In previous posts, I have presented an interview with one of our administrative clinicians outlining how he deals with disruptive behavior and the Principles of Partnership we have with Ministry Health Care clinicians. We also must deal with this issue at our hospitals, most of which have independent physicians. Regardless of the setting, we have to establish the baseline for acceptable behavior. One of our hospital medical staffs formed a Respect Committee that then interviewed a number of individuals. The interviews uncovered numerous examples of respectful behavior and a few examples showing disrespect. The Committee then produced a PowerPoint presentation that has served as a cornerstone establishing respectful behavior. The basic contents of the PowerPoint is listed below. Examples of respectful and disrespectful behavior has proven to be helpful on many occassions.
Ministry Health Care: Values Behavior
- Treating Others with such a sincere regard that each person feels important and worthwhile
- Recognizes others for their achievements and capabilities
- Provides honest, non-judgmental feedback to others
- Creates an environment where frustrations and concerns can be expressed without fear of repercussion
Ministry Medical Group Professional Practice Standards
- We believe each patient, customer and staff member is important. …. we strive to treat each person in a respectful nature that honors his or her importance and worth.
Cultural Assessment Questionnaire:
- Ministry-wide and local norms
- Physicians in this organization treat other staff members with respect
- Employees Treat Each Other with Respect
What Additional Data Did We Want to Gather?
- Are there recognizable characteristics of “Best Practices”?
- Are there characteristics of the opposite?
- What makes staff feel that they are respected?
- What makes staff feel that they are disrespected?
- Can we show improvement in staff perception of respect over time?
- Can we change behaviors to achieve this end?
Respect Committee Intentions
- This is NOT a disciplinary committee
- Emphasize the POSITIVE, the IMPROVEMENT
- To be EDUCATIONAL, not punitive
- To provide TOOLS for the Medical Staff and MMG Clinic Divisional Chairs to improve RESPECT
- To EDUCATE all employees regarding respect issues and holding ALL WHO WORK here to the same standards
- Try to learn something about SUCCESSFUL physician/nurse and physician/employee relationships that can benefit all.
- IT HAS DIRECT CONSEQUENCES AFFECTING PATIENT CARE
Intimidating and verbally abusing nurses and pharmacists may lead to patient harm: Institute for Safe Medication Practices (ISMP) Survey of Nurses and Pharmacists
- 7% involved in medication error where intimidation played a role
- 49% said history of intimidation altered the way they asked for clarification of medication orders
- 40% said at least once in past year a concern was overlooked in order to avoid confrontation
Types of Behavior :
- Condescending language 21%
- Impatience 19%
- Verbal Abuse 48%
- Threatening body language 43%
AMA News: Sept 2004
- Staff Less Tolerant of Rude Doctors
- Survey of Physician Executives :
- One physician can taint the culture of the unit
- 83% problems with physician behavior involve disrespect
- 50% problems only reported when doctor completely out of line and serious violation occurs
- 95% met with disruptive physician in last two years
- 40% said physicians who generate high amount of revenue are treated more leniently than doctors who bring in less revenue OUCH !
What We Did
- Focus groups were interviewed with representatives from Clinic and Hospital departments with high and low respect scores. Included nursing and clinical staff, administrative, and non-clinical employees.
- Individual Responses
- Highlight the most pressing and prevalent problems
- What are some examples of times you felt very respected by physicians? What specific behaviors caused you to feel this way?
- In general, is this behavior on the part of most or all physicians? Or is it more specific to a minority of them-but a minority who have a significant impact on others?
- What are some examples of times you felt you were not respected by a physician? What specific behaviors caused you to feel this way?
- In general, is this behavior on the part of most or all physicians? Or is it more specific to a minority of them-but a minority who have significant impact on others?
- What physician/employee situations have you heard of?
- How many times have you heard about situations versus times you actually experienced them?
- How frequently does this behavior occur?
Sample of Comments Regarding Positive Respect
- MAJORITY of physicians
- Has IMPROVED over couple years
- HOSPITALIST program has decreased call issue complaints and a change for the better, hospitalists working together
- LISTENING and taking suggestions.
- INCLUDING nurses as part of a team by discussing plan of care and asking for input
- ACKNOWLEDGE skill level, opinion and judgment
- RECOGNITION for good patient care
- THANKING YOU for asking questions, bringing patient concerns to the attention of the physician
- APOLOGIZING when a mistake has been made
- Basic MANNERS…thank you, acknowledgement in hallways even if just say “hi”, using pleasant voice, eye contact
- ASKING rather than telling
- Creating a learning environment
- There are no “dumb” questions, no belittlement
- Performance is improved by physicians who teach
- Errors are handled non-judgmentally
- Physicians act upon being called
- Compliments in front of others and patients
- Positive outweighs the negative
Sample of Comments Regarding Disrespect
- Minority, some departments
- Dismisses what you (staff) are doing
- Expecting problem to be immediately fixed
- Complaints about other departments/doctors
- Belittling in front of patients or peers
- Inappropriate comments about other physicians to patients
- Not dealing directly with the issue
- Yelling, hanging up phone
- Taking out frustration on wrong people
- Using sarcasm or intimidation
- Requests to move patients to other areas without discussing reason
- Unavailable, not answering page
- Personal things taking precedence of work related duties
- Being told not to call for certain reasons by on-call physicians and reprimand for calling
- Unapproachable, avoid connecting
- Being asked to lie/give excuses when physician is scheduled to be in two places at once
- Taking out anger on staff for being awoke or called while on call
- Criticizing staff for not being as prepared or skilled as another unit
- Poor communication of treatment plan
- Physician behavior differs between hospital and clinic
- Heard about disrespect more than experienced it