imagine, right, these people are spread all over.
00:01:14
Speaker
This is a big time hassle for them.
00:01:16
Speaker
So with this new approach, we need to deal with an occasional technical issue that comes up.
00:01:23
Speaker
But this is far, far less of a challenge than dealing with reconfiguring work schedules, late and missed flights, hotel reservation problems, and all the other joys of air travel.
Report Writing with Joel Lashley
00:01:37
Speaker
Anyway, on our last episode, we had Brian Hamilton as the interview moderator, and that was such a hit that we decided to do it again.
00:01:45
Speaker
So Brian is a Vizslar advisory board member, president-elect of the International Association for Healthcare Security and Safety.
00:01:54
Speaker
And in this episode, Brian interviews Joel Lashley.
00:01:57
Speaker
And Joel's a Vizslar team member and author of the book, Confidence in Conflict for Healthcare Professionals.
00:02:04
Speaker
Creating an Environment of Care that is Incompatible with Violence.
00:02:08
Speaker
And just a great book that Joel's written.
00:02:10
Speaker
Anyway, they discuss a very important topic, report writing following an incident of an emotional or physical violence.
00:02:19
Speaker
So Brian and Joel will take it from here.
00:02:29
Speaker
Welcome to the Confidence in Conflict podcast.
00:02:32
Speaker
I'm Brian Hamilton, and we're joined today by Joel Lashley.
00:02:35
Speaker
Joel, thanks for joining us today.
00:02:38
Speaker
Morning.
00:02:38
Speaker
Thanks, Brian.
00:02:39
Speaker
Glad to be here.
00:02:40
Speaker
Thanks for having me.
00:02:42
Speaker
Absolutely.
00:02:42
Speaker
Now, before we get in, I just want to give you an opportunity to introduce yourself and just share some of your experience and why we're discussing this topic with you today.
00:02:50
Speaker
Okay.
00:02:53
Speaker
Well, I've been in public safety all my adult life.
00:02:58
Speaker
and first started in healthcare safety and security in 1991.
00:03:04
Speaker
So that makes me a veteran, I think.
00:03:07
Speaker
It's the 30th anniversary.
00:03:10
Speaker
So, you know, 30 years in acute care, behavioral health, home visit, you know, nurses and social workers, CPS workers had to visit the home working with and training them.
00:03:24
Speaker
And currently I work as a,
00:03:26
Speaker
you know, a writer and an instructor with VISTLR.
00:03:32
Speaker
Excellent stuff.
Importance of Thorough Incident Reporting
00:03:33
Speaker
Now, the thing that we're going to be focusing on today is incident report rating.
00:03:38
Speaker
And I guess we'll kick it off by just discussing the benefits of good incident report rating.
00:03:45
Speaker
Well, you know, there's lots of benefits that I don't think we communicate very well to people who do the work in the field that have, you know,
00:03:54
Speaker
It's always a struggle as leaders in security and public safety to get people to write reports to be complete, to report incidents.
00:04:04
Speaker
Healthcare in particular, among clinical staff is notorious for underreporting.
00:04:11
Speaker
They're good at reporting about medical issues, but when it comes about violence, disrespect, gateway behaviors that lead to violence, that they're notoriously bad at.
00:04:21
Speaker
and for lots of different reasons, because they think it's part of the job and all the things that they've been told over the years that isn't true and it's just made them more vulnerable.
Impact of Increased Reporting on Safety
00:04:35
Speaker
So when we report incidents, the biggest benefit is we get more reaction to incidents.
00:04:41
Speaker
We get safer and we get more compliant.
00:04:44
Speaker
An example of that would be
00:04:46
Speaker
when I worked on an initiative with the hospital to get them to increase reporting, the security responses went way up at that hospital.
00:04:57
Speaker
So security is being called much more.
00:04:58
Speaker
They were writing many more reports.
00:05:02
Speaker
And so at the first meeting with the chief nursing officer and leaders among the nursing and medical staff, their perception was,
00:05:15
Speaker
The hospital's going crazy.
00:05:16
Speaker
He goes, there's all kinds of violence in the hospital.
00:05:19
Speaker
And I said, well, actually what's happening is people are calling more.
00:05:22
Speaker
And as we examined the results, we saw that incidents of nurses experiencing violence, even insofar as workman's compensation claims had been cut in half in that period.
00:05:38
Speaker
And the thing that started that was getting people to report more.
00:05:43
Speaker
So the biggest benefit it is, is it keeps us safer and we get hurt less.
00:05:49
Speaker
And that's real world results that people have to start to understand.
00:05:55
Speaker
The other one is it justifies our FTEs.
00:06:00
Speaker
Leaders know that.
00:06:03
Speaker
We have to have our staff understand that in order for us to hire more people because you say you need more help,
00:06:11
Speaker
or in order for to protect your job, when they start cutting back, we have to be able to demonstrate your worth.
00:06:19
Speaker
And that's, at the corporate level, that's done in reports.
00:06:25
Speaker
That's the only thing that's justified.
00:06:26
Speaker
How many reports do you need writing and what are they about?
00:06:31
Speaker
And then for the individual, it's your opportunity to shine.
00:06:36
Speaker
You know, the individual officer can write a good report, make themselves look good, still be honest, right?
00:06:42
Speaker
They can write a good report makes them look good, right?
00:06:46
Speaker
And when we promote, you know, inside security organizations, if we're not looking at the reports that those candidates are writing, shame on us, because that should be one of the primary metrics.
00:07:02
Speaker
So I would consider all of those very important benefits.
00:07:07
Speaker
of good report writing.
00:07:10
Speaker
And there's something
Detailed Reporting and Its Benefits
00:07:11
Speaker
interesting that you mentioned in there too, was just looking at the fact that there are more calls for security being made, but also just within your incident reporting, if you're really breaking it down with the subcategories and the incident types, you can really drill down on what type of violence is occurring and what the impact is to help tell that story as well.
