Fisher and Shapiro's Core Emotional Concerns framework is a highly regarded approach, particularly in negotiation and conflict resolution. It identifies key emotional concerns that significantly influence people's behaviour in situations of conflict or stress. These concerns are:
Appreciation: Recognising and valuing what others think, feel, or do. Open disclosure involves actively acknowledging the patient’s and family's’ feelings and perspectives.
Affiliation: Treating others as colleagues rather than adversaries. Building a cooperative relationship with the patient and family, rather than a confrontational one, can help manage difficult conversations.
Autonomy: Respecting others’ freedom to decide. In OD, this means allowing patients and families to express their views and be involved in decision-making processes related to their care and resolving the issue at hand.
Status: Recognising and valuing the importance of others. This is crucial in healthcare settings where patients might feel vulnerable or disempowered. Respecting their status as key stakeholders in their health journey is important.
Role: Ensuring that one's role is fulfilling and adds value. In the context of OD, this involves the healthcare professionals understanding that the patient’s role in life may be compromised by the event, such as their role as a mother, daughter or carer. Also, the patient or family may have other roles, such as contributing to service feedback or development.
Using this framework in the context of Open Disclosure can help understand and address the emotional underpinnings of patients' and families' responses to medical errors or adverse events. It can guide healthcare professionals in crafting their interactions to address these core concerns, thus facilitating a more constructive and empathetic communication process.
Your understanding and appreciation of the Core Emotional Concerns framework can be particularly useful in managing situations where patients or families are angry or upset, as it provides a structured approach to identifying and addressing their underlying emotional needs.
💡 Example scenario: Tania experienced a wrong surgical procedure incident: a tubal ligation was performed instead of the intended tubal patency (fertility) check.
1. Verbal Statements for Appreciation:
"I want you to know that we understand how important starting a family is to you, and we deeply regret the impact this error has had on your journey."
"It's clear that you've been through a lot, and your feelings about what happened are completely valid and understandable."
"I appreciate your willingness to discuss this with us today. It’s critical that we hear your perspective and fully appreciate what this means for you."
"I can see how distressing this situation must be for you, especially given your long journey towards trying to conceive."
"Your strength in facing this situation is admirable, and we are here to support you through this process."
"I value the honesty you're bringing to this conversation. It helps us understand your experience better."
"Thank you for sharing how you're feeling. We need to know how this has affected you personally."
"Your insights into how this situation has impacted you are invaluable in helping us ensure we provide the care and support you need."
Non-Verbal Strategies for Appreciation:
Active Listening: Maintain eye contact, nod in understanding, and lean in slightly to show you are fully engaged and listening.
Open Body Language: Position your body to face Tania directly, with uncrossed arms and legs, to demonstrate openness and receptiveness.
Facial Expressions: Use empathetic facial expressions that mirror the patient's emotions, such as nodding with concern or showing understanding through facial cues.
Attentive Pauses: Allow for pauses after Tania speaks, indicating you are thoughtfully considering her words rather than rushing to respond.
These verbal and non-verbal strategies can help address the patient’s need for appreciation, show respect for her emotions and perspective, and foster a more empathetic and supportive environment during the open disclosure process.
2. Verbal Statements for Affiliation:
"We want to make this right and rebuild your trust. Our priority is to work with you to find the best way forward."
"Your input is crucial to us; we want to make decisions with you about your care."
"I'm here not just as a nurse/doctor but as someone who wants to support you through this situation."
"Let’s talk about how we can address this in a way that aligns with your values and needs."
"I want to understand your perspective fully so we can consider all possible options for your treatment."
"You're not alone in this; we are committed to providing you with ongoing support and care."
"We value the trust you place in us and want to maintain an open and honest line of communication with you."
"It’s important that we build this plan together; your insights and feelings are a vital part of this process."
Non-Verbal Strategies for Affiliation:
Mirroring: Subtly mirroring Tania’s body language (like leaning forward when she does) to create a sense of rapport.
Physical Proximity: Maintaining an appropriate physical distance to create a comfortable and personal space without being too distant or intrusive.
Gestures of Inclusion: Inclusive gestures like open hands or showing palms while discussing plans can signal collaboration and partnership.
Consistent Eye Contact: Maintaining consistent but non-intimidating eye contact to show engagement and presence in the conversation.
These strategies aim to build a collaborative relationship with the patient, making her feel like an active participant rather than a passive recipient in the disclosure and decision-making process. This can help establish trust and rapport, which are crucial in effectively navigating a challenging situation.
3. Verbal Statements for Autonomy:
"We want to ensure you have all the information you need to make decisions you feel comfortable with."
"It’s your choice to decide which treatment option feels right for you, and we will support whatever decision you make."
"Please let us know what more information you need or if there are other options you’d like us to explore."
"You’re in control; we’re here to provide information and recommendations and to respect your decisions."
"We understand that this is your body and your health, and you have the final say in how we proceed."
"We're here to guide you, but ultimately, the decision is yours, and we’ll support it."
"If at any point you feel uncomfortable or wish to change the course of action, please let us know."
"Your views and preferences are central to our planning. Please be open about what you need from us."
Non-Verbal Strategies for Autonomy:
Nodding in Agreement: When Tania expresses her preferences or concerns, nodding shows that you are acknowledging her autonomy.
Providing Space: Physically stepping back slightly or giving her room to gesture and express herself, indicating that she has the ‘floor’.
Open and Inviting Gestures: Use hand gestures that invite her to speak or express her opinion, such as an open palm or a gentle forward motion.
Note-Taking: Writing down her preferences or concerns as she speaks, indicating that her input is valued and considered.
These strategies focus on empowering Tania in the decision-making process, ensuring she feels her autonomy is respected and that she is an active participant in her care, especially important in the context of the error and its impact on her life.
4. Verbal Statements for Status:
"Your experience and what you’ve been through are extremely important to us and to improving our care."
"We recognise the significant impact this error has had on your life, and we take your concerns very seriously."
"You bring a unique and valuable perspective to this situation, and we want to learn from your experience."
"Your feedback is crucial in helping us improve our processes and prevent such errors in the future."
"We respect your resilience and your strength in dealing with this challenging situation."
"It's important for us to understand your viewpoint, as it will help us provide better care to you and others."
"Thank you. Your input has been key in resolving this situation and helping us to reduce the chance it happens again."
"Your role in this process is vital. Your insights will help shape how we approach similar situations in the future."
Non-Verbal Strategies for Status:
Respectful Gestures: Use respectful gestures, like a slight nod or placing a hand over the chest, to convey respect when Tania speaks.
Maintaining Eye Contact: Consistent eye contact that is respectful and not overbearing, showing that you are fully engaged and valuing her words.
Levelled Seating: Ensure that seating arrangements are such that Tania is at the same level as the healthcare professionals, physically reinforcing her equal status in the conversation.
Expressive Acknowledgment: Show expressions of understanding and respect, such as nodding or leaning forward, when Tania shares her thoughts or experiences.
These strategies aim to reinforce Tania's sense of importance and value in the open disclosure process. By recognising her status, the healthcare team can foster a more respectful and productive dialogue, contributing positively to resolving the situation.
5. Verbal Statements for Role:
"Your role in helping us understand and learn from this incident is crucial. We value your input highly."
"As someone directly affected by this, your perspective is key in shaping how we handle such situations in the future."
"You have a unique role in helping us improve our care and services. Your experience and feedback are integral to this process."
"Your involvement in this process is vital, and we are committed to listening and responding to your needs and suggestions."
"We want to prioritise your needs today. What are the most important issues you’d like to ensure are discussed?"
"Part of our commitment to you is ensuring that you feel your role in this process is respected and valued."
"It's important for us to work together, recognising your role as central in our decision-making and future planning."
Non-Verbal Strategies for Role:
Equal Seating Arrangement: Arrange the seating so that Tania is at the same level as the healthcare professionals, symbolising her equal role in the discussion.
Inclusive Gestures: Use gestures that indicate inclusion, like opening arms when referring to 'us' or 'we,' to visually reinforce her role as a part of the team.
Passing Documents or Materials: Physically handing her any relevant documents or materials, signifying her active role in reviewing and understanding the information.
Engaged Body Language: Maintain an open and engaged body posture, such as leaning slightly forward, to show active involvement in her contributions.
Using these verbal and non-verbal strategies, the healthcare team can emphasise Tania's important role in the open disclosure process, empowering her and ensuring her voice is heard and valued. This approach can help to build trust and collaboration, essential elements in effectively managing the situation.
A further article about the approach from Harvard Health is linked here.