SHAPES IT

The conflict transformation skills module, a core element of MGL training, addresses high stakes conflict in health care settings and addresses the effects of actual or perceived medical harm. We bring together a powerful set of skills that SHAPES people’s Interests to Transform conflict into a pathway forward to resolution. Our acronym SHAPES IT names the elements that are the key to this process of change. We present each of the skills below:

SPACE
This word reminds us of the need to give space to a distressed patient or family member. Upset persons may need to urgently express their feelings and thoughts while we are still, do not interrupt and leave space before we respond. We need to pay attention to the physical space we are in as we engage. Click here for examples

HEARTFELT ACKNOWLEDGMENT
We are responding with a genuine, empathic, heart felt expression of our emotion to their distress, anger, anxiety and fear. We share either an admissable or inadmissible apology depending upon whether the standard of care had been met or been breached. Click here for examples

ACKNOWLEDGING FEELINGS
We pay close attention to the feelings we notice through the patient and family members’ verbal and non-verbal communication. We tentatively name the feelings we sense the patients and family are experiencing. We select from a large array of affective descriptions and select the intensity of the feeling word that is as close as possible to the intensity of the emotion being exhibited by the patient or family member. Acknowledging feelings of the person promotes recognition, validation and understanding of the person in how they are being emotionally affected. Click here for examples

PARAPHRASING
This skill involves reflecting back important key words and phrases in a brief manner. The purpose is to express the essence of what a person is communicating. Paraphrasing is helpful to check-out that the listener is capturing the key message. Paraphrasing focuses on key events and issues, is past-oriented and sometimes can take several efforts to gain the accuracy necessary to be clear on the patient of family member’s communication. Click here for examples

EFFECTS
Exploring the effects of the adverse event on the patient and family member(s) helps surface the possible needs that can be anticipated by the affected family. This practice helps the health care provider more fully understand the impact of the averse event while at the same time assisting them to provide high quality empathy and support for the suffering experienced by the patient and family that is overt as well as beneath the surface. Click here for examples

SUMMARIZING
This skill is the same as paraphrasing but covers a longer period of conversation and pulls together key themes. Summarizing draws attention to the patient and family members that progress is being made in the series of interactions taking place. The central goal of summarizing is for the health care provider to help regain control and find intentionality in the series of interactions as well as demonstrate understanding and establish readiness to transition to a new topic. Click here for examples

INTERESTS
Identifying interests helps us look past positions people take in a conflict and has us look to the needs, beliefs, and values which are the interests below the surface. Focusing on interests helps us establish what is truly important. Exploring interests helps us get to the heart of the issue. This practice helps the listener move people beyond polarized positions and sets the stage for mutual understanding. Establishing interests prepares the ground for generating creative options and pivoting the conversation toward practice solutions. Click here for examples

TRANSFORMATION
The transformation skill involves translating statements of interests expressed by patients and family members into an action oriented frame. The interests are framed in terms of what s/he wanted or hoped for or what they expected. The goal of the transformation skill is redirection by focusing on underlying interests, not positions or complaints. Transformative statements are expressed in neutral or positive terms and serve as a bridge to the future. Click here for examples

Space: 

  • Being aware of where you are meeting

  • Engage in steady eye contact

  • Pay attention to your body language & voice tone

  • What is the physical distance between you and the distressed person?

  • Can you sit down with the person and show them with your non-verbal responses (eyes and facial expression) that they have your undivided attention?

  • Is your voice tone soothing, empathetic and kind?

  • Are you speaking quietly and slowly in the face of distress and agitation?

  • Are there unnecessary physical barriers, which might escalate interactions between you and the other person?

  • Is the physical space confidential, clean and welcoming if you are having a planned high stakes meeting? 

Heartfelt acknowledgment:

  • I’m so sorry...

  • I am sorry this happened. I want you to know that we are conducting a thorough investigation to learn as much as we can about what occurred. I will keep you informed as we discover more.

  • Pay attention to your body language & voice tone

  • What is the physical distance between you and the distressed person?

  • Can you sit down with the person and show them with your non-verbal responses (eyes and facial expression) that they have your undivided attention?

  • I am so sorry for your loss.

  • I am wanting to offer my condolences and the condolences of my staff to you and your family.

  • I am very sad to hear what happened.

  • This is a devastating set of circumstances.

  • This is a terrible situation you are going through.

Acknowledging feelings & asking effective questions:

  • I hear that you have been deeply disrespected... What is it that most concerns you right now?

  • This must be devastating.

  • I can see how shocked you are right now.

  • This has got to be deeply upsetting.

  • I can imagine that you might have lost a lot of trust of your doctor because of what has happened.

Paraphrasing:

  • The doctor did not return your call despite efforts to contact her. Is that right?

  • What I am hearing is that there has been a series of deeply troubling events that have happened one after the other.

  • Let me see if I have understood your main concerns. First, you are wanting to seek more information on why the information on the test was not relayed to you when it was available.

Effects of the problem:

  • What is the effect of this lack of response on you?

  • Tell me more about the impact of the pain is having on your day to day life associated with this recent diagnosis.

  • What have been the effects of not being able to trust your doctor any more?

Summarizing:

  • Let me see if I have understood the key ideas… I want to be really clear about the information you would like to have brought forward.

  • I’d like to interrupt you for a minute. You have said a lot of things in the last 5 minutes. I want to make sure I have captured the main issues so that I can communicate this information to the Head of Nursing.

Interests:

  • You want your concerns to be addressed quickly and effectively

  • What I hear is you want to re-establish a trusting relationship with your doctor. Is that right?

  • You would like to be listened to and hear a sincere heartfelt apology.

Transforming & translating interests:

  • Arrangements will be made today to address these new goals we have identified.

  • It sounds like you are ready to talk to the doctor and tell him how you feel. Shall I help you set up an appointment today.

  • Let's organize a meeting where you can hear first hand an appropriate response from the Department where things went so terribly wrong. I will call you later today with an appointment to help bring some closure to this awful set of circumstances.

 

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