00:07:33
Speaker
Absolutely.
00:07:34
Speaker
And that's a big part of how the reports are analyzed.
00:07:39
Speaker
And then we can see reducing incidents, not only because security is intervening, but we're teaching clinical people real prevention.
00:07:49
Speaker
Litigation is always an important consideration as well in terms of the documentation.
00:07:54
Speaker
What are some of the key considerations for report writing with the reality that reports can become evidence in court?
00:08:01
Speaker
Well, first of all, I think we have to think in terms of more than our reports for evidence in court because, you know, you can have your whole career and only go a handful of times in the hospital security wind up in court.
00:08:17
Speaker
But your reports are judged by leaders, right?
00:08:22
Speaker
By physicians, by hospital leaders, system leaders, internal officers,
00:08:29
Speaker
attorneys, like you're saying, right, corporate counsel.
00:08:33
Speaker
So the most important things to consider is in order to make my report defendable, right, is it has to be timely.
00:08:41
Speaker
That's probably the biggest barrier right now.
00:08:46
Speaker
As I saw it, you know, working in leadership and health care security was, if we have to go back and write the report after somebody asked for it, it's suspect.
00:08:58
Speaker
No one's going to believe it.
00:08:59
Speaker
they're gonna think you made it up.
00:09:01
Speaker
Your point of view is always gonna look biased.
00:09:04
Speaker
So if it's not timely, it's not a very good report no matter how well you write it.
00:09:12
Speaker
It has to be complete because if you have to go back and add stuff, that's always suspect, right?
00:09:19
Speaker
So it has to be timely and it has to be complete.
00:09:23
Speaker
If it has to be changed, even if it's true, even if it was just a mistake, it has to be changed
00:09:30
Speaker
It's always suspect.
00:09:32
Speaker
An attorney can always say, well, why did you go back and change this report?
00:09:37
Speaker
And create suspicion in the judge's mind or the jury's mind or whoever might be listening.
00:09:43
Speaker
And that's valid suspicion.
00:09:47
Speaker
So it has to be timely and it has to be complete.
00:09:51
Speaker
And of course it has to be truthful.
00:09:55
Speaker
But if it's not timely and complete,
00:09:57
Speaker
whether it's truthful or not, people aren't necessarily gonna believe what you have to say.
00:10:01
Speaker
And as one of my mentors who trained me and one of the founders of Vistola, the company I work for, he says, if you didn't write it down, it didn't happen.
00:10:11
Speaker
You gotta go back and write a report later.
00:10:14
Speaker
It doesn't matter what you gotta say.
00:10:16
Speaker
No one's gonna believe it.
00:10:18
Speaker
So in order for it to defend us in court or face-to-face or to leaders, it has to be truthful, timely and complete.
00:10:28
Speaker
Absolutely.
00:10:28
Speaker
That's some, that's some good stuff there.
00:10:31
Speaker
Now, something that we spoke about offline was the per the persuasion sequence.
00:10:36
Speaker
So for those who may not be familiar with the persuasion sequence, can you explain how it ties into articulation in terms of report writing?
Non-Escalation Methods in Reporting
00:10:45
Speaker
Yeah, you know, like, um, like we said before, you know, healthcare is notorious for under reporting incidents.
00:10:54
Speaker
And the persuasion sequence is a way to get people to think about how to respond to incidents, how to report the incidents and how to defend their actions later.
00:11:04
Speaker
The persuasion sequence is the part that we get to in what we call non-escalation or de-escalation training, right?
00:11:12
Speaker
Is when people are resisting, pushing back, they don't wanna comply with our requests,
00:11:18
Speaker
commands, they don't want to cooperate with us, whatever the case might be, we have to be able to persuade people.
00:11:25
Speaker
We have to be able to go beyond, this is the policy and you must follow it or you have to leave.
00:11:29
Speaker
It's just a challenge.
00:11:31
Speaker
It almost never works.
00:11:33
Speaker
The old paradigm of ask, tell, make, how is that working for you?
00:11:37
Speaker
It doesn't work for the police, doesn't work for us, right?
00:11:41
Speaker
So we have to get good at persuading people.
00:11:44
Speaker
And, um,
00:11:45
Speaker
The way we do that is, you know, we ask people to comply with us because people want to be asked, not told.
00:11:53
Speaker
You know, I'm going to ask you not to yell or curse.
00:11:55
Speaker
There's children around and they can hear you.
00:11:57
Speaker
Or see that little old guy in the wheelchair?
00:12:01
Speaker
You know, he doesn't look so good.
00:12:02
Speaker
You know, you're yelling and cursing.
00:12:05
Speaker
This has to be a safe and appropriate environment.
00:12:07
Speaker
You know, I'm going to get that old guy a heart attack.
00:12:09
Speaker
That's not a HIPAA violation, right?
00:12:11
Speaker
The guy's right there, he's sitting right there, he's in a wheelchair.
00:12:14
Speaker
We're building context for that person.
00:12:16
Speaker
This is the environment we're in.
00:12:18
Speaker
We're modeling the behavior by being quieter, also very persuasive.
00:12:22
Speaker
But what we're doing is we're asking them to comply and we're telling them why and real world reasons.
00:12:28
Speaker
This has to be a safe and appropriate environment for our patients, right?
00:12:32
Speaker
There's children here and I think we're frightening them, right?
00:12:36
Speaker
We're waking up the other patients
00:12:39
Speaker
Right, those sorts of things.
00:12:41
Speaker
And then when that doesn't work, hey, F you, then little dog too is the response, is then we can trot out the policy.
00:12:48
Speaker
Well, the policy is we have to observe silence between 8 a.m.
