enhancing a culture of quality, safety & respect: addressing disruptive behavior preparation...
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Enhancing a Culture of Quality, Safety & Respect: Addressing Disruptive Behavior
Preparation Notes—long versionPlease review note pages before presenting materials
Enhancing a Culture of Safety: Addressing Disruptive Behavior
Presentation to:Add Your Unit/Department Name
Agenda Disruptive Behavior defined
Impact of Disruptive Behavior on workplace quality and safety
Causes of Disruptive Behavior
Content of revised UMHS Policy 04-06-047— Disruptive or Inappropriate Behaviors by UMHS Personnel
Importance to Our Work Team
Q &A
ObjectivesAfter reviewing and discussing UMHS Policy 04-06-047 Disruptive or Inappropriate Behavior by a UMHS Employee or Faculty Member at the end of this session participants will:
Understand the potential negative impact of disruptive or inappropriate behavior on workplace quality and safety throughout the organization—in clinical and non-clinical areas
Be able to provide examples of appropriate and inappropriate behavior
Understand recommended guidelines for reacting in the moment to disruptive or inappropriate behavior
Use paper or on-line reporting tools to report inappropriate behavior
Disruptive Behavior defined
Any conduct that interferes with the effective
operation of UMHS or suggests a threat to UMHS
personnel or to patient care . That a person’s
behavior is unusual, unorthodox, or different is not
alone sufficient to classify it as “disruptive
behavior”.
Lateral Violence defined
Inappropriate behavior, confrontation or conflict
between coworkers that humiliates, degrades or
otherwise indicates a lack of respect for the dignity
and worth of an individual – often caused by
communication mishaps.
Disruptive Behavior Linked To
Medical errors & adverse outcomes Reduced staff performance, innovation Increased staff turnover Patient dissatisfaction Lack of information sharing Processing delays
Too Often, Often Unreported With Negative Consequences
Studies with similar findings across several Health Care organizations
> 90% have witnessed disruptive behavior by MDs
30% - knew nurses who left hospital as a result of disruptive behavior
> 70 % of nurses witnessed disruptive behavior among nurses
14% aware of actual adverse consequences
“serious problem within and across disciplines”
Voluntary Hospital Association 2002, 2005 studies (Rosenstein)
“But I Don’t Work In Clinical Area.”
Disruptive and Inappropriate behavior can negatively impact your work environment too.
The policy applies to all UMHS personnel
UMHS Survey Measures Respect
UMHS asks questions about respect inour workplace in our Employee Engagement survey.
Q29—We hold ourselves and others appropriately accountable if we fail to meet our commitments
Q30—We treat each other with mutual respect even when we have clear differences of opinion
We are making some improvementsand have opportunity for more What are our unit’s survey
results?
It Does Happen Here!Quotes on Inappropriate Behavior
“The doctors can be disrespectful to the nurses who can be disrespectful to techs who are disrespectful to housekeepers, etc.)
“There are no consequences for these behaviors so you become demoralized and they just continue.”
“Surgeons are very belittling—they call you names . . .”
“There is a director who screams at his supervisors all the time and no one does anything because they are afraid of him.”
“I would like to see people written up—people don’t take things seriously. Supervisors hate confronting people.”
From 2007 UMHS Employee Engagement Focus Groups
Causes of Disruptive Behavior
Individual factors high stakes high emotion personal problems fatigue substance abuse lack of interpersonal, coping or conflict-management skills lack of tolerance or understand of workplace diversity
Historical factors tolerance and indifference to
disruptive behavior
Systemic factors increased productivity demands cost containment requirements
changes in shifts rotations of
interdepartmental support staff
Leaders who fail to address unprofessional conduct through formal systems are indirectly promoting it.
We See ItBut We Don’t Speak Up
Because: That’s the way it’s always been. Who will listen? I don’t want to get in trouble. I can take it. We can overlook it because of the person’s
technical expertise, rank, etc.
