Module 5: The Problem Solving Process - Resolution
Overview
The purpose of this module is to discuss:
The ombudsman role in resolving problems.
How to use the information gained during the ombudsman investigation to plan resolution strategies.
The primary ombudsman approaches in resolving problems.
The ombudsman responsibilities for follow-up after a resolution strategy has been attempted.
This module is a sequel to “The Problem-Solving Process Investigation” module. It covers Stages 2 and 3 of the problem-solving process. The information gathered during intake and investigation is analyzed and used to plan a resolution strategy. The long-term care ombudsman (LTCO) then acts to resolve the problem. If these actions are skipped, the ombudsman risks being ineffective in resolution.
The Problem Solving Process
Learning Objectives: At the conclusion of this module, individuals will know basic information about:
The ombudsman role in resolving problems;
How to use the information gained through investigation to plan resolution strategies;
The primary ombudsman approaches in resolving problems; and
Ombudsman responsibilities with follow-up after a resolution agreement.
Duration: 2 hours
If you are having trouble viewing the module, click here for some technical tips.
SECTION 1: Analysis and Planning
Once a complaint has been investigated, as a LTCO you are ready to analyze the information you have gathered to determine the reason the problem occurred. The example of Mrs. Bronner’s missing purse in the Investigation Module illustrated the importance of identifying the underlying problem of knowing why the problem occurred. This analytical process will enable you to more effectively plan resolution strategies by defining potential solutions and identifying obstacles that may be encountered.
Analysis and Planning is Stage 2 of the problem-solving process for LTCO. There are three steps in this stage of problem solving:
1. Analyze the situation
2. Identify potential solutions.
3. Identify potential obstacles.
Click here to read more about these steps.
SECTION 2: Resolution
From the information gained in Stages 1 and 2 (see Table 1: The Problem Solving Process), you should be ready to choose an approach to resolve the complaint, act, and evaluate the outcome. Remember the potential obstacles identified in Stage 2, and be flexible enough to use a different approach if your initial choice does not achieve the expected results.
Resolution simply means coming up with a solution. Sometimes you will develop a solution to try to “sell” to the respective parties; at other times, you may have to bring people together and help them work out the solutions that are meaningful. The important point is that the solution has to “fix” the problem. For example, helping a resident search for lost clothing may be a nice thing to do, but it does not provide a lasting solution to a problem of mishandling of laundry or personal possessions. On another case, you might have a charge nurse who agrees to let a resident stay up late tonight which is the resident’s usual routine. To achieve a lasting solution, the resident’s care plan might need to be revised or a note made on the resident’s records about her preference for a later bed time. All night staff who work with this resident need to be notified about this change. Without these additional steps, a later bed time might be only a one night accomplishment; then you will have to deal with the same problem a second time.
It is important to recognize when a solution to a problem or an agreement has been reached. Some people become so involved in investigation or negotiation that they fail to realize that they have won their point or solved the problem. On the other hand, you should also recognize when a satisfactory solution has not been reached, and the problem continues to reoccur. When a satisfactory agreement has not been reached, it is time to discuss the problem with your LTCO supervisor or with the State Long-Term Care Ombudsman (SLTCO).
VIDEO: Problem Solving Through to Resolution
Follow Mary's problem solving through to resolution in the video clip below.
While you watch the situation unfold, be thinking about the following questions:
How does Mary prepare the residents for the meeting?
What role did Mary assume during the meeting? What techniques or skills did she use?
How did Mary respond when Ms. Flores became defensive?
Who controlled the meeting and the agenda? How?
How does the residents' behavior change during the meeting?
What does the meeting accomplish?
Who decides what solutions are acceptable?
What should Mary and the residents do if Ms. Flores had refused to make any changes?
SECTION 3: The Three Steps of Resolution
Stage 3 of the problem-solving process, Resolution, involves the following three major steps:
1. Choose and approach for resolution.
2. Act to resolve the complaint.
3. Evaluate the outcome.
The remainder of this section will walk you through these three steps.
1. Choose an Approach
Complaints may be resolved in many ways. Most are resolved at the facility level by simply bringing the problem to the attention of the staff or administrator in a polite manner. The obvious exception is when the resolution of a problem is beyond the facility’s control, such as Medicaid’s denial of a resident’s application for a customized wheelchair. The Medicaid agency has to be involved in the resolution of this problem. However, there are other, more adversarial approaches that may be required when the complaint cannot be resolved at the facility level. These are discussed later in this section. To begin with, LTCO focus on the collaborative methods used for solving the complaint within the facility.
Click here to learn more about strategies for resolving the problem in the facility.
VIDEO: Negotiating with an Administrator
Watch an ombudsmen begin a negotiation with an administrator.
While you watch the negotiation, be thinking about the following questions:
What was accomplished?
