Health Care and Treatment

Recommendations For An Effective WPV Safety and Health Training Program That Is In Alignment With Joint Commission and OSHA Guidelines

Workplace violence (WPV) in healthcare is well documented. Out of all workplace assaults in the United States, fully 75% of them occur in healthcare and social service settings (OSHA — (Occupational Safety and Health Administration).

This shouldn’t be surprising given the prevalence of the following WPV risk factors in healthcare settings that have been identified by California OSHA and NIOSH (National Institute for Occupational Safety and Health).

Employees who:

• Have contact with the public
• Work alone
• Work late at night or during early morning hours
• Perform duties that put them in conflict with others or that could upset people
• Deal with people known or suspected to have a history of violence
• Have a mobile workplace, deliver passengers or goods, and must enter areas with a high crime rate
• Exchange money with the public

Workplaces that are:

• Often understaffed
• Located in an area with a high crime rate

Anyone who has ever worked in healthcare (e.g., hospitals, residential treatment, clinics, community care, home care) has come to accept that these risk factors are, largely, just part of the job. Therefore, it should be no surprise that workers in health care settings are four times more likely to be victimized than workers in private industry (Security Industry Association and IAHSSF Foundation).

What Is Workplace Violence? 

The Joint Commission’s infographic — Take a stand: No more violence to health care workers — lists the following forms of violence to healthcare workers: biting, kicking, punching, pushing, pinching, shoving, scratching, spitting, name-calling, intimidating, threatening, yelling, harassing, stalking, beating, choking, stabbing, and killing.

The U.S. Department of Labor “defines workplace violence as an action (verbal, written, or physical aggression) which is intended to control or cause, or is capable of causing, death or serious bodily injury to oneself or others, or damage to property. Workplace violence includes abusive behavior toward authority, intimidating or harassing behavior, and threats.”

OSHA addresses employee complaints of workplace violence and assesses employers based on OSHA’s General Duty Clause, Section 5(a)(1) of the Occupational Safety and Health Act of 1970.

“(a) Each employer shall furnish to each employee employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to employees”

As further evidence of the problem of workplace violence in healthcare settings, of OSHA’s inspection resulting from an employee complaint, more than 65% over the last few years involve the healthcare industry. And, given the prevalence of the risk factors listed above and the number of workplace violence incidents in healthcare, it is likely that OSHA identifies some level of hazard with every inspection.

It is important to understand that, even if OSHA identifies a hazard, they cannot cite a healthcare organization just for not having a WPV program — since no specific workplace violence standard exists. Instead, OSHA can only cite an organization if OSHA can show that a hazard abatement action would have reduced the likelihood of “death or serious harm.” Therefore, even though OSHA doesn’t have a specific workplace-violence standard, employers can protect themselves from a citation by having a strong WPV program.

The goal for healthcare organizations should be to have sufficient elements of a WPV program in place to minimize the chance that OSHA will be able to show that actions could have been taken to materially reduce whatever hazard they identify during an inspection.

Other reasons to have a strong WPV program are:

• Protect the safety and well-being of employees, patients, and visitors
• OSHA is in the process of developing a workplace violence standard for healthcare settings
• Several states (CA, CT, IL, MD, MN, NJ, OR, NY) now require an employer-run healthcare violence program and many others have laws designating penalties for assaults that include nurses (American Nurses Association — Workplace Violence)

In absence of a standard, OSHA has published Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers – 2015, which identifies these five building blocks for an effective WPV prevention program:

1. Management commitment and employee participation
2. Worksite analysis
3. Hazard prevention and control
4. Safety and health training
5. Record-keeping and program evaluation

What Should Be Included In A Safety and Health Training Program?

At Vistelar, due to our trainer’s 30-plus years of providing conflict management training for healthcare employees, we often are asked what should be done relative to the fourth building block: safety and health training.

To answer this question, we encourage our clients to first review what the Joint Commission and OSHA have to say about workplace violence training.

The Joint Commission’s latest publication on this topic — Physical and verbal violence against health care workers (Sentinel Event Alert Issue 59, April 17, 2018) — says this on page 6:

“Train all staff, including security, in de-escalation, self-defense and response to emergency codes. When threatening language and agitation are identified, initiate de-escalation techniques quickly. – – Self-defense training may include topics such as violence risk factors, de-escalation techniques, alarms, security support, safe rooms, escape plans, and emergency communication procedures. Regarding de-escalation and self-defense, experts suggest that hospitals prohibit firearms from campus, except for firearms used by law enforcement officers. – – Conduct practice drills that include response to a full spectrum of violent situations, which could range from a verbally abusive family member to an active shooter.”

In their 2015 Guidelines, OSHA says this on page 24:

“Education and training are key elements of a workplace violence protection program, and help ensure that all staff members are aware of potential hazards and how to protect themselves and their co-workers through established policies and procedures. Such training can be part of a broader type of instruction that includes protecting patients and clients (such as training on de-escalation techniques). However, employers should ensure that worker safety is a separate component that is thoroughly addressed.”

In OSHA’s report, Caring for Our Caregivers December 2015, they say this on page 25:

“Training is a key component of a successful workplace violence prevention program. It helps healthcare workers learn to recognize potential hazards and learn how to protect themselves, their coworkers, and their patients. Training and reinforcement through role-playing and other means can provide employees with strategies that increase their confidence for handling potentially violent incidents before they arise and reduce the likelihood of violent incidents occurring. Education also reinforces that violence is not an acceptable part of healthcare work.”

The OSHA Guidelines go on to recommend these specific elements of an effective WPV safety and health training program:

• Involve all workers, including visiting staff, contract workers, supervisors, and managers
• Provide special instruction for workers who face specific safety and security hazards
• Teach the concept of “universal precautions for violence” (violence should be expected but can be avoided or mitigated through preparation)
• Communicate the importance of a culture of respect, dignity, and active mutual engagement in preventing workplace violence
• Instruct at the comprehension level appropriate for the staff — using qualified instructors
• Cover policies and procedures as well as de-escalation and self-defense techniques
• Use role-playing, simulations, and drills
• Train new workers before beginning their job duties, train all workers at least annually, and in high-risk settings, train quarterly or even monthly

Relative to topics to be covered in a WPV safety and health training program, the OSHA Guidelines say this on 25 and 26:

“Training topics may include management of assaultive behavior, professional/police assault-response training, or personal safety training on how to prevent and avoid assaults. A combination of training programs may be used, depending on the severity of the risk. In general, training should cover the policies and procedures for a facility as well as de-escalation and self-defense techniques. Both de-escalation and self-defense training should include a hands-on component.”

And here are some of the topics OSHA suggest be covered:

• Workplace violence prevention policy
• Risk factors that cause or contribute to assaults
• Recognition of escalating behavior, warning signs, or situations that may lead to assaults
• De-escalation techniques which can be used to prevent or diffuse volatile situations or aggressive behavior
• Approaches to deal with aggressive behavior in people other than patients and clients, such as relatives, visitors, or intruders
• Self-defense procedures where appropriate
• Ways to protect oneself and coworkers, including working in teams when necessary
• Policies and procedures for reporting and record-keeping

Here are a few additional points OSHA makes about an effective WPV safety and health training program:

• Train all workers who are reasonably expected to interact with patients, including admissions staff
• Training programs are most effective when they are designed specifically for a facility or unit’s particular risk profile. Also, because duties, work locations, and patient interactions vary by job, violence prevention training can be more effective if it is customized to address the needs of different groups of healthcare personnel. For example:
  • Provide direct caregivers with training tailored to the specific patient population with which they work — such as behavioral health patients, the developmentally disabled, and geriatric patients with Alzheimer’s and other forms of dementia
  • Specialized training for ED staff with a focus on the most common threats faced at their facility (using such resources as those available from the Emergency Nurses Association)
  • Specific training for security personnel, including the psychological components of handling aggressive and abusive clients, and ways to handle aggression and defuse hostile situations
  • Separate training for housekeeping, food service, maintenance, and other support staff
• Training and policies should cover all types of workplace violence, not just violence by patients against employees (e.g., employee-on-employee violence, employee-on-patient violence
• Interactive exercises make training more effective by allowing participants to practice and apply the skills they have learned, such as de-escalation and self-defense techniques
• Web-based training offers fidelity of presentation and automated documentation while requiring minimal supervision and allowing flexible timing and pace. Web-based training may be more effective when paired with live instruction and practice (blended training)
• It can be helpful to have a team of trained WPV prevention trainers in-house. One option is for employees to attend a more in-depth course offered by an outside training provider to become certified to train others within their organization
• Another approach is to have one or more “safety coaches” for each unit or floor to offer guidance and coaching in real-time and to run ad hoc refresher sessions

Again, OSHA cannot cite a healthcare organization for not having a WPV safety and health training program. However, they can cite an organization if 1) they identify “hazards that are causing or likely to cause death or serious physical harm to employees” 2) they can show that some action could have been taken to materially reduce the hazards.

Obviously, having a strong WPV program in place reduces the chances that OSHA would make such a determination during an inspection as a result of an employee complaint about workplace violence.

Vistelar’s Alignment With Joint Commission and OSHA

As stated earlier, the above review provides a foundation for Vistelar’s recommendations relative to developing an effective WPV safety and health training program — the fourth building block specified in OSHA’s Guidelines for Preventing Workplace Violence for Healthcare and Social Server Workers – 2015.

Obviously, it is important to follow the Joint Commission’s and OSHA’s published guidelines to provide protection from an OSHA citation and in anticipation of OSHA developing a workplace violence standard for healthcare settings. In addition, in Vistelar’s opinion, these guidelines are sound and practical in terms of protecting the safety and well-being of employees, patients, and visitors.

Although these guidelines for an effective WPV safety and health training program are relatively new, Vistelar’s trainers have identified and embraced most of the recommended elements for over thirty years. The following are just a few examples of the alignment of Vistelar training programs with the published guidelines of the Joint Commission and OSHA.

• Offer programs that address the entire spectrum of human conflict — non-escalation, de-escalation and crisis intervention coupled with physical alternatives (personal protection, self-defense, and defensive tactics — including active shooter preparation and response). Vistelar trains individuals and teams to prevent and better manage conflict — from simple disagreements to physical violence.
• Address all the topics suggested by OSHA (plus more — see below) which cover all types of workplace violence (patient-on-employee, employee-on-employee, and employee-on-patient violence). We train on how to:
  • Maintain safety when presented with a conflict situation
  • Predict and prevent conflict
  • De-escalate anger and abuse
  • Control crisis and aggression
  • Effectively manage physical violence
• Provide a spectrum of programs — web-based programs for admissions and support staff (“gatekeepers”), in-person and blended training workshops for direct caregivers, specialized programs for high-risk areas (e.g., ED, behavioral health) and security professionals, and instructor schools (train-the-trainer programs) for organizational instructors and “safety coaches.”
• Customize programs to meet our clients’ specific needs to ensure our training aligns with their unique mission, vision, and values and that the learning provided by our training is more sustainable over time.
• Underscore the need for physical, organizational, legal and emotional safety (Vistelar’s P.O.L.E. acronym) — with the goal of enhancing customer satisfaction, improving employee safety and morale, preventing reputations from being destroyed, reducing liabilities and injuries, and saving lives.
• Teach the concept of “universal precautions for violence” (in Vistelar terms — conflict is inevitable but it can be effectively managed to prevent and mitigate violence). Over the years, we’ve learned that you can’t stop conflict from happening but you can manage it in order to keep everyone safer.
• Share Vistelar’s core principle of conflict management — “treat people with dignity by showing them respect.”
• Train using Vistelar’s “fire drill versus fire talk” approach, which includes an optimum blend of student interaction, scenario-based skill practice, memorable stories, and analysis of real-life events captured on video — instead of solely lecture-based training. Also, in most classes, we video- and audio-record student role plays to document that learning has taken place and to emphasize that, in today’s society, the likelihood of an interaction getting caught on camera is almost 100%. Finally, our physical alternatives training is almost entirely hands-on.
• Emphasize a tactic Vistelar calls “Closure,” which we define as “follow-through considerations, such as ensuring the situation is stabilized, summarizing decisions, and reviewing the interaction.” The goals of this tactic are to achieve the best possible outcome, to end the interaction in a better place than where it started, and to establish a positive foundation for all future interactions. Incident reporting is strongly emphasized during coverage of this tactic.

Vistelar’s Additional Recommendations

Vistelar has developed additional recommendations based on our 30-plus years of training all levels of employees in a wide range of healthcare settings (e.g., hospitals, residential treatment, clinics, community care, home care) — as well as law enforcement professionals — beyond what the Joint Commission and OSHA recommends for an effective WPV safety and health training program,
Most of these recommendations are based on Vistelar’s Point-Of-Impact Conflict Management
Framework™ (“6 C’s of Conflict Management”).

Note that this graphic has blue boxes (“blue brick road”) and red boxes (“red brick road”). Vistelar’s training emphasizes keeping people on the “blue brick road.” However, sometimes people take us on the “red brick road,” inflicting various levels of emotional and physical violence. When that happens, Vistelar’s training teaches how to bring people back to the “blue brick road,” with the goal of producing the best possible outcome.

As represented by the orange and red jagged bars, there are two types of conflict: non-violent and violent — and it’s critically important to recognize that violent conflict is a possibility in every healthcare setting.

In addition, while uncomfortable to some, Vistelar uses the term “Combat” as a means to emphasize that physical engagement is a possibility in all jobs and must not be glossed over in conflict management training.

That is why Vistelar’s training programs “address the ENTIRE spectrum of human conflict” — meaning we cover all six elements of the conflict management framework.

• Context: Approach considerations prior to an interaction, such as assessment of risk and physical positioning, decision on whether to proceed, and personal mindset
• Contact: Interaction considerations, such as words used, tone of voice, facial expressions, eye contact, hand position, body language, and posture
• Closure: Follow-through considerations, such as ensuring the situation is stabilized, summarizing decisions, and reviewing the interaction
• Conflict: When questioning, anger or verbal abuse enters into an interaction
• Crisis: When the person with whom you are interacting is displaying at-risk behaviors
• Combat: When resistance or aggression results in physical engagement initiated by either party

In other words, Vistelar’s additional recommendations for an effective WPV safety and health training program are almost all related to ensuring the program doesn’t lead to employees having their “training tape run out” when faced with an uncommon situation.

For example, we recommend that all employees get at least some training on how to respond in the face of violent crisis intervention or physical engagement (a tactic we call “Take Appropriate Action”).

Note: Vistelar’s expertise in dealing with violent crisis and physical violence stems from our founders’ 30-plus years of field-proven law enforcement and military experience. In fact, throughout the 80s and 90s, one of our founders helped develop Wisconsin’s nationally recognized unified tactical training systems (D.A.A.T and P.O.S.C®). Every police officer, jail/juvenile detention officer and prison/probation/parole officer is trained in one of these systems.

Another example is that we recommend training on two tactics we call “Be Alert & Decisive – Respond, Don’t React” and “Proxemics 10-5-2,” which emphasize personal safety awareness and the use of distance, relative positioning and hand placement to stay safe.

A third example is that we devote significant time in class to perspective taking — how to demonstrate empathy to another person’s situation. Perspective taking is the basis of our emphasis on “non-escalation,” preventing conflict to minimize the chance that simple disagreements will escalate to emotional and/or physical violence.

In general, our additional recommendations, are focused on ensuring your organization’s safety and health training programs embed in students the knowledge, skills, and abilities to interact with anyone and to:

• Engage in a way to not cause conflict or unnecessarily escalate situations
• Confidently and professionally deal with questioning, anger, and verbal abuse
• Participate in difficult conversations and mediate positive outcomes
• Effectively de-escalate conflict and remain safe in crisis situations
• Persuade others to cooperate in the face of resistance
• End an interaction in a better place than where it started
• Know what to do and how to do it when resistance or aggression results in physical engagement
• Defend oneself from a physical assault
• Take appropriate action (e.g., exit, evade, escape, stabilization, control) based on the employee’s role within the organization and their training and experience, the environment they are in, established policies and procedures, availability of security or police, and defined rules of engagement
• If necessary, articulate a legal defense for taking appropriate action

Conclusion

Workplace violence is a significant problem in healthcare settings as evidenced by 65% of OSHA complaints involving the healthcare industry. In order to support the safety of employees, patients, and visitors and to protect themselves from OSHA citations, healthcare organizations should put in place a strong WPV prevention program.

One element of such a program should be an effective WP safety and health training program which follows the published guidelines of the Joint Commission and OSHA.

This report summarizes those guidelines and offers additional recommendations based on Vistelar trainer’s 30-plus years of experience in providing training in healthcare to address the entire spectrum of human conflict — non-escalation, de-escalation, and crisis intervention coupled with physical alternatives.

Joel Lashley describes himself as the healthcare “violence nerd.” He has been studying healthcare violence for over 30 years and is the author of Confidence In Conflict For Healthcare Professionals: Creating an environment of care that is incompatible with violence.

In this 22 minute audio, Joel discusses the “one voice” tactic for managing a crisis situation with Allen Oelschlaeger, the host of the Confidence In Conflict podcast.

[cxl url=https://www.cxl1.net/8hbGfxTsKLM width=400 height=40 skin=black]

 

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When was the last time you took a listening class? If you are like most people, the answer is probably never.

During my eight years of post-secondary education and my 30+ years working in the corporate world, I know I never had any listening training. I received training on almost every imaginable topic (and some that were unimaginable), but never listening.

However, I repeatedly heard this cute phrase: “We have two ears and one mouth so that we can listen twice as much as we speak” (Epictetus 55-135 BC) — but no one ever taught me HOW to do what I was supposed to be doing when I had my mouth shut.

Sure, over the years I received a spattering of simplistic advice (e.g., look people in the eye, don’t check your phone) — but that was about it.

The Benefits Of Being A Good Listener

My experience is almost universal despite the fact that listening is one of the most valuable human skills. The benefits of being a good listener include:

• Increases productivity
• Speeds problem solving
• Improves decision making
• Generates trust and respect
• Defuses conflict
• Boosts self-confidence
• Reduces mistakes
• Improves customer service
• Enhances teamwork
• Motivates others to take initiative
• Demonstrates empathy
• Improves negotiation outcomes
• Facilitates products/services improvement
• Causes you to be viewed as a “good conversationalist”
• Makes you more popular

In addition, you will likely learn new things:

“A good listener is not only popular everywhere, but after a while, he knows something.” – Wilson Mizner — American Playwright 1876 to 1933

In 1992, a commission was put in place by then Secretary of Labor, Lynn Martin, to determine the skills people need to succeed in the world of work. The benefits of listening were highlighted in a report by the Secretary’s Commission on Achieving Necessary Skills (SCANS) (http://www.academicinnovations.com/report.html).

As you might expect, the commission identified a wide range of skills (37 skills to be exact) but just five were specified as “Basic” skills — and “Listening” was one these five (the others were reading, writing, speaking, and math).

Here is how “Listening” skills were defined by SCANS:

“Receives, attends to, interprets, and responds to verbal messages and other cues such as body language in ways that are appropriate to the purpose; for example, to comprehend; to learn; to critically evaluate; to appreciate; or to support the speaker.”

Why Don’t We Get Trained In How To Listen

You would sure think that, with the many benefits of listening and with listening being widely recognized as a critical success skill, more effort would be put into teaching people how to listen — but that doesn’t happen. We all get plenty of training in reading, writing, speaking, and math, but not listening.

I’ve wondered over the years why that’s the case and I haven’t been able to come up with a good answer.

Maybe listening is like walking. No one taught us how to walk; we just figured it out. Possibly that’s the expectation for listening — we’ll each just figure it out.

But, even that explanation doesn’t seem right. Although most people don’t pay any attention to it, there’s actually a lot of training on how to walk. There’s even a “Walk Magazine.” I looked and looked and I can’t find any magazine about listening.

Again, I just don’t get it. If I was running the US education system, I would make sure a block of instruction on listening was required at every grade in primary and secondary school and that there was at least one required class in college about listening. I’d also push for every organization to provide a class on listening to all employees.

Now — obviously — I’m not the first person to recognize the importance of listening. Here are some quotes from several well-known individuals:

“Most of the successful people I’ve known are the ones who do more listening than talking.” — Bernard M. Baruch, economic advisor to six presidents (1870 to 1965)

“It takes a great man to be a good listener.” — Calvin Coolidge, thirteenth president of the United States (1872 to 1933)

“The art of conversation lies in listening” — Malcolm Forbes, publisher of Forbes Magazine (1919 to 1990)

“One of the most sincere forms of respect is actually listening to what another has to say.” — Bryant H. McGill,  author, Nobel Prize nominee (1969 to present)

We Need To Learn How To Listen

There are plenty of people who have recognized the importance of listening over the years but few who have taught us HOW to listen.

The late Steven Covey, the author of the best-selling book The Seven Habits of Highly Effective People (sold over 25 million copies in 40 languages), is probably one of the world’s biggest advocates of listening. His fifth habit was labeled “Seek First To Understand, and Then To Be Understood” but it was all about listening.

I read this book when it first was published in 1990 and have read it several times since. I reviewed the chapter about Habit 5 again in preparation for writing this article. Covey’s main point is that you need to practice “empathic listening” — listening with the intent to understand, to fully and deeply understand from a reference point of the other person’s perspective, not yours.

He describes how most people listen “autobiographically” — they evaluate (agree or disagree), they probe (ask questions from their own point of view), they advise (give counsel based on their own experience), or they interpret (try to figure people out based on their own motives). In other words, most people listen from their own frame of reference rather than the frame of reference of the speaker.

In the 25 pages Covey writes on listening, he does an outstanding job of selling the value of listening, with some great stories. Also, unlike almost everything I’ve ever read about listening, he actually teaches a couple of skills about HOW to listen — and he demonstrates how to apply those skills via an excellent example of a dad trying to listen to his son who is complaining about school.

If you haven’t read Covey’s book, it is worth getting a copy just to read this six-page example. He ends this section of the chapter with this:

“I have gone through the skills of empathic listening because skill is an important part of any habit. We need to have the skills. But, let me reiterate that the skills will not be effective unless they come from a sincere desire to understand.”

This is an incredibly important point. Without this attitudinal foundation, the application of any listening skill will not be effective and, in many cases, might even come across as manipulative. Note, there’s a second approach to not coming across as manipulative that I will cover in a future article.

Must Have A Foundational Understanding of Empathy To Be A Good Listener

You may know from my past articles that I work for a company called Vistelar. We are a conflict management training company and we’ve learned over the last thirty years that effective listening is one of the most powerful methods of managing conflict. However, we also know how easy it is for people to seem manipulative if their attitude isn’t right.

Therefore, before we share any listening skill in our training, we work hard to develop in our students a foundational understanding of empathy, as well as a strong buy-in to empathy’s critical importance in the management of conflict.

We’ve learned that without this foundation, applying “listening skills” can actually cause negative outcomes. Again, I will elaborate on this point and explain the second approach we teach in a future article.

Effective listening is such an important element of conflict management that we go far beyond the couple of skills that Covey teaches. In fact, we teach eight “active listening” techniques. Additionally, people frequently don’t say what they mean in conflict situations so we teach another listening tactic we call Beyond Active Listening that has six elements.

I don’t have room in this article to cover all eight of our “active listening” techniques and all six elements of our Beyond Active Listening tactic, but I do want to describe one of the six.

The Reflect Tactic

We call this element “Reflect” and its one of the most powerful, but also one of the most rarely used, listening tactics. Here is how we describe this tactic in Vistelar’s conflict management training manual.

Reflect — Acknowledge the person’s emotions and give him or her the opportunity to talk out his or her feelings (rather than act them out). State your view of what the other person is feeling and why — succinctly and precisely as possible.

“Hmmm. You’re feeling anxious because you’re not sure where your mom is. Do I have this right?”

Keep your Reflection tentative and be sure to give the other person time to respond to your question.

Note that strong emotions — anger, hate, fear — usually don’t need reflecting because the other person is often well aware of these feelings. Instead, use the Reflect element to bring out more subtle emotions that the other person might not recognize he or she is feeling.

This element helps you understand the nature and intensity of the other person’s emotions. Be sure to always end this tactic with a confirming question.

As you may know, I spent a fair amount of time in the hospital during 2017 and most of my interactions with hospital staff are now a blur. However, I distinctly remember the few times when this Reflect element was used, because — at the time — it was like a mammoth breath of fresh air.

“Mr. Oelschlaeger, you must be concerned that you’ve been here for four days and we still haven’t figured out what’s going on. Is that right?”

“Mr. Oelschlaeger, you’re feeling worried about this procedure because it wasn’t successful the first time we tried it. Am I right?”

“Mr. Oelschlaeger, you’re sounding frustrated because the doctor hasn’t come to see you yet this morning. Do I have that right?”

“Mr. Oelschlaeger, you’re looking pleased that you are going home today. Am I reading you right?

Do you know what my reaction was with each of these incidences? “Finally — someone seems to be paying attention to my feelings rather than just going through the motions of their job.”

It is really quite amazing the memorable impact these simple comments had on me. It’s not like I was treated badly otherwise. The reality is that I was treated quite well. During my multiple hospital stays, everyone was competent, friendly and nice — and they all must have done a pretty good job since I’m alive to write this article.

But, still, it was these few Reflect comments that were so refreshing at the time and have stuck with me many months later.

To be effective at the Reflect tactic, you must must go “beyond active listening” to discover the meaning and feeling behind the other person’s words, tone of voice, and non-verbals (e.g., facial expressions, eye contact, hand position, body language, posture) — always with the awareness that people often don’t say what they mean and that feelings are often disguised behind non-feeling words.

The goal is to accurately express in your own words, tone of voice, and non-verbals what you perceive are the meaning and feeling conveyed by the other person.

The Four Developmental Stages of Listening

Covey discusses the four developmental stages of empathic listening: mimic content, rephrase content, reflect emotion, and, finally, our Reflect approach, where you rephrase content and reflect emotion.

In the first example above, the content is the four days I was in the hospital without a diagnosis and the emotion was concern.

In the second example, the content was the need to repeat the procedure and the emotion was worry.

In the third example, the content was the absent doctor and the emotion was frustration.

In the fourth example, the content was getting out of the hospital and the emotion was pleasure.

Note that you can Reflect both negative and positive content/emotions. In either case, the goals is for the other person to feel: a) he or she has been heard and understood, and b) you are interested in what he or she is trying to communicate.

When you Reflect negative content/emotions, the negativity is lessened and when you Reflect positive content/emotions, the positivity is deepened.

As Covey says, “What happens when you use this fourth stage of empathic listening is really incredible. As you authentically seek to understand, you rephrase content and reflect feeling, you give him psychological air. You also help him work through his own thoughts and feelings… [If you do this], there will be times when you will be literally stunned by the pure knowledge and understanding that will flow to you from another human being.”

As stated in Vistelar’s conflict management manual in the section about the Reflect element of the Beyond Active Listening tactic, “Keep your Reflection tentative and be sure to give the other person time to respond to your question.”

If you are reasonably confident in your perceptions, you could start the Reflection with a lead-in like, “It seems to you,” or “As you see it,” or “You figure.” However, if you are less confident or if you’re unsure if the other person will be receptive to your listening, you might start with a lead-in like, “It seems like,” or “It might be that,” or “I’m guessing that.” Such lead-ins set the right stage for the next step — to state your view of what the other person is feeling and why, as succinctly and precisely as possible.

You always want to end a Reflection with a confirming question and then to actually listen to the other person’s response.

Let me give you one more example of the use of the Reflect element, which is based on the story in Covey’s book about the dad trying to listen to his son.

Son: “Boy, Dad, I’ve had it. School is for the birds.”

Dad: “You’re really frustrated about school. Is that right.”

Do you see how this response provides so much more psychological air to the son than these more common responses:

Dad: “I don’t think that’s true.” (evaluating)

Dad: “What’s the matter son?” (probing)

Dad: “You need to suck it up.” (advising)

Dad: “You just don’t want to go to school today.” (interpreting)

What To Do In The Face Of Anger, Hate, or Fear

Before ending this article, I want to elaborate on one more point from the Reflect section of Vistelar’s conflict management manual: “Note that strong emotions — anger, hate, fear — usually don’t need reflecting because the other person is often well aware of these feelings.”

For example, consider the reaction you’d likely get if someone was conveying considerable anger via their words, tone of voice and non-verbals and you said “You’re feeling angry because someone stole your car. Do I have that right?”

Do you think that would defuse the situation? Or, do you think it might make things worse — “Duh, darn right I’m angry. Someone stole my #$@&%*! car.”

Given this possibility, it’s best to not use the Reflect tactic when the other person is conveying strong emotions.

However, there may still be times when using the Reflect element can lessen the negativity. For example, that might be true if someone is “in crisis.”

Crisis occurs when an individual has an experience that exceeds his or her coping skills and is actively displaying at-risk behaviors (e.g., behaviors that could cause emotional or physical harm to the individual in crisis or to others).

At Vistelar, we have a systematic and multi-step approach for how to effectively manage such situations and the Reflect tactic is one element of this approach. People in crisis can lose cognitive, emotional and/or behavioral control where they’re not in touch with their feelings. Therefore, it can sometimes help — in addition to a wide range of other crisis intervention tactics — to say something like, “You’re feeling some strong emotions. But you’re safe with me. Let me help. Is that OK?”

This crisis-intervention Reflection is even more tentative than a Reflection where you’re trying to accurately express another person’s more subtle emotions. Note the use of “strong emotions” rather than an explicit label of the emotion (e.g., anger, hate, fear).

I will dig deeper into HOW to listen in future articles. But as a result of this one, I hope you now understand:

• Listening is one of the most valuable of human skills (if not THE most valuable)
• People frequently make common listening mistakes
• Training on HOW to listen should be vastly more prevalent in our schools and organizations
• How to use the Reflect element of Vistelar’s Beyond Active Listening tactic

“The most basic of all human needs is the need to understand and be understood. The best way to understand people is to listen to them.” — Ralph G. Nichols, author Are You Listening (1957) and widely considered the father of the field of listening.

A hospital is meant to be a place for healing but there is a wide range of issues that can get in way of healing. These roadblocks can lead to longer patient stays, lower patient satisfaction, and even an increased incidence of death.

In this article, I want to discuss a barrier to healing that is often ignored — but let me first briefly review the issues getting in the way of healing that are well understood.

Hospital medical errors, generally considered to be the third leading cause of death in the United States, is one of these issues. Poorly controlled pain, undernutrition, and lost sleep are other well-established factors that get in the way of patient healing.

In addition, there is solid evidence that the environment can contribute to reducing errors, falls, and infections, and improving privacy and comfort (“Healing environment: A review of the impact of physical environmental factors on users,” Building and Environment Volume 58, December 212, pages 70-80).

In her 2010 white paper “Creating Environments That Heal,” Susan Mazer, MA, President & CEO of Healing Health Systems suggests that even clutter in patient rooms, hallways, and nursing stations can be roadblocks to healing.

And, we certainly can’t forget poor compliance with hand-washing protocols.

So those are the well-understood barriers to healing. Now let’s look at a barrier that’s often ignored — stress.

Origins Of Stress As It Applies To Medicine

Dr. Hans Selye (1907-1982) coined the term “stress,” as it applies to medicine, in 1936.