UMHS Strategic Principles/Values
UMHS values include: RESPECT, TRUST, INTEGRITY
Our Strategic Principles include: Integration, Collaboration & Team Work Taking Care of Our Own Cultural Competency Integrity and Trust
UMHS Policy 04-06-047--Disruptive or Inappropriate Behavior by UMHS Personnel
States UMHS commitment to addressing disruptive/ inappropriate behavior by UMHS personnel
Expresses importance of collaboration, communication and collegiality to patient care, education, research & effective operation
Acknowledges that reporting can be intimidating, therefore provides support and process• Outlines who to report to• Allows for anonymous reporting
Identifies the procedure for reporting
Specifies outcomes, including potential consequence of formal corrective action
UMHS Policy 04-06-047--Disruptive or Inappropriate Behavior by UMHS Personnel
The policy also provides:
Definitions Examples of Appropriate and Inappropriate Conduct Policy Standards Procedures General Guidelines, including related policies Exhibits
A. guidelines for reaction in the momentB. reporting formC. reporting process flowchart
References used in creating the policy
Conduct
Appropriate Conduct Demonstrates clear,
direct, honest and respectful communication
Accepts and provides feedback in a constructive and civil manner
Appropriate Conduct Demonstrates clear,
direct, honest and respectful communication
Accepts and provides feedback in a constructive and civil manner
Inappropriate Conduct Threatening or abusive
language (e.g. belittling, berating, screaming . . .)
Derogatory comments (as opposed to constructive criticism) about the quality of care being provided by the Health System . . .
Inappropriate Conduct Threatening or abusive
language (e.g. belittling, berating, screaming . . .)
Derogatory comments (as opposed to constructive criticism) about the quality of care being provided by the Health System . . .
Excerpts from examples provided in UMHS Policy 04-06-047. See page 2 of policy
Exhibit A: Guidelines for Reacting in the Moment to Disruptive Behavior
1. Address the situation at the time it occurs
2. Redirect the focus onto the patient’s needs to depersonalize
3. Move the conflict away from patient areas—if needed closer to other staff
4. If you witness verbal abuse, signal to co-workers to act as a witness
5. If a violent act occurs (immediate assistance needed), contact a supervisor and dial 911
From Defusing Disruptive Behavior: A Workbook for Healthcare Leaders. Joint Commission on Accreditation of Healthcare Organizations Resources. 2007
Procedure Encourages reporting at department level
Strongly encourages individuals subjected to or witnessing disruptive behavior to report it
Requires the reporter’s supervisor to act:• Document • Resolve
May include involving the next administrative level and HR in the investigation/resolution
Reporting Options
Complete a Behavior Report Form or report verbally to the supervisor who will document the form • fax to Risk Management 734 763 5300 or on-line (in
development) Call the University Compliance Hotline
• at 866 990-0111 or • submit on-line to https://www.tnwinc.com/WebReport/
If a violent act occurs or immediate assistance is needed, contact a supervisor or dial 911
Behavior Report Form
Strongly Encouraged to Report!
1) Print Page in Policy (Exhibit B) & Fax to Risk Management
- or -
2) Online submissionPer
son r
epor
ting
Employee/S
taff Behavio
r
Anonymous
option
Behavior Form Follow Through
1) Risk Management forwards online reports to appropriate department
2) Per Disruptive Behavior policy, the reporter’s supervisor follows up:
a) Resolves with his/her own department b) Relays report to disruptive person’s supervisor
3) Per departmental policy, appropriate action is determined at the local level
4) Data tracked through the RiskPro system. Reports produced by: a) Individual b) Department c) Unit/Division (Faxed forms are inputted by Risk Management)
Joint Commission Standard LD.03.01.01 Sentinel Event Alert #40 issued July 2008The alert cites a national survey on intimidation that says 40 % of clinicians have kept quiet or remained passive during incidents. “Most” have witnessed disruptive behavior.
JC Standard LD .03.01.01Leaders create and maintain a culture of safetyand quality throughout the [organization].
UMHS Policy 04-06-047— Disruptive or Inappropriate Behaviors by UMHS Personnel
Importance to Our Work Area
RESPECTRESPECT
Can I Avoid All Conflict? No. Conflict can not always be avoided. Conflict is a normal and can be a healthy part of
team interactions Conflict handled appropriately allows team
members to:• Share ideas• Voice concerns• Improve team relationships
Managing conflict in a respectful manner is key.