What was the administrator’s attitude? What gave you that opinion?
How did the LTCO respond, verbal and nonverbal?
What might have happened if the LTCO had begun the meeting by listing the applicable standards or handed a list of these to the administrator?
How did the ombudsman’s response affect the administrator?
Ombudsmen Need to Know!
Check with the Resident
To recap, you have investigated and verified the complaint, identified the underlying problem, identified potential solutions, obstacles and appropriate resolution strategies. Before you act to resolve the complaint, check back with the resident!
The reasons for this pause in your resolution work are to:
Share with the resident what you've learned.
Be sure the resident wants to resolve the problem.
Verify the outcome the resident is seeking.
Discuss ideas regarding how to resolve the problem (your ideas as well as any ideas the resident has).
Encourage the resident to participate in the resolution process.
Discuss potential ramifications to the resident, if any.
Discuss potential outcomes to what might be gained, checking for any flexibility in terms of what will be satisfactory to the resident.
If you by-pass this step, you risk solving the "wrong" problem, proceeding when the resident wants to withdraw the complaint, and taking control and decision-making away from the resident.
2. Act to Resolve the Complaint
Once you have chosen an approach and checked with the resident, you act to resolve the complaint. You implement your plan, keeping other options in mind if your initial strategy does not achieve the desired results. There are numerous skills that will be helpful in the actual resolution process. Most of these were discussed in previous sections of this module. Two more skills are presented here: earning trust and dealing with authority figures. Remember, a LTCO always seeks to be “fair, firm, and friendly”.
Confronting Authority Figures and Building Trust
This section will walk you through strategies for confronting individuals in positions of authority and building trust with residents, staff and administrators.
Click here to read more.
Video: Addressing the Facility Administrator
Watch the skills Mary uses when addressing the facility administrator in the clip below.
While you watch the negotiation, be thinking about the following questions:
What did Mary want from the administrator, Mr. Delgado?
What were the administrator’s concerns?
Why is it important to understand the perspective of the other person in a confrontational situation?
Why did Mary take action to move the conversation to Mr. Delgado’s office?
What behaviors or skills did Mary use?
If Mr. Delgado refused to meet with Mary, what is the next step in resolving the issues?
How Mary concludes this interview.
PEP Method: Point, Evidence, Repeat Point
A proven way to reach resolution that works in many types of situations is the Point, Evidence, repeat Point (PEP) method. This method uses the communication skills and problem-solving approaches that have been discussed throughout these curriculum modules. PEP is focused, direct, respectful of the other person and allows you to be the residents' advocate.
Click here to read more.
Video: PEP Method
This video shows a situation where an ombudsman stays focused and uses the P.E.P. method.
3. Evaluate the Outcome
Once you have implemented a solution to a problem, you must evaluate the outcome to see whether it was actually resolved. This requires checking back with the persons involved to see whether the problem has been resolved to their satisfaction. The purpose of follow-up is to verify that resolution of the complaint has occurred and evaluate your effectiveness.
Click here to read more.
Video: Follow-Up Visit
Remember when Mary conducted her initial interview with Mrs. Woods (Clip 1 of Module 4)? Watch the approaches Mary uses and their results as she makes a follow-up visit.
Ombudsmen Need to Know!
Resolution in Assisted Living and Board and Care Facilities
Although the problem solving skills and approaches that have been discussed are generic to LTCO work in all settings, some adaptations may be necessary when working in assisted living and board and care facilities. Such facilities have fewer regulations and different staff and resident dynamics than nursing facilities. An excellent resource to assist you in adapting the problem-solving process to these types of facilities is, “Translating Nursing Home Ombudsman Skills to Assisted Living: Something Old, Something New,” by Robyn Grant. You can get this resource from the National Long-Term Care Ombudsman Resource Center or download it from the Center’s website.
SECTION 4: Community Resources and Support Systems
You may frequently encounter problems that require services that you, as an ombudsman, cannot provide, or that require knowledge you do not have. You need to be aware of the state and local community resources and support systems that are available to meet residents' needs in these areas. A few such resources and systems are discussed in this section. Every state has additional resources that are not contained in this module. Consider this information as a beginning point in your list of resources.
Click here to learn more.
SECTION 5: What an Advocate Should Know
A good advocate must be knowledgeable about long-term care facilities, conditions and issues. There is no substitute for current factual information to support your advocacy efforts.
Click here to learn more.
SECTION 6: Working to Change the System: The Larger LTCO Role
Although the major day-to-day job of the LTCO is to resolve individual problems, it is important that you have some knowledge of the broader issues that affect facilities and the long-term care system in general.
Click here to learn more.
For more information on systemic advocacy, visit the NORC website.
Review Quiz
Click on your state or territory in the list below to take the Review Quiz.