00:12:51
Speaker
or 8 p.m.
00:12:52
Speaker
and 8 a.m., whatever your policy is.
00:12:55
Speaker
Do you understand the policies I told you, sir?
00:12:59
Speaker
Most people, if we ask them and we tell them why, we give them really good reasons, we'll then comply.
00:13:04
Speaker
We'll say, okay, this is whatever.
00:13:06
Speaker
They'll comply.
00:13:07
Speaker
They may not have a great attitude about it, but we focus too much on attitudes.
00:13:12
Speaker
The attitude will come later.
00:13:13
Speaker
We just want them to comply.
00:13:15
Speaker
This is ridiculous.
00:13:15
Speaker
Okay, whatever.
00:13:16
Speaker
As long as they comply, that's good.
00:13:18
Speaker
Okay, thanks, sir, for your cooperation.
00:13:20
Speaker
Give them good closure.
00:13:22
Speaker
Once in a while, that doesn't work.
00:13:25
Speaker
And then we have to offer them their options.
00:13:28
Speaker
Sir, if you stop yelling and cursing, we can step over to this conference room.
00:13:32
Speaker
We can have a discussion.
00:13:32
Speaker
I can call the nursing supervisor, whatever I can do to help.
00:13:37
Speaker
If you insist on yelling and cursing and disturbing the other patients, we're going to have to ask you to leave.
00:13:40
Speaker
Don't want to do that.
00:13:42
Speaker
Rather, you just cooperate with me now and let me work on helping you with your issue.
00:13:45
Speaker
I'm not going to go anywhere.
00:13:46
Speaker
We'll help you with that.
00:13:49
Speaker
Most people will take the good choice at that point.
00:13:52
Speaker
But if we threaten them, which is a natural thing to do, if you don't stop yelling and cursing, you'll have to leave.
00:13:56
Speaker
I ain't leaving.
00:13:58
Speaker
That's the response you're going to get.
00:14:01
Speaker
It's persuasive to help them make a good decision, starting with the good ones.
00:14:05
Speaker
that doesn't work, then we have to give them a final chance.
00:14:09
Speaker
And we'll get to why that's important for reporting.
00:14:12
Speaker
So anything I could say to get you to cooperate, sir, before we have to escort you out of the hospital and they still don't cooperate, then we take appropriate action according to our policies.
00:14:22
Speaker
If it's escort people out, if it's taken to a safe area and, you know, call social, whatever our policy is, you know, in our facility, that's when we take action.
00:14:32
Speaker
And then we're able to defend them later.
00:14:33
Speaker
So not only is this a
00:14:35
Speaker
an effective tool for persuading people that I've used for many years in my career.
00:14:42
Speaker
And I got so good at it that when I asked someone, give them their options, and they told me to flake off, I had to think for a minute, OK, now what am I supposed to do?
00:14:54
Speaker
Because it was that effective.
00:14:55
Speaker
And I had to think about that four step.
00:14:57
Speaker
There's anything I can say?
00:15:00
Speaker
But for those times when they make the bad choice,
00:15:05
Speaker
you have to be able to defend that later.
00:15:08
Speaker
And it's very effective for doing that.
00:15:11
Speaker
It's great in the sense that it actually
00:15:14
Speaker
when you're articulating it, you actually are showing that you gave them multiple opportunities to comply.
00:15:19
Speaker
It's not as if security just rushed in and dragged that person away.
00:15:23
Speaker
I think the communication skills are the most important tool for the frontline security professional.
00:15:28
Speaker
I know one thing I used to say as well that worked well for me was if the individual would say, you know, if they're swearing and you're asking, you know, please don't use foul language.
00:15:37
Speaker
There's other people here and their response is,
00:15:40
Speaker
you know, F them, you know, like you had alluded to.
00:15:43
Speaker
The other thing that I used to always do was say, you know, but okay, for myself, I'm speaking to you very respectfully.
00:15:48
Speaker
Can we just have a respectful conversation?
00:15:51
Speaker
Usually a lot of times that would work as well.
00:15:54
Speaker
That is a great tactic.
00:15:55
Speaker
And I've used that as well.
00:15:58
Speaker
Very similar kind of rap.
00:15:59
Speaker
I said, you know, sir, I'm treating you with respect.
00:16:01
Speaker
Can I ask you to treat me with respect as well?
00:16:03
Speaker
That sort of thing, you know?
00:16:06
Speaker
So that's a very effective tactic.
00:16:10
Speaker
And I've used that too.
00:16:11
Speaker
And it's part of persuasion, building context for people.
00:16:15
Speaker
Yeah, absolutely.
00:16:17
Speaker
One of the myths in healthcare, and if you've worked in healthcare, you've heard this one.
00:16:20
Speaker
If you've worked in for any length of time, and the myth is, if I say something, it'll make it worse.
00:16:28
Speaker
Right?
00:16:29
Speaker
And the reality is, it's usually if we don't say something, it gets worse.
00:16:34
Speaker
Right?
00:16:35
Speaker
So...
00:16:36
Speaker
Most of us have heard people say, after you say something like that, you know, sure, I've been treating you to respect.
00:16:41
Speaker
Can I ask you to treat me to respect?
00:16:43
Speaker
Is they'll say, and most of us have heard people say this, I'm sorry, I didn't mean that.
00:16:47
Speaker
I'm just upset.
00:16:50
Speaker
And everyone who's heard that it's exploding that destructive myth that if I say something, it'll make it worse because I've heard that a dozen times in my career.
00:16:58
Speaker
And it always makes me crazy because that's the foundation for training is helping people
00:17:03
Speaker
that it's not true that if you say something will make it worse, it's not true that, you know, if we kill them with kindness, they'll get nicer.
00:17:11
Speaker
Right?
00:17:13
Speaker
Part of that mythology.
00:17:17
Speaker
And I guess the one caveat there, if you're saying to the individual, I've been speaking with you respectfully, you know, you actually have to have spoken to them respectfully.
00:17:26
Speaker
Yeah, yeah.
00:17:27
Speaker
You gotta, you gotta do it.
00:17:29
Speaker
You're meaningless.
00:17:30
Speaker
That's for sure.
00:17:31
Speaker
You know, and people have different ideas of what being respectful is.
00:17:36
Speaker
So that's part of training is we actually train people how to treat people with dignity by showing them respect, you know.
00:17:44
Speaker
So exactly, you know, doesn't mean anything if you're not walking the walk.
Training for Better Reporting Practices
00:17:51
Speaker
100%.
00:17:51
Speaker
Now, I want to talk to you about some of the challenges in terms of incident reporting.
00:17:57
Speaker
So what are some of the common challenges that you see in terms of reporting in the health care environment?
00:18:05
Speaker
Well, you know, getting people to write reports to begin with, you know, to report things.
00:18:11
Speaker
When people are under-trained, they're unsure of themselves, even if things go well, they may not want to report it because, you know, they're worried about being judged, you know.
00:18:22
Speaker
And they don't want to write the report.
00:18:24
Speaker
It's paperwork, and it's a hassle.
00:18:28
Speaker
So getting people to write reports is huge.
00:18:31
Speaker
And people are looking for the easy answer.
00:18:34
Speaker
How do we get people to report more?
00:18:37
Speaker
And once we've decided to increase reporting, which will dramatically affect the amount of violence and disruption that we have in our facility, because part of that is getting clinical staff to call us more, right?
00:18:51
Speaker
It has to be a thoughtful decision, but it requires investment and leadership.
00:18:56
Speaker
We have to invest in training for the clinical staff, why it's important for them to report, control gateway behaviors like yelling, cursing, things like that.
00:19:04
Speaker
Why it's a myth that if you say something, it'll make it worse.
00:19:07
Speaker
We need people up here to respond to this.
00:19:10
Speaker
So we have to make a real investment in people's point of view, their worldview in healthcare.
00:19:17
Speaker
So that means some education.
00:19:19
Speaker
And then it means some training
00:19:21
Speaker
so they know what to write.
00:19:23
Speaker
The persuasion sequence, we have to train people how to do that so they know how to articulate it, so they can articulate it for their reports, so they know what to write.
00:19:34
Speaker
We tell people, write a report who, what, when, where, why, how, and then we cut them loose.
00:19:41
Speaker
And training and reporting are intimately related.
00:19:47
Speaker
We have to report like we train.
00:19:52
Speaker
And you made me think of something there.
00:19:53
Speaker
I think another effective thing that you want to be able to leverage as a security director, or again, we talked about a little bit, we touched on a little bit earlier in terms of analytics and the data that you're pulling.
00:20:06
Speaker
Now, say for example, there's a situation where you have a patient who's been threatening or they've actually been violent, they're still in the facility.
00:20:15
Speaker
If you have your team, if you just create an incident category for example, violence prevention rounding, maybe you have another word for it, but as your team's going through and doing those roundings, again, that's another statistic that you can show how your team is working to prevent those incidents from occurring.
00:20:33
Speaker
But it only comes with that reporting.
00:20:36
Speaker
Yeah, and rounding is a way to generate that.
00:20:39
Speaker
I've seen that done.
00:20:42
Speaker
And I think it's very effective and works well.
00:20:45
Speaker
And I've had hospital leaders actually get involved in security rounding, chief nursing officers and such.
00:20:52
Speaker
So they're not just hearing it from us.
00:20:54
Speaker
They're hearing it from their leadership.
00:20:56
Speaker
How are the patients today?
00:20:58
Speaker
How is so-and-so in 103 based on the history and such?
00:21:04
Speaker
So security rounding, I think, is an important tool, something we should all be involved in, in health care security.
00:21:12
Speaker
Absolutely.
00:21:14
Speaker
Now, in terms of the under-reporting piece, what are some of the ways that you found effective to actually get more of those reports generated, get people to actually call security, and really just get people out of that stigma that violence is part of their job?
Addressing Violence in Healthcare
00:21:30
Speaker
Well, rounding, like you said, I mean, that's
00:21:34
Speaker
And we actually got, you know, I had many institutions involved in putting it in their nursing orientation.
00:21:43
Speaker
You know, once we give nurses and other healthcare providers this training, the thing I've probably heard the most is why didn't I get this in nursing school?
00:21:55
Speaker
You know, nurses show up at a hospital, fresh out of nursing school, you know, fresh faced and eager, right?
00:22:03
Speaker
And no one told them they had just joined the most violent profession in North America.
00:22:09
Speaker
No one told them that, right?
00:22:12
Speaker
No one told them that depending on where they work and which hospitals and any hospital, right?
00:22:18
Speaker
That they're gonna get assaulted more than a corrections officer in a prison.
00:22:21
Speaker
No one told them that, right?
00:22:25
Speaker
And so we have to tell them an orientation in a way that maybe we won't scare them off.
00:22:30
Speaker
That, you know, violence is not,
00:22:33
Speaker
part of the job.
00:22:35
Speaker
If people touch you inappropriately, curse at you, yell at you, threaten you, sexually harass you, scream at you, demean you, this is how you respond.
00:22:45
Speaker
And this is how we get safe.
00:22:47
Speaker
This is how we get help, right?
00:22:49
Speaker
We have to make that part of their training.
00:22:52
Speaker
We wouldn't even consider not giving, you know, basic safety training to corrections officers.
00:22:57
Speaker
We don't do it for nurses.
00:23:01
Speaker
And nobody knows more about this, really, than the healthcare security people who have studied this, understand it.