I heard Dr. Selye speak many years ago and I still remember the story he told about the origins of his theories on the impact of stress on the human body. He entered the German Medical School in Prague at the age of 17 and, while he was a medical student, he described his first visit to an intensive care unit. The attending physician asked the students for their impressions and Selye’s response was that all the patients “looked sick.” As Dr. Selye explained, this observation was the first step in his recognition of “stress” as a contributor to health issues.

Today this is common knowledge but, surprisingly, it hasn’t always been. However, due to all the research over the last eighty-years, almost everyone now recognizes the impact of stress on health and healing.

An Example Of The Impact Of Stress

Here is an interesting example of the impact of stress that I found in writing a book about weight, nutrition, and fitness in the mid-2000s. I learned about a small town in Pennsylvania (Roseto) where, in 1961, a local doctor was completely baffled by the townspeople’s near-immunity to heart disease.

He got a grant to research this phenomenon and his study was published in the Journal of the American Medical Association (JAMA) in 1964. During the seven-year study period (1955 and 1961), no one under 47 died of a heart attack, there was a complete absence of heart disease in men under 55, and the rate of heart attacks in men over 65 was half the national average.

Obviously, the researchers were pretty curious about what was protecting these folks. Because most of the town were Italian immigrants, they first assumed it was their “Mediterranean” diet. However, the people in this small town didn’t have enough money for fish so they ate high-fat meatballs and sausages and fried much of their food in lard. 40% of their caloric intake was fat.

So, the researchers next assumed it must be “lifestyle” factors that were protecting the population from heart disease. But, they found the men worked in slate quarries where they contracted illnesses from gasses and dust — and smoked unfiltered stogies and drank wine “with seeming reckless abandon.”

Remember, this wasn’t some casual study; it was published in a rigorously peer-reviewed medical journal. The population of Roseto had almost no heart disease yet the townsfolk ate red meat deep-fried in lard, smoked and drank heavily and worked in toxic slate mines. The researchers also looked at ethnicity, water supply, environment, you name it. They were totally stumped.

What they finally concluded was the town’s near-immunity to heart disease was due to low levels of stress. The community was very cohesive, there was no keeping up with the Joneses, people were mutually supportive, and everyone just got along.

If that isn’t crazy enough, check this out. The researchers came back to this small community 30 years later and found the population had become increasingly insular, separated, and less supportive of each other. And, sure enough, the levels of heart disease had risen to levels on par with surrounding towns. Like the 1964 research, this study was peer-reviewed and published in 1992 in the American Journal of Public Health and is an example of the health impact of stress in the community.

Stress Within Hospitals

Besides the community impact of stress, it’s also an issue in hospitals — and is a barrier to healing. I know from personal experience.

Between January and November of 2017, I had six surgeries so I spent a lot of time in the hospital. Nothing life threatening and I’m fine now (parts of my insides migrated to where they shouldn’t be and they had to be put back).

I wouldn’t want to go through this again but, as a partner in a conflict management training company (http://www.vistelar.com), I found my hospital stays of various lengths (as long as eight days) to be valuable research opportunities.

Besides the physiological stress of illness and treatment that’s obviously present in all hospital patients, there are also high levels of emotional stress that gets less attention. Where does that stress come from? — primarily conflict.

Conflict is the source of almost all emotional stress— which arises from disagreements, indignity, fear, and vulnerability, which are so prevalent in a hospital.

The training company I work for “addresses the entire spectrum of human conflict at the point of impact,” and I’m one of the partners who is constantly looking for approaches to better manage conflict and reduce stress. Therefore, being in the hospital was, for me, like being in my own private research lab.

The core concept we teach at Vistelar is that, if your goal is to reduce conflict, you should “treat people with dignity by showing them respect” and then we share our five approaches to showing respect.

Ask and Explain Why

One of those five approaches is to “ask and explain why” and, through my many days in the hospital, I learned this approach has an opportunity for great application in hospitals.

Let me explain.

First, here is the explanation of this approach to showing respect from Vistelar’s training manual.

“Every time you would like someone to do something, make a conscious effort to ask him or her to do it rather than tell them. Show people respect by asking a question rather than barking a command. Asking is for human beings, telling is for dogs (sit, roll over, bark).

Then, once you have asked, make the assumption that people can be easily confused. Presume the individuals with whom you interact may not understand what is going on or have any idea what will happen next. Take the time to provide an explanation for why things are done as they are.

Realize that, if you don’t explain why, the other person will likely fill in the blanks with their own reasons which could be incorrect and will probably be negative.”

Ask

Like we do in our training, let’s cover this in two parts — first “ask” and then “explain why.”

When I was in the hospital it was so much better to be “asked” to do something rather than being “told:”

“Can you have a seat while you wait?” versus “Take a seat.”

“Are you able to get on the scale?” versus “Get on the scale.”

“Can you please come with me?” versus “Come with me.”

“Are you able to get up and go for a walk?” versus “Let’s go for a walk.”

At Vistelar, we primarily train “conflict professionals” — individuals who directly interact with the general public or an organization’s clients — and, of all the tactics we teach, this “ask versus tell” tactic is probably the simplest. But, its simplicity doesn’t degrade from its effectiveness in better managing conflict.

Conflict management training is often described as “de-escalation” training — how to take a situation involving conflict and calm it down. In our training, we focus on “non-escalation” — how to prevent conflict from developing in the first place.

The goal of “ask versus tell” is non-escalation. In a hospital, people are already stressed due to a wide range of physiological or emotional factors, so the tiniest little thing can set people off. There were certainly times during my six hospital stays when I felt quite fragile and it was so calming when people asked me to do something rather than telling me to do it.

Telling causes stress and stress impedes healing. The “ask” tactic reduces stress and, as a result, can be a significant contributor to healing. That was certainly my experience.

Explain Why

So, let’s look at “explain why”.

When I was in the hospital I literally experienced thousands of situations where “explain why” could have been used but wasn’t. For example, here are some explanations a healthcare worker could provide.

“When you are in the hospital, you will be repeatedly asked to tell us your name and date of birth. You might find this a bit annoying, but the reason we do this is ….”

“We are going to take you down for an x-ray now. The reason we are doing this test is …”

“I just wanted to let you know that visiting hours will be ending in about 30 minutes. The reason we don’t allow guests to stay after 8:00 PM is because …”

“We will be taking your vital signs now. The reason we do this every six hours is because …”

As we state in our conflict management training manual, you should “make the assumption that people can be easily confused. Presume the individuals with whom you interact may not understand what is going on or have any idea what will happen next. Take the time to provide an explanation for why things are done as they are.”

