“A Happy Patient = A Healthy Patient = Great Outcomes”

A Clinic Manager’s Philosophy and Strategies on Adherence 

Each month, ESRD Network 12 receives several calls about patients who are not coming in for treatment and/or staying their full treatment. Based on one of these discussions, the Patient Services Team asked a clinic manager to share about her philosophy and strategies she has used to improve patient attendance and adherence to their treatment plans. Thank you Mindy Monning, RN from DCI-Boonville for sharing your patient centered approach and insight into this challenging situation that clinic teams face.

Our number one approach is to listen to each patient. To do this it is important to completely clear your mind of any preconceived ideas and let the patient tell you what is going on. Once you truly listen to what your patient is telling you then you can begin to reach into your data base of knowledge and apply it to each person. I often repeat what the patient is telling me as it often makes them pause and think about what they said. For example…Patient says, “I feel great so I don’t think I need to be here”. I would respond, “I understand what you are telling me. You think that there is no need for dialysis”. Then lead into an open ended conversation by saying. “I really want to be there for you and help you with whatever you need me to. I don’t want to guess so I need you to help me to understand what happens when you miss dialysis and how I can make that better”. It is amazing when they begin to talk about the symptoms of missing dialysis that a light bulb comes on for them. I let them talk and then will follow up with, “so you are telling me that you do have side effects to missing dialysis. Do you see a solution for avoiding these side effects?” We know that the best way to learn is by teaching. So why not reverse that concept with the patients? Let them teach you to what they need and they will often stumble upon their own answers.

Secondly, I also make certain that the patient is clearly told that dialysis is 100% their decision and although I would love to see them every day and enjoy their lives with them I also understand that they have lives to live. I always incorporate into this conversation that I want to help them meet their goal for dialysis and living. I find allowing the patient to dictate the course of their treatment will result in positive outcomes. Some patients may have to stumble just a little but I am always there for them. I never stress out about how their decision affects my outcomes. Those are just numbers. Yes they are great to trend but my number one goal is make each and every one of my patients as happy as I can with their situation. Interestingly enough the numbers tend to shape themselves in a positive direction. A happy patient equals a healthy patient equals great outcomes.

Next, as a clinic we always talk as a group to what we have discussed and what each person could do to follow up on this. I have taken many courses in conversation and listening and help to guide my staff to doing the same. I have a strong charge nurse who also excels in communication and the combine effort of her and I make a huge difference. Every nut can be cracked you just have to figure out how.

Finally, before I finish I think it is important to stress to everyone that you don’t know it all. The moment you start to think you do know it all and become unwilling to learn is the moment you begin to fail. I have been nursing over 22 years and discover new things every day. No one is truly an expert just a little smarter. Don’t think your better than anyone else because we are all the same just molded a little different.


Mindy Monnig, RN

Nurse Manager

Boonville- DCI