“Me, too!”
It has become the battle cry for those harmed by harassment in the workplace. While the movement emerged primarily in response to sexual harassment, it should send a loud and clear signal to all companies that their employees will not tolerate the same level of inappropriate, unprofessional behavior that they have in the past.
Beyond sexual harassment, health care provider organizations have made clear in policy that unprofessional behaviors harm a safe, highly reliable work environment. But even with more structured policies, do harmful, inappropriate behaviors persist in practice? Both the “Me, too!” movement and the findings of a new study led by a Vanderbilt University professor suggest that smart organizations dedicated to safe care should re-double efforts to reduce inappropriate, harmful behaviors.
Who is hurt most by inappropriate, disruptive behavior?
Whether the behavior is exhibited by a physician, nurse or member of management, much of our focus in provider organizations has been on the destructive impact it has on the staff members who are in the direct line-of-fire. And indeed, the effect on teamwork, morale and the overall work environment is significant.
But a new study published in the venerable Journal of the American Medical Association (JAMA) shows a strong correlation between reported unprofessional conduct by colleagues and an increased risk of patient complications. In this study, among surgeons with the most reported complaints, the risk to patients of complications was 32% higher than it would have been if they had been under the care of a surgeon who had no complaints.
The results of this study, which was led by William Cooper, MD, the Cornelius Vanderbilt Professor of Pediatrics and director of the Center for Patient and Professional Advocacy at Vanderbilt University Medical Center, underline that for governing boards and leadership teams, not aggressively addressing unprofessional behaviors is akin to allowing practices that jeopardize safe care to be permitted in the organization.
Reliable statistics on the prevalence of unprofessional behaviors in provider organizations are tough to come by. While virtually all provider organizations have instituted formal policies prohibiting disruptive and inappropriate behaviors to comply with CMS and Joint Commission regulations, most health care leaders would likely agree that problems persist. Have we truly done enough to make unprofessional behaviors “never events” like other practices that impact patient safety? Following are several suggestions for taking our efforts to the next level.
Develop a united front for confronting disruptive behavior
Developing Medical Staff and hospital policies prohibiting disruptive, unprofessional behavior is the easy part. Confronting physicians and other care professionals who violate the policies can be exceedingly tough. While the chief medical officer or an appointed representative of the Medical Staff may ultimately be responsible, it is not fair – or often effective – to ask one individual to carry this burden alone.
Organizations sometimes send one individual to make the conversation less unpleasant for the accused. But should the comfort of the perpetrator even be a consideration? A united, group conversation carries the most weight and provides support for the individuals taking on this unenviable task. Candidates for the conversation should include members of the Medical Executive Committee, the chief medical officer, another senior executive (CEO, COO, general counsel or head of human resources, depending on the situation) and potentially a member of the governing board if the issue is serious enough and/or recurring. Keep in mind that these behaviors affect the quality of care, and ultimately, the Board of Directors carries that responsibility.
Provide clear, specific education at all levels of the organization
Remember last year when all Starbucks locations shut down one afternoon for company-wide education regarding diversity and racial sensitivity? Starbucks learned that it was not enough to simply post a corporate policy on diversity. Every employee had to understand what that looked like in practice every day. Health care organizations need to learn the same lesson.
In his interview with FierceHealthcare, Dr. Cooper emphasized that providing data regarding the impact of unprofessional behaviors helped physicians understand the importance of this issue. Data indeed is important, but in this area where the term “unprofessional” can be interpreted very differently, education that includes specific examples, case studies and clear expectations serves all members of the care team best.
Make it easier for team members to speak up
Most organizations emphasize that any care team member can speak up – in fact, has a responsibility to speak up – when they see an issue or practice that they deem unsafe. But when the issue is disruptive, unprofessional, harassing behavior, especially by a physician, asking a staff member to “just speak up” is akin to the failed “just say no” strategy of the 90s designed to reduce illegal drug use. It just isn’t that simple.
Because the fear of direct or indirect retribution is real (remember that perpetrators of unprofessional behavior are not our best organizational citizen to start with), staff members need safe ways and places to voice concerns. When managers in any way discourage staff members from openly sharing serious concerns, they become accessories to the unsafe care that this study shows can be an outcome of unprofessional behavior.
In theory, addressing unprofessional behaviors is straightforward. In reality, it is complicated and uncomfortable. Underlying these behaviors are hierarchical, gender, emotional, political, and power dynamics that discourage organizations from confronting a technically talented surgeon who generates millions in billings. But if Hollywood, the media and professional sports can put millions in revenue at risk, shouldn’t a problem that impacts quality and patient safety be a non-negotiable for health care, too?
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