I can confidently say that hospitals are confusing places for everyone. I have a degree in pharmacy, practiced hospital pharmacy for many years, and worked as a senior executive in the pharmaceutical and medical device industry for decades — and I was confused.

Why are you doing this?

What is going to happen next?

Why am I taking all of these medicines?

What are all of these tests for?

Why hasn’t the doctor been in to see me?

Why am I so dizzy?

Why can’t I have salt on my food?

I could go on and on and on.

Again, at Vistelar, we categorize the “explain why” tactic as a non-escalation tactic — to prevent conflict from happening rather than to de-escalate conflict that’s already occurred.

When you don’t explain why people come up with their own reasons and those reasons are often wrong and almost always create a lot of stress. Relative to the examples above, here is how a patient might respond:

“You must think I have a mental disorder because you’re always asking me to repeat my name and date of birth.”

“They must have found something pretty bad or they wouldn’t be doing this x-ray.”

“They must not like my family or they’d let them stay.”

“They must be pretty worried about me to wake me up just to take my temperature.”

As with “telling” (instead of “asking”), I believe that “not explaining” is a barrier to healing. In contrast, “explaining why” is a show of respect and, when done consistently, can prevent a great deal of the angst and frustration of a hospital stay.

Again, that was certainly my experience during my six hospital stays during 2017.

A Simple Application Of “Explain Why”

In fact, I believe that one simple application of “explain why,” if used consistently in every hospital in the United States, would have a measurable effect on healing.

Every night over 600,000 patients are woken up at “o-dark-thirty” for a blood draw. The door swings open, the bright lights are turned on, and a well-meaning phlebotomist asks each of these patients for their name and date of birth and then sticks a needle in their arm.

Over the last several years, I’ve asked a lot of prior hospital patients why they think this happens and I’ve never received an explanation that was correct. Instead, I’ve heard such things as “I have no idea” (most common), “They just want to be mean,” “Phlebotomists only work in the early morning,” and other crazy reasons.

What would be the impact if every night nurse in the United States was trained to give a brief description as to what to expect the next morning relative to the daily blood draw and a correct explanation as to why this needs to happen (“The reason we do this so early is so we can get the results back before your doctor comes to see you later in the morning. That way he can decide on what to do next and keep any delays in your treatment from happening.”)

I’ve spent a lot of nights in the hospital and no one has ever given me this explanation. I know the reason from my hospital pharmacy days, but in my experience, almost no-one else understands why the hospital needs to “be so mean.”

So, what happens? — some portion of these 600,000+ people get upset but don’t say anything, others act out their anger by verbally abusing the phlebotomist, others give a lower rating on the patient satisfaction survey due to this practice and I’m guessing some actually file a complaint.

I don’t know if this is true, but I would bet that every night in America there are phlebotomists who are either emotionally or physically hurt by the behavior of a patient. And, if that’s true, I wonder the impact that has on phlebotomist turnover.

What would be the impact of every night nurse in the United States using this simple “explain why” tactic with every patient? Personally, I think the accumulated effect — when used night after night, every day of the year, and with every patient — would be significant.

————-

Well, there you have it — a simple and free tactic to improve healing by reducing the stress of a hospital stay and to increase patient satisfaction scores.

As Hans Selye said, every patient in a hospital “looks sick,” they are all experiencing stress — both emotionally and physiologically. Given my experience during 2017 and Vistelar’s experience over the last three decades, I’d encourage you to try this tactic to reduce stress levels by preventing conflict (non-escalation). As we learned from the research in Roseto, Pennsylvania, reducing stress can have a significant impact on health and wellbeing.

At Vistelar, we’ve been working on conflict management tactics for smoothing interactions between contact professionals (e.g., in law enforcement, healthcare, education) and individuals who are experiencing mental illness, under of influence of drugs and/or alcohol, or are having a personal crisis in their lives.

People experiencing homelessness often have some or all of these attributes. In this article, we will examine the impact of homelessness, which has become a national issue, from a moral, safety and financial perspective.

First, homelessness is a moral issue in that there is a question if it is right or wrong to allow people to not have a home in today’s society. If we believe it is wrong, then we should be careful with the term we use to describe these individuals who are less fortunate than us. Are they “homeless?” — which is a dehumanizing term. Or, because their condition is hopefully temporary, should we refer to them as “persons experiencing homelessness?”

Second, homelessness is safety issue, especially for contact personals — such as police officers, correctional officers, security officers, fire and EMS personnel, medical & treatment personnel, and social services personnel — who have to interact with these individuals on the street, in private & public buildings, and within various institutional settings. Because these individuals might have some or all of the attributes listed in the first paragraph above, they should be approached with caution — but also with respect.

Pablo Velazquez, a member of the Genesis Group and a Vistelar conflict-management trainer, does a great job of explaining how to safely and effectively approach anyone (an essential conflict management skill), especially a “person experiencing homelessness”, in the video below.

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We need to keep in mind that people develop a feeling of ownership of any location in which they’ve taken up residence — whether that be a box under a bridge, hallway, shelter behind a dumpster, public stairwell, seat on a bus, hospital room, or jail cell. Just like you would do in entering anyone’s “residence,” announcing yourself and treating the person with respect will help to maintain everyone’s safety. Keep your distance, announce your approach, and seek permission to enter this person’s “living room.” It is more respectful, safer, and is likely to end up better for all parties involved.

Third, homelessness is a financial issue because of the short and long-term cost of not dealing with this national epidemic. The Radio Health Journal did a great podcast describing the healthcare costs of not finding housing for the individuals experiencing homelessness, which you should definitely listen to. Here is just one sad statistic from this program — the average lifespan of “persons experiencing homeless” is the late 40’s.

https://radiohealthjournal.wordpress.com/2018/03/25/18-12-segment-1-hospitals-and-housing/

Just the cost of emergency room care could be but dramatically by reducing the homelessness problem. In addition, think about the amount of conflict-management time and money that’s spent by our EMS services, social services, and police on repeat calls for the same “persons experiencing homelessness.” Added to this is of the cost of mental-health treatment and incarceration, which is often a revolving door cycle without resolution.

Homelessness must be addressed for moral, safety, and financial reasons. As contact professionals, are we willing to support these changes? Please share your comment below.

Years ago, I provided my initial training at the Milwaukee County Behavior Health Division. There I met Delores Linear-Wilson, a registered nurse, who shared a concept that called “One Voice” that I have shared ever since.  See the infographic posted above.

I have taken this mental health concept and shared it with 100’s of trainers over the years sharing it with police, corrections, military, and security trainers.  Gerard O’Dea, our Verbal Defense & Influence representative in Great Britain, shares it with his teachers and social services professionals for use in the classroom.  See the video posted below.   Let us know what you think of this tactic or have used it in the past in the comments section.

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Last week I spent 3 days at the Orthopedic Hospital of Wisconsin getting my left hip replacement replaced.  My hip had started squeaking a week prior to my operation.  Yes, squeaking that could be easily be heard by people near me.  The doctor told me that my hip was highly worn, had started squeaking, and needed to be replaced.  My hip that was first replaced 8 year ago had worn out.  I wonder how that happened.  Go tell.  I have to say that my operation was completely successful and my stay at the hospital was most enjoyable.  I would like to present a “shout out” the hospital’s staff for a job well done.   I loved the daily staff board pictured below that told you who would be your staff on this shift.  This helped the patient and staff to bond together by personalizing their contact.  Staff also introduced themselves from the doctors to the housekeeping staff.  This introduction answered several important questions for the patient that includes who are you, who do you represent, why are you here, and a relevant question.   This introduction help to set up pleasant and productive interactions.

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I would like to thank all of the hospital staff from the clerical staff that checked me in, to the doctors, nurses, and med techs who treated me, to the food service and housekeeping staff who took care of me.   I would like to present all of them a TREAT PEOPLE RIGHT Card that is pictured below.

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They certainly know how to treat their patients with dignity and show them respect utilizing the Five Maxims that are also posted below.

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One of the components of the Five Maxims that they performed best was the second component that states the you should explain why you are asking someone to do something.   Setting Context helps the person understand why they need to go with the program.  This was done verbally in their interactions with me and in signage like the sign posted below: QUIET PLEASE – Healing Zone.  Instead of tell the person to BE QUIET because I say so, the sign explains the reason why.  QUIET PLEASE – This is a healing zone where your loved ones and other people loved ones are healing and need quiet atmosphere to do so.  This sign gives a visual aid to keep the noise down that can be used to emphasize and explain why.  This is a powerful tool of explanation and persuasion.

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Again thanks to John, Jessica, Kamila, Susie, Chris, Katie, Betty, Jennifer, Beth, Dave, Glenda. Stephanie, Joan, Jamie, Caleb, and any other staff members that I have missed for making my stay so positive, supportive, and successful.

You truly know how to treat people right.

 

Hello,

This is Gary Klugiewicz.

I am the director of training for Verbal Defense & Influence that I recently had an phone conversation with Doug Lynch, one of our Vistelar Trainers.  He asked an an important question about the difference types of instructors that I wanted to share with you.

His question to people who provide instruction to others was What type of Instructor are you?

I asked him to provide his thoughts on this question that I posted below:

When I first started as an instructor, I proudly called myself a trainer. I was in front of people and telling stories, showing PowerPoints, getting a few laughs and told to come back again. I thought I could train. But, my students were failing to do what I needed them to do once they left the class. Was it me? Was it them? Was it both? Thus, started my journey.

I sought out mentors and coaches and was lucky enough to meet and learn from some of the best in the business; Gary Klugiewicz, Bob Lindsey, Peter Jaskulski, Dave and Betsy Smith, Jack Hoban, and about a dozen more. I am thankful for their patience and transfer of knowledge. It became apparent I was a Presenter, not a trainer. There was much more that needed to be accomplished in a classroom than just getting people to agree with what I was instructing.

Below is a small bit of that information to help  instructors better understand what they are doing, what they are capable of and what they need to be able to perform to master a style/level. It helps us to explain to non-instructors what to look for and what to expect from different styles/levels. In most cases, these are levels, not styles. Instructors progress through them from 1 to 4 over a career/lifetime. But, there are always exceptions.

1. Presenter / Presentation: Passive, lays out information for students. Minimal, if any, checks for understanding, learning and performance are done. To become a Presenter, one becomes proficient at public speaking and holding the audiences interest.
2. Teacher / Teach: Passive, guides students through information, confirms cognitive knowledge.
3. Trainer / Train: Active, students learn how to perform tasks, ability to perform under stress confirmed.
4. Coach / Coaching: Efficient, mastery of the levels below them. Able to TRAIN people to be competent at any of the first three levels.

His categories illustrate an increase in both competency and effectiveness that I find thought-provoking.   Do we want our instruction to merely provide information or do we want it to provide skills and changes in long-term behavior?  As with most things, the answer depends on who you are instructing, your purpose, and the length of time you have to do it.

Please post your comments below.

Dave Young here.

Inmates are the masters at developing and using improvised weapons. Every year corrections officers seize hundreds of improvised weapons confiscated inside their facilities. Everything from a file down comb to sharpen toothbrush to melted down plastic ware.  There is no limit is their imagination.

Your safety depends on your understanding what to look for; how do identifying threat indicators during contact; managing distance to control position; knowing what your escape routes are; and understanding when it is time to disengage.

The class then provided realistic “hands on” and “weapons on” responses to an edged weapon assaults.

In addition, on the front-end, the class covered how to de-escalate the situation and the back-end how to follow through after the incident to keep everyone safe both physically and legally.

Watch the video link below to see the class in action.

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I want to thank all the trainers in the state of West Virginia to include the West Virginia regional jails instructors on a great job, energy and effort this week!  See everybody again soon!

 

Dave Young, Kati Tillema, and I just finished a great class at the Las Vegas Metro Police Department.   Vistelar has just updated it material with a major upgrade to it curriculum and courseware.  New manual, workbooks and PowerPoints were added. Check out the class photo.

Dave Young made several additional to the material with tactical nuggets that better explain what we do and how we do it.   One of these nuggets explained that the power of the Universal Greeting in that it establishes contact, builds rapport, and gathering information from people who are usually extremely difficult to find common ground.  People remember the beginning and end of conflict situations.  Use the Universal Greeting to make a positive, memorial initial contact.

Take a look at this video where Tom Wiehe from the University of Cincinnati Police Department empowers a person with significant mental health issues to control his her behavior at the point of impact.  Watch this video that emphasizes the importance of using EMPATHY as a tool of Active Intelligence Gathering to quickly get information necessary to keep everyone safe – now and later.  Tom’s thoughtful initial contact made the difference between a positive successful encounter and another viral video on YouTube showing another questionable interaction.

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Please post your comments below.