00:23:10
Speaker
And once you become a resource in your facility by how you train, being more involved in training with nurses or with other staff, the more they'll rely on you.
00:23:22
Speaker
You know, at one hospital where I worked at when outlying clinics would call for things like
00:23:28
Speaker
We have a child with autism that comes to our clinic and has a meltdown every day.
00:23:33
Speaker
Can you send somebody to train our staff?
00:23:36
Speaker
You would think they would send a psychologist.
00:23:39
Speaker
You would think they might send a nurse that works with children with neurocognitive disorders.
00:23:44
Speaker
They sent the security trainer.
00:23:47
Speaker
Think about that for a minute.
00:23:50
Speaker
You know, we were actually part of the clinical picture at that point.
00:23:53
Speaker
Entering into the medical record, what we did.
00:23:57
Speaker
And then you see real changes in culture, real changes in the amount of violence we experience.
00:24:05
Speaker
It has to be in their orientation, in their education and training, that violence is a part of the job, that killing with kindness, you know, would you, would you, you know, if one of your peers said, hey, I went on a date the other day and the guy called me the B word and shoved me, would you tell her to kill him with kindness?
00:24:26
Speaker
Go out with them again.
00:24:27
Speaker
Just kill them with kindness.
00:24:28
Speaker
It's a ridiculous thought.
00:24:30
Speaker
It's a ridiculous paradigm.
00:24:32
Speaker
The way we respond isn't unkind.
00:24:35
Speaker
It's professional and respectful.
00:24:39
Speaker
Right?
00:24:40
Speaker
But to lavish them with praise and lots of sorries and thank yous when people are disrespecting us just generates more violence, validates it, encourages it.
00:24:51
Speaker
Right?
00:24:54
Speaker
If you say something, it'll make it worse.
00:24:56
Speaker
What's the nonverbal message of silence?
00:24:58
Speaker
It's okay to treat me that way.
00:24:59
Speaker
I have no authority.
00:25:01
Speaker
You're entitled to treat me this way.
00:25:04
Speaker
Right?
00:25:05
Speaker
Nothing will happen if you do it again.
00:25:07
Speaker
That's the most dangerous message of silence.
00:25:12
Speaker
Right?
00:25:12
Speaker
We help people understand those dynamics, how gateway behaviors lead to violence, cursing, yelling, threatening.
00:25:20
Speaker
They've studied these extensively.
00:25:21
Speaker
We can share those studies with clinicians, like the STAMP study from Australia, Dr. Loretta Lutt.
00:25:29
Speaker
She found that it was something like seven out of 10 violent attacks on nurses were preceded at some point by a sarcastic comment.
00:25:38
Speaker
Where'd they get you?
00:25:39
Speaker
Did you get your diploma out of crackerjack box?
00:25:42
Speaker
Who would think that that was a precursor to violence?
00:25:46
Speaker
It's a reliable one.
00:25:48
Speaker
So we have to train people to recognize, oh, I'm in danger now.
00:25:51
Speaker
They're disrespecting me.
00:25:53
Speaker
And how do I redirect that?
00:25:56
Speaker
Your statement.
00:25:57
Speaker
So I've been treating you through respect.
00:25:58
Speaker
Can I ask you to treat me through respect as well?
00:26:00
Speaker
And most times people will reset.
00:26:02
Speaker
OK, that's not going to work here.
00:26:03
Speaker
It may work at home.
00:26:06
Speaker
It's not going to work here.
00:26:08
Speaker
And then they reflect the behavior that we model.
00:26:12
Speaker
And that's usually the case.
00:26:15
Speaker
Yeah, it's important.
00:26:16
Speaker
Along with the answer.
00:26:18
Speaker
No, it's all good stuff because it is important to be able to take that approach where you can be assertive without being overbearing, but you're really still driving home the point that that's not going to be effective here.
00:26:32
Speaker
You need to basically fall in line.
00:26:36
Speaker
Now, you spoke earlier about the, you know, the important elements of writing a report.
00:26:41
Speaker
So the five W's and how.
00:26:44
Speaker
Now, and one of the things that you really emphasized was, you know, it's important to properly train the why and the how part.
00:26:52
Speaker
Can you elaborate on that a little bit?
00:26:54
Speaker
Yeah, you know, when you think of writing reports, you know, everybody gets the who, what, when, where, why, how.
00:27:02
Speaker
And we spend a lot of time on, you know,
00:27:07
Speaker
you know, who, when, where, right?
00:27:10
Speaker
And we'll really control that.
00:27:12
Speaker
We spent a lot of control on that time on that.
00:27:14
Speaker
I, Officer Smith, arrived, you know, at the urgent care clinic due to a disturbance complaint at such and such time, right?
00:27:23
Speaker
On such and such day.
00:27:25
Speaker
Very formal.
00:27:27
Speaker
And then we're good.
00:27:28
Speaker
We're okay, we're done report writing, right?
00:27:29
Speaker
Really formally like that, you know, when you arrived, where you went, and what the call was about.
00:27:35
Speaker
And you're good.
00:27:36
Speaker
Now write your report.
00:27:38
Speaker
And spend almost nothing on the why and the how, which is the most important part of the report.
00:27:44
Speaker
You could cut off the top paragraph that everybody's so worried about.
00:27:48
Speaker
And here's the really interesting part, Brian.
00:27:51
Speaker
You know how we talked about before how if you have to change it, it's suspect.
00:27:56
Speaker
Those things that we're so worried about are the one exceptions to that.
00:28:01
Speaker
In other words, think about it.
00:28:03
Speaker
If I wrote a report and gave the wrong date and the wrong time or the wrong time and someone caught it and said, oh, hey, you know, you put the wrong date on here.
00:28:15
Speaker
That was yesterday.
00:28:16
Speaker
Oh, OK.
