joseph p. myers, md, facp professor of internal medicine ... · ¡db results in patient...
TRANSCRIPT
JosephP.Myers,MD,FACPProfessorofInternalMedicine
NortheastOhioMedicalUniversity
¡ Medicalerrors¡ Adverseoutcomes¡ Reducedstaffperformance¡ Reducedstaffinnovation¡ Increasedstaffturnover¡ Patientdissatisfaction¡ Lackofinformationsharing¡ Processingdelays
Any abusive conduct, including sexual orotherformsofharassment,orotherformsofverbalornonverbalconductthatharmsor intimidates others to the extent thatquality of care or patient safety could becompromised.
Reference.AmericanMedicalAssociation.2011AMACodeofMedicalEthics.Opinion9.045–Physicianswithdisruptivebehavior.Availableat:www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion9045.page.AccessedJanuary12,2015
Specificallymentionedarethefollowingactions:¡ Physicallythreateninganyone[inthehospital]¡ Makingthreateningorintimidatingphysicalcontactwithanotherperson
¡ Throwingthings¡ Threateningviolenceorretribution¡ Sexualorotherharassment¡ Persistentinappropriatebehavior,risingtothelevelofharassment.
Specificinappropriatebehaviorsoutlinedinthecodeinclude,butarenotlimitedto,thefollowing:¡ Makingbelittling,sarcasticorcondescendingstatements
¡ Callingpeoplenames¡ Usingprofanity¡ Blatantlyfailingtorespondtopatientcareneedsorstaffrequests
¡ Deliberatelyfailingtoreturncalls,pages,messages
Reference.RosensteinAH,O’DanielM.DisruptiveBehavior&ClinicalOutcomes.AJN2005;105(1):54-64.
Reference.RosensteinAH,O’DanielM.DisruptiveBehavior&ClinicalOutcomes.AJN2005;105(1):54-64.
Reference.RosensteinAH,O’DanielM.DisruptiveBehavior&ClinicalOutcomes.AJN2005;105(1):54-64.
Reference.RosensteinAH,O’DanielM.DisruptiveBehavior&ClinicalOutcomes.AJN2005;105(1):54-64.
Reference.RosensteinAH,O’DanielM.DisruptiveBehavior&ClinicalOutcomes.AJN2005;105(1):54-64.
Stress+Frustration+
LossofConcentration+Reducedteamcollaboration+Reducedinformationtransfer+
Reducedcommunication+ImpairedRN-MDrelationship=
UnsafeWorkEnvironment
¡ 102participatingVHAhospitals¡ January2004–March2007¡ 4,5030totalparticipants:
§ Nurses 2846§ Physicians 944§ Administration 40§ Other 700
Reference.JointCommissionJournalonQualityandPatientSafety2008;34(8):464-471.
Reference.JointCommissionJournalonQualityandPatientSafety2008;34(8):464-471.
¡ DBresultsinpatientdissatisfaction,errors,staffdissatisfaction,andlackofteamwork.Somenursesareafraidtocallsomephysicians...
¡ MostnursesareafraidtocallDr.Xwhentheyneedto,andfrequentlywon’tcall.Thepatient’ssafetyisalwaysinjeopardybecauseofthis.
¡ DBresultsinmedicationerrors,slowresponsetimes,andtreatmenterrors.¡ DBcausedincreasedstressandlackofconcentration,whichcausedanurseto
makeamistake.¡ Poorcommunicationpostopbecauseofadisruptivereputation,resultedin
delayedtreatment,aspiration,andthepatient’seventualdeath.¡ Myconcernisthatthenewnursesareafraidtocallaboutpatientproblems
andissuesthattrulyneedtobeaddressedinatimelymanner.¡ Physiciansbecomeclosemindedtosuggestionsbynursesfordifferent
treatment,andsoon,afterbecomingupsetwithstaffforotherreasonsorinsultedbynurses’ideas.
Reference.JointCommissionJournalonQualityandPatientