Risk prevention means teamwork: preventing risk in a facility involves all staff and all "customers".

Prevention is a critical aspect of any effective risk-management program. It is important that we provide ourselves and our staff with tools to deal with uncomfortable and unfortunate situations, as they will arise frequently to no fault of the individual staff members. In this article, I will discuss the importance of communication to enhance risk prevention.

Individuals who come to our facilities or wish to retain our services are making a choice, thus they are consumers. We are not the only options who offer or "sell" the same healthcare product. To effectively communicate our marketplace value--our "expected outcomes" of care--we need first to determine who the customer is.

Generally we would consider the residents our customers, as the services are provided for them. It is important, though, to also include the family and/or interested parties as customers, because their reactions to our services have an impact not only on us providers, but on our residents. Some questions to ask families to consider during the start of a new relationship with our facility would include:

* What experiences have you had from another facility service such as ours?

* Has anyone explained to you the disease(s), condition(s), or potential outcome(s) involved with your loved one?

* What do you want to see happen and in what time frame?

* How do you like to be communicated with regarding important developments (e-mail, pager, cellular phone, etc.)?

* How should we approach you when things do not go as desired or planned?

Second, we should spend time learning and using service-specific risk-prevention techniques with all our customers, regardless of which department and function are involved; everyone counts in risk prevention. Some suggestions include:

* Be an available staff. Many people are not comfortable complaining and may even fear the outcome of doing so, no matter how much we encourage them to be open and honest. One reason is that most people (ourselves included) strongly fear conflict. People often act and even say, if asked, that everything is "fine"--fine, that is, until they eventually blow up in frustration. Rarely is the reason for the blowup the last small irritant--it's really the big picture. So give involved family members a sense of control whenever possible. If possible, involve them in day-to-day activities, care, and appropriate decisions.

* Meet with customers often, not just when required. Think back to some of your own consumer experiences. Sometimes if the service person asks "Are you pleased with your care or services?", even when you've had issues you probably felt less upset because at least you were asked.

* Identify realistic limitations. There are times when the goals of the customer are not realistic. If this is left unaddressed, then when the inevitable does occur and the expectation is not met, we have someone who is twice as angry: e.g., "You asked what I wanted, I told you, and I still didn't get it."

* Keep the customer informed and ask for his or her opinion often. If we get it wrong--and sometimes we may--we can show that we are trying to get it right.

* Most importantly, learn to take a complaint, and teach your staff how to do so, too. Learn "when to hold and when to fold." If the family complains that the food is cold, and a staff member gets another tray and the customer is now happy, that is a "hold." On the other hand, if the staff member gets another tray and the family is still unhappy (even though the second meal obtained is fine, they are still upset), that's a "fold." A "fold" should require that another team member (preferably a management staff member) be brought into the situation ASAP.

* Learn to say "I'm sorry"--and, if you say it, be sincere. No one is perfect (not even us!). Saying you are sorry does not mean something is necessarily your fault. For instance, if the meal carts come to the floor and you pass out all of the meal trays and then, while rounding, realize that someone didn't get his dinner and you get him a tray, it is perfectly fine to say you're sorry he had to wait. Generally the late tray is chalked up to human error and forgotten.

* Learn to watch for verbal and nonverbal cues that indicate customer unhappiness. Family members who bring in supplies that the facility should (and probably does) provide, or always come at certain care times and seem discontent with the care and services provided (with a facial expression that says, "I had to come and do it or it wouldn't have been done at all"), are dangerous customers. They are usually polite and pleasant up front, and shy away from conflict, but they are not happy. It's surprising how the sense of this comes through if you're alert for it.

Customers identify most favorably with us when they engage in positive interactions and feel they have received individual and personalized care and services from people who show care and respect for them and their loved ones. If you need any more motivation to work at this, remember, it is by far easier and more fulfilling to stay out of trouble than to get out of it.

This article is based on a presentation at the 17th Annual NADONA/LTC conference, Orlando, Florida, 2004.

BY ROBIN A. BLEIER, RN, CLC, LHCRM

Robin A. Bleier, RN, CLC, LHCRM, is a licensed health risk manager and certified legal consultant with RB Health Partners, Inc., Crystal Beach, Florida. She was 2003 Nursing Administrator of the Year with the Florida Association of Directors of Nursing Administration (FADONA) and is that organization's second vice-president. For further information, phone [phone]. To comment on this article, please send e-mail to [e-mail]. For reprints in quantities of 100 or more, call [phone].