00:28:17
Speaker
And then you change it.
00:28:19
Speaker
No one would care.
00:28:24
Speaker
All right.
00:28:25
Speaker
What we don't get is the how and the why.
00:28:28
Speaker
How did I do what I did?
00:28:30
Speaker
How did I come to the decision that I made?
00:28:33
Speaker
How did I try to affect the behavior in the other person?
00:28:36
Speaker
How did I address them?
00:28:37
Speaker
How did they react?
00:28:39
Speaker
We don't spend almost no time training them on that.
00:28:43
Speaker
And we don't train them on why we did what we did.
00:28:45
Speaker
Right?
00:28:48
Speaker
Through the person on the hospital.
00:28:50
Speaker
Why'd you do that?
00:28:51
Speaker
They're being disrupted.
00:28:52
Speaker
Well, how are they being disrupted?
00:28:53
Speaker
Is that in your report?
00:28:56
Speaker
Well, what did they say?
00:28:57
Speaker
Were they yelling?
00:28:59
Speaker
Were they cursing?
00:29:02
Speaker
Right?
00:29:02
Speaker
Were they crying, mumbling under their breath?
00:29:08
Speaker
All these things that we leave out that we can't articulate later.
00:29:13
Speaker
And we have very much different.
00:29:14
Speaker
And if we have to make it up later or we have to recall it later and then write about it later, no one's going to believe it because it's too late now.
00:29:24
Speaker
We train people how to respond.
00:29:26
Speaker
And then we teach them how to report their response.
00:29:33
Speaker
And the best way to do that, I guess, would be to give an example.
00:29:39
Speaker
So for my own career, I was once asked to make an account of myself to a physician.
00:29:51
Speaker
I was the third shift security supervisor at the time.
00:29:56
Speaker
And we had to escort the mother of a cancer patient out of a hospital, a minor cancer patient.
00:30:03
Speaker
a pediatric cancer patient.
00:30:04
Speaker
So you can imagine that's the last person you want to throw out of a hospital, the mother of a child with cancer.
00:30:12
Speaker
It's almost unfathomable.
00:30:15
Speaker
So, you know, we did what we had to do.
00:30:20
Speaker
We responded, did what we had to do.
00:30:22
Speaker
I made the decision.
00:30:23
Speaker
So really, I did what I had to do.
00:30:26
Speaker
And then the next day, as you might imagine, the physician wanted my head on a plate.
00:30:32
Speaker
And so she called the security office.
00:30:33
Speaker
I'm going to knock that guy up here right now.
00:30:36
Speaker
I'm going to wipe through my patient's mother out of the hospital.
00:30:40
Speaker
So I go up to the floor.
00:30:42
Speaker
She meets me by the elevator.
00:30:44
Speaker
She's loaded for bear.
00:30:45
Speaker
She's really hot.
00:30:46
Speaker
Before I can even open my mouth, you know, the elevator door is open.
00:30:51
Speaker
Are you the guy who threw my patient's mother out of the hospital?
00:30:55
Speaker
I said, um,
00:30:57
Speaker
Yeah, I was a supervisor last night for security.
00:31:00
Speaker
You know, my name is Joel.
00:31:01
Speaker
I'm a security supervisor, you know, for third shift.
00:31:03
Speaker
The reason I'm here is I understand you're really angry about my decision to escort the mother out of the hospital last night.
00:31:10
Speaker
If you have any questions for me, you know, I'm happy to answer them.
00:31:15
Speaker
You know, and that's a universal greeting that we train to use.
00:31:17
Speaker
So, you know, we walk up and give a universal greeting.
00:31:20
Speaker
It really affects other people's behavior, answers a lot of questions in their head, kind of removes that perception that you're just a jerk, right?
00:31:29
Speaker
So she looks at me and then she says, well, that child had cancer.
00:31:33
Speaker
Don't you know that?
00:31:34
Speaker
And I said, yes, doctor.
00:31:35
Speaker
I do understand that.
00:31:36
Speaker
You know, however, the nursing staff called about a disturbance.
00:31:41
Speaker
And when we arrived, we could hear mom all the way down the hallway yelling and cussing.
00:31:45
Speaker
You know, at midnight, there's other parents standing outside the door looking really worried and angry.
00:31:51
Speaker
And it's a cancer unit, a pediatric cancer unit.
00:31:53
Speaker
So we have to think about all those patients being frightened and woke up.
00:31:57
Speaker
So...
00:31:58
Speaker
You know, we responded immediately said you just threw her out and I said no that's not that's not how we were trained to respond, I said, you know, I approached her, you know.
00:32:08
Speaker
At a respectful distance I introduced myself like I did to you hi my name is Joel, I'm a security supervisor on duty and.
00:32:15
Speaker
He said I then I asked her, you know if she could stop yelling and cursing let her know that I was there to help.
00:32:25
Speaker
And she said, well, what'd she say?
00:32:27
Speaker
She said, F you and, you know, F them kids.
00:32:31
Speaker
So then I really, you know, explained why it's important and told her what I could do for her.
00:32:35
Speaker
I said, ma'am, if we walk over to this conference room, said I can call a social worker for you.
00:32:40
Speaker
I said, I can call the hospitalist, the physician on call.
00:32:45
Speaker
I might answer any questions you have.
00:32:48
Speaker
Patient relations.
00:32:49
Speaker
I said, whatever your issue is, I'm not going to go anywhere.
00:32:52
Speaker
I'm at your disposal to help
00:32:54
Speaker
addressed your issues.
00:32:56
Speaker
He said, but can I ask you to please stop yelling and cursing because you're waking and frightened the children and they need to rest and we're worried about your daughter as well that she gets the rest that she needs.
00:33:07
Speaker
And she said, F you and free country, F you little dog too, kept yelling and screaming.
