[B]Alert Issued on Dealing with Workplace Hostility[/B]
Disruptive or hostile behavior among health care professionals threatens patient satisfaction and safety, because when people feel too intimidated to speak up, errors can happen, warns a new Joint Commission Sentinel Event Alert.
Alert Issued on Dealing with Workplace Hostility
Mark Chassin, MD, MPP, MPH, announced new Joint Commission standards to address unacceptable behavior.
“We’re talking about a spectrum of different behaviors that encompasses passive-aggressive behaviors like refusing to answer questions or answer pages, condescending or demeaning attitudes, verbal abuse, all the way to physical threats that jeopardize safety,” said The Joint Commission’s president, Mark Chassin, M.D., MPP, MPH, during a press conference announcing the alert. “These behaviors are not just unpleasant when they occur in the workplace, they create an unsafe patient-care environment.”
The Joint Commission has found through its serious events database that caregivers’ failures to communicate underlie many adverse events, and that intimidating behaviors create barriers to good communication.
In similar findings, the Silence Kills: The Seven Crucial Conversations for Healthcare survey of more than 1,700 health care professionals found that 77 percent of nurses work with someone who is condescending, insulting or rude, and fewer than 10 percent of physicians, nurses and other clinical staff directly confront their colleagues about their concerns. One in five physicians said they have seen harm come to patients as a result. The survey was co-sponsored by the American Association of Critical-Care Nurses and VitalSmarts, a leadership training company.
“The most common strategy is to watch it, say nothing and complain to friends and family,” said Kerry Patterson, co-author of Crucial Confrontations: Tools for Resolving Broken Promises, Violated Expectations, and Bad Behavior and co-founder of VitalSmarts. “That doesn’t work. The problem escalates and it leads to bad morale.”
A better option for people in an unhealthy environment is to observe it, document it carefully, including expressions and behaviors, and report it to a person in authority, Patterson said.
Alert Issued on Dealing with Workplace Hostility
Author and consultant Kerry Patterson says that to break the silence surrounding workplace hostility, you need to stop and identify a more professional way of handling disruptive behaviors.
“The next level of incursion is to deal with it yourself in the moment,” Patterson said. VitalSmarts has developed a training course called Crucial Conversations to help people speak up.
Patterson offers as an example a verbally abusive and insulting physician. In a situation like this, he recommends talking to the offender in private.
“Don’t let yourself become angry,” Patterson advised. “You become angry when you tell yourself a story that says, they are a jerk who enjoys making me suffer.”
When the confronter becomes angry, the conversation goes down a bad path, he said. Patterson recommends trying to understand what might have contributed to the outburst, not accepting the behavior but not allowing oneself to let anger interfere.
“You start by describing the behavior. You quote the actual terms,” Patterson said. Then you explain the words were hurtful, unprofessional and damage the recipient’s credibility. “You explain the consequences, so they hopefully don’t do it again.”
Patterson suggests explaining the importance of a culture of openness and how bad behavior contributes to unsafe patient care.
“You do this until the other person comes around and says, ‘You are right. It’s inappropriate and I need to control that. I’ll be better in the future.’ You get a commitment from them,” Patterson said.
If that doesn’t happen, Patterson advises the person to inform the offending party that since they cannot reach an agreement, he or she will need to report the situation to human resources. “This is one way of bringing power into a fairly powerless circumstance,” said Patterson, adding that institutions need to stand behind people who do speak up and to sanction inappropriate behaviors.
Several hospitals have provided the Crucial Conversations training to their staffs. VitalSmarts reports MaineGeneral Health in Augusta has noted a 167 percent improvement in employees’ willingness to speak up when they see someone being disrespectful.
Likewise, Maimonides Medical Center in New York experienced a 54 percent improvement in how leaders handle disrespectful behavior and a 39 percent improvement in confronting violations of respect after 1,250 people at the hospital completed the training.
“We want everybody to have the same confidence and skill set,” Patterson said.
The Joint Commission has introduced new standards, which take effect January 1, 2009, requiring health care organizations to create a code of conduct that defines acceptable and unacceptable behaviors and to establish a formal process for managing unacceptable behavior.
“The new standards present a real opportunity to change a culture that has no place in health care today, to create an environment that has to be focused more than ever before on assuring safety and quality,” Chassin said.
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