Key Considerations
We (our patients and our co-workers) are worth the investment• Intervention leads to insight which leads to changed
behavior.
The better the Patient Safety Culture, the better the Health System performance
Every health system employee has a role to play.
Leadership engagement and oversight critical. Report your concerns to me.
Questions??
Manager Resources The following slides are additional resources
for supervisor/manager for use in preparing for the presentation.
Resources (Place in Slide Show Mode and mouse over program name to view
resources for each area.)
HR EAP
SECURITYCOMPLIANCE
NURSING M HEALTHY
In addition to exploring resources in your own area, the following sources provide some or all of the following:
• Consultation•
Assessment• Intervention
• Training Programs• Referrals
Office of Clinical Affairs
Department Services, Books, VideosBooks & Articles Dutton, Jane. Energize Your Workplace: How To Create & Sustain high Quality Connections at Work.
San Francisco. Jossey-Bass. 2003. Farber, June. Smart Nursing: How to Create a Positive Work Environment that Empowers and Retains
Nurses . New York. Springer Series on Nursing Management and Leadership. 2005. Frederickson, Barbara. Positivity. Groundbreaking Research Reveals How to Embrace the Hidden
Strength of Positive Emotions, Overcome negativity and Thrive. New York. Crown. 2009. Tarkan, Laurie. “Arrogant, Abusive and Disruptive and a Doctor.” New York Times. December 2, 2008. Rosenstein, A.H., O’Daniel, M. “Managing Disruptive Physician Behavior: Impact on Staff Relationships
and Patient Care.” Neurology. 70. 2008. 1564-1570.
Videos—See Employee Resources-Audio/Visual Resource Inventory http://www.med.umich.edu/i/umhshr/avinventory.htm#Conflict
MANAGING CONFLICT VIDEOS Self-Discipline and Emotional Control:How to Stay Calm and Productive
Under Pressure, Volume 1 (Brief video description) Self-Discipline and Emotional Control:How to Stay Calm and Productive
Under Pressure, Volume 2 (Brief video description) Dealing With Conflict (Brief video description)19 Min Communicating Non-Defensively (Brief video description)20 Min Managing Stress (Brief video description)26 Min Dealing With Conflict and Confrontation, Volumes 1, 2, and 3 (Brief video description)
To aid in the clarity, examples of "appropriate" conduct, and "inappropriate or disruptive" conduct include, but are not limited to:
APPROPRIATE INAPPROPRIATE
Demonstrates clear, direct, honest and respectful communication •Responds to pages in a timely, civil manner •Responds to requests in a cooperative manner •Demonstrates respect for patients, their family members and staff •Clarifies points of agreement and seeks to partner to resolve points of disagreement in patient-care or other work-related matters •Accepts and provides feedback in a constructive and civil manner •Respects need for privacy •Handles problems or dilemmas in a cooperative, respectful manner •Chooses appropriate timing to bring up problems for discussion •Offers appreciation and affirmation to peers-coworkers when they function well •Accepts the inevitability of mistakes as a learning opportunity •Reliably demonstrates patient care in adherence to agreed-upon standards
Threatening or abusive language – regardless of medium – directed at patients, their guests, or UMHS personnel (e.g., belittling, berating, screaming and/or non-constructive criticism that intimidates, undermines confidence, or implies incompetence); •Threatening or abusive behavior (e.g. throwing items, slamming doors); •Degrading or demeaning comments or nonverbal communication regarding patients or their guests, UMHS personnel, or the Health System •Profanity or similarly offensive language while on Health System sites and/or while speaking with UMHS patients, their guests or personnel; •Physical contact with another individual that is or appears threatening or intimidating; •Derogatory comments (as opposed to constructive criticism) about the quality of care being provided by the Health System, a medical staff member, or any other individual outside of appropriate medical staff and/or administrative channels; •Medical record entries impugning the quality of care being provided by the Health System, medical staff members or any other individual; •Imposing unreasonable requirements on fellow UMHS personnel; •Refusal to abide by University of Michigan Policies, including UMHHC Medical Staff Bylaws, U-M Medical School Bylaws, Practices, Agreements and Policies (e.g. Hand Hygiene and Smoke-Free Environment).
From U-M Health System Policies and Procedures UMHS Policy 04-06-047, Disruptive or Inappropriate Behavior by UMHS Personnel Section IV. Examples of Conduct
Frequently Asked Questions Can I avoid all conflict? What if I am afraid to report because I fear
retaliation? What resources are available to me if I want more
skills in handling difficult situations—so that my behavior is not viewed as inappropriate?
My teammates always yell at each—that’s how we get our work done. That’s okay, right?
What if the person I want to report is my supervisor or another manager?
Can I report a single occurrence of inappropriate or disruptive behavior?
Scenario ActivityPurpose: To practice effective ways of responding to offensive language and
behavior in conjunction with Exhibit A of the policy.
Exhibit A :Guidelines for Reacting in the Moment to Disruptive Behavior
Address the situation at the time it occurs Redirect the focus onto the patient’s needs to depersonalize Move the conflict away from patent areas – if needed closer to other staff If you witness verbal abuse, signal to co-workers to act as a witness If a violent act occurs (immediate assistance needed), contact a supervisor
and dial 911
Activity: In small groups discuss and then formulate a response to one of the 7
scenarios provided by responding to the questions at the end of the scenario. Be prepared to share your response with the larger group.
Debrief
Scenarios follow
Scenarios for Group DiscussionEnhancing a Culture of Quality, Safety & Respect: Addressing Disruptive Behavior
Scenario I: Two Managers
Scenario II: Outpatient Clinic Manager and Patient Assistant
Scenario III: Faculty – Nurse – Technical Staff
Scenarios for Group DiscussionEnhancing a Culture of Quality, Safety & Respect: Addressing Disruptive Behavior ~ cont’d
Scenario IV: Office Administrator and Environmental Services Staff
Scenario V: Faculty – Nurse
Scenario VI: Manager (Jane) & Outpatient Assistant (John)
Scenarios for Group DiscussionEnhancing a Culture of Quality, Safety & Respect: Addressing Disruptive Behavior ~ cont’d
Scenario VII: Physician and Nurse
Scenario VIII: Two office workers
Scenario IX: Allied Health Professional – Faculty
Resources
HR EAP
SECURITYCOMPLIANCE
NURSING M HEALTHY
Nursing Health & Safety Committee
Educational Services for Nursing
Educational Plans for Management of Aggressive Behavior
734-615-9721
Click to return
Office of Clinical Affairs
Resources
HR EAP
SECURITYCOMPLIANCE
NURSING M HEALTHY
UMHS Human Resource Services
Human Resource ConsultantsHuman Resources Organizational
Effectiveness ConsultantsMediations Services – Fernando Caetano
734 647 5538
Click to return
Office of Clinical Affairs
Resources
HR EAP
SECURITYCOMPLIANCE
NURSING M HEALTHY
Compliance Office
Information: 734-615-4400
Compliance Questions or Concerns24 hour Compliance Hotline:
866-990-0111
Click to return
Office of Clinical Affairs
Resources
HR EAP
SECURITYCOMPLIANCE
NURSING M HEALTHY
Michigan Healthy Community Understanding U Website
Assistance in Managing the Ups / Downs of Life Featuring tools, strategies, tutorials and resources
http://hr.umich.edu/mhealthy/programs/mental_emotional/understandingu/
Click to return
Office of Clinical Affairs
Resources
HR EAP
SECURITYCOMPLIANCE
NURSING M HEALTHY
UMHS Employee Assistance Program
Supervisory, Staff and Team Consultations
763-5409
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Office of Clinical Affairs
Resources
HR EAP
SECURITYCOMPLIANCE
NURSING M HEALTHY
Health System Security Services
Full 24-hour coverage
Emergencies: 911
Non Emergencies: 936-7890
Click to return
Office of Clinical Affairs
Resources
HR EAP
SECURITYCOMPLIANCE
NURSING M HEALTHY
Heather Wurster – Policy Lead ,
Resource for Staff, and Medical School Point Person
Maureen Naszradi - Medical Staff Peer Review Coordinator 232 - 1687
Click to return
Office of Clinical Affairs