00:33:13
Speaker
So when the doctor said, well, so you just threw out?
00:33:15
Speaker
And I said, no, I didn't do that.
00:33:17
Speaker
I said, at that point, we're trained to give them their options.
00:33:21
Speaker
So I said, man, we have a couple of hours.
00:33:22
Speaker
I said, if you go with me to the conference room, stop waking the children.
00:33:27
Speaker
I said, I can call anybody, you know, or, you know, help you in any way that I can.
00:33:31
Speaker
So, but if you insist on yelling and screaming, we're going to have to escort you out of the hospital.
00:33:35
Speaker
Don't want to do that.
00:33:36
Speaker
I'd rather you to come over and join me over here and we can work on your problem.
00:33:42
Speaker
And she said, well, what'd she say then?
00:33:43
Speaker
She said, F them kids and F you too.
00:33:46
Speaker
Dr. said, okay, I get it.
00:33:48
Speaker
I understand.
00:33:48
Speaker
You did everything you could.
00:33:49
Speaker
I said, didn't you throw her out?
00:33:51
Speaker
I said, no, I didn't throw her out.
00:33:53
Speaker
Then she looked at me kind of puzzled, you know, like, you didn't.
00:33:55
Speaker
I said, why not?
00:33:56
Speaker
I said, well, at that point in our training, we're supposed to give them, you know, an opportunity to change their mind, to reconsider.
00:34:03
Speaker
So I said, ma'am, is there anything I can say to get you to stop yelling and cursing so I can help you rather than escort you out of the hospital?
00:34:12
Speaker
I'd like to think so.
00:34:15
Speaker
But
00:34:15
Speaker
At that point, she just kept yelling and screaming.
00:34:18
Speaker
So we didn't have any choice.
00:34:19
Speaker
We couldn't just leave her there yelling and screaming and frightening and disturbing the other parents and children.
00:34:26
Speaker
And the doctor said, and then you finally threw her out?
00:34:28
Speaker
She goes, yeah.
00:34:30
Speaker
I said, well, you're a nicer person than I am.
00:34:33
Speaker
That's what she said to me.
00:34:34
Speaker
So she went from wanting my head on a platter to saying, wow, you took a lot more crap than I would have.
00:34:39
Speaker
This is essentially what she said, right?
00:34:44
Speaker
If I had just shown up and said, well, I did everything I could, but she just wouldn't listen to reason, that's not good enough.
00:34:51
Speaker
We have to be able to articulate the steps we took.
00:34:53
Speaker
And all we have to do is repeat our training.
00:34:57
Speaker
And then we can write that in our report.
00:35:01
Speaker
Then we can do it.
00:35:02
Speaker
I, officer Lashley, arrived on such and such time on such and such date and due to a disturbance call and met with Mr. Smith.
00:35:09
Speaker
And then I get in the wine house.
00:35:11
Speaker
I observed that she was yelling and screaming and disturbing the other patients and parents, other parents, were stepping out of the room, you know.
00:35:20
Speaker
And then I arrived, did my universal grading.
00:35:23
Speaker
I got to take it even how I announced myself.
00:35:26
Speaker
So no one said, you just rushed in.
00:35:27
Speaker
No, I didn't.
00:35:28
Speaker
I stood five feet away, which is part of the proxemics that we train at Vistolar.
00:35:35
Speaker
I gave them a universal greeting, right?
00:35:38
Speaker
Hi, my name is Joel.
00:35:39
Speaker
The reason I'm here, I'm the security supervisor on duty.
00:35:41
Speaker
The reason I'm here is I could hear you down the hallway.
00:35:44
Speaker
It seems to be a disturbance.
00:35:46
Speaker
So do you have any questions?
00:35:47
Speaker
Can you tell me what's got you so upset today, ma'am?
00:35:50
Speaker
That relevant question.
00:35:52
Speaker
And then I'm able to say that I asked them to stop and told them why.
00:35:55
Speaker
I'm able to say that I offered them options and they took the bad one.
00:36:00
Speaker
And then I'm able to say, I gave them a last chance, an opportunity to reconsider.
00:36:04
Speaker
And they didn't take that.
00:36:05
Speaker
And so that we were forced to then escort them out of the facility.
00:36:09
Speaker
Good for court.
00:36:11
Speaker
Good for that patient's doctor.
00:36:14
Speaker
Maybe even good for that patient, that mother's husband, you know, because after you've done this for a while, you know, I've had wives call me and say, Hey, thanks for throwing the old man out last night.
00:36:25
Speaker
You know, this particular woman, she wrote a letter to the president of the hospital.
00:36:34
Speaker
thanking me for my response, said I treated her with respect and apologizing for her behavior that night.
00:36:41
Speaker
I never got a letter for finding somebody's car.
00:36:44
Speaker
I never got a letter for a lost person.
00:36:49
Speaker
I got letters for throwing people out of hospitals, though.
00:36:52
Speaker
It's not what you do, it's how you do it.
00:36:55
Speaker
It's like the police officer who gets lots of thank yous when he writes people tickets.
00:37:01
Speaker
It's because of the way they do it.
00:37:02
Speaker
It's not what they do.
00:37:03
Speaker
It's how they see it.
00:37:06
Speaker
Couldn't agree more.
00:37:07
Speaker
Now, one thing that you said early on there was when you were talking about articulating the behavior.
Objective Descriptions in Incident Reports
00:37:14
Speaker
And one thing that I used to teach managers, even in terms of performance management, and it applies to this as well, but you want to focus on the behavior.
00:37:22
Speaker
So you want to actually really describe that, not just say the person was being rude or they were being disrespectful.
00:37:27
Speaker
Or, you know, you want to articulate that and say, okay, what were they doing that was rude?
00:37:31
Speaker
What were they doing that was disrespectful?
00:37:33
Speaker
What were the behaviors that they exhibited?
00:37:36
Speaker
Yeah, and that's so important.
00:37:40
Speaker
It really means everything because disrespectful is subjective.
00:37:45
Speaker
It's your opinion what's disrespectful, you know?
00:37:49
Speaker
But yelling isn't subjective.
00:37:51
Speaker
They were yelling, shouting.
00:37:53
Speaker
They said, call me an MF-er.
00:37:57
Speaker
That's not, that's objective.
00:38:00
Speaker
That's disrespectful, you know, wherever you go.
00:38:02
Speaker
You call people names, call fat people fat.
00:38:08
Speaker
racial epithets, those are objective.
00:38:11
Speaker
Those are disrespectful in everybody's worldview.
00:38:16
Speaker
So one thing I want to hit on, Joel, is in terms of training.
00:38:19
Speaker
So when you're training security officers to write reports, what are some of the things that you're trying to really focus on or identify through that process in terms of just their abilities to actually properly articulate what transpired?
00:38:37
Speaker
Okay.
00:38:39
Speaker
Well, in order to do that, first we have to train them.
00:38:42
Speaker
We have to train them in their defensive tactics, their stabilization tactics, their verbal non-escalation, de-escalation, crisis management, crisis event, all that stuff, right?
00:38:53
Speaker
We have to train them that thoroughly, help them understand it, demonstrate it, articulate it, and then we can teach them how to report it.
00:39:03
Speaker
Because when we say, I went in and I stabilized that patient,
00:39:08
Speaker
Then they're able to articulate, you know, I approached perpendicular to the bed, my hands above my waist.
00:39:14
Speaker
The patient reached up.
00:39:15
Speaker
I, you know, stabilized his right arm at the wrist and the elbow onto the mattress.
00:39:22
Speaker
And then, you know, you get the idea.
00:39:24
Speaker
So they're able to articulate then through the lens of their training what they're doing.
00:39:31
Speaker
We can't do it backwards.
00:39:32
Speaker
They have to be trained first and then we can train them to report.
00:39:37
Speaker
what they do.
00:39:38
Speaker
So really, if we're having people hit the floor right away, which often happens in hospitals, as they're going through the training period and they're being accompanied by, hopefully, by a training officer, that as they're being trained, you know, if they're going through different defensive tactic courses and stuff, they can rely on their training officers to guide them through the reporting process
00:40:05
Speaker
until they're completely trained and able to generate the report based on the common language themselves.
00:40:14
Speaker
I don't know if that's the answer that you were looking for, Brian.
00:40:17
Speaker
No, that's good.
00:40:19
Speaker
Okay, I'll wrap it up here.
00:40:22
Speaker
Thanks, Joel.
00:40:23
Speaker
That's some great stuff there.
00:40:25
Speaker
Now, is there anything I haven't asked you yet that you'd like to discuss at this point?
00:40:32
Speaker
I guess I would just like to help
00:40:34
Speaker
I think it's important to emphasize for people that communications training is less about what you say and how you say it.
00:40:42
Speaker
And people know that, but what does that mean really?
00:40:46
Speaker
So nonverbal communication is something that we have to train on when we're teaching people these skills, their tone of voice, the volume of their voice.
00:40:57
Speaker
All behavior equalizes.
00:41:00
Speaker
As security people, we have to demonstrate
00:41:03
Speaker
confidence, concern, right?
00:41:06
Speaker
We have to lead people down with this, right?
00:41:09
Speaker
We can't force people to calm down, even though we try real hard and it never works.
00:41:13
Speaker
Calm down, right?
00:41:15
Speaker
We have to learn to lead them down, right?
00:41:19
Speaker
Once we learn to lead them down and put them to sleep with our presence, then you'll get really good at this job, right?
00:41:27
Speaker
Awesome stuff.
00:41:28
Speaker
Well, Joel, thank you for taking the time.
00:41:30
Speaker
Thank you for letting us benefit from your experience in the field.
00:41:33
Speaker
I think there is some great discussion here and I appreciate it.
00:41:37
Speaker
I really enjoyed it, Brian.
00:41:38
Speaker
Thanks.
00:41:41
Speaker
Well, that wraps up another episode of Confidence in Conflict.
00:41:45
Speaker
Here are just a few of the key points that I got from Brian's interview with Joel.
00:41:50
Speaker
First, under-reporting, big time issue with reports.
00:41:55
Speaker
Got to make sure the reports get done.
00:41:57
Speaker
Two, you know, our own Gary Klugowitz's quote, if you don't write it down, it didn't happen.
00:42:04
Speaker
Three, good report writing reduces incidents because it provides an opportunity to teach prevention.
00:42:11
Speaker
Four, good report writing starts with good training on how to manage conflict.
00:42:17
Speaker
Five, having a framework for how to manage conflict makes report writing much easier.
00:42:23
Speaker
And Joel gave a great example of that when he talked about how he had to kick somebody out of the hospital and the framework he used to go through the process.
00:42:34
Speaker
Next, to get more and better incident reports written, leadership must get involved to make it clear as to what are unacceptable behaviors that
00:42:43
Speaker
And Joel made the point that a lot of nurses just don't know what's acceptable or unacceptable.
00:42:49
Speaker
And finally, a good incident report needs to include not just the who, what, when, and where, but also the how and why.
00:42:57
Speaker
Well, that's it for this episode.
00:42:58
Speaker
If you want more expert advice on how to prevent and better manage conflict, subscribe to this podcast at Apple Podcasts, Stitcher, or wherever you get your podcasts.
00:43:08
Speaker
And if you like this episode, please write us a review.
00:43:10
Speaker
Also visit vistalar.com slash blog to get notes for this show, share your comments, and access additional conflict management resources.
00:43:20
Speaker
Take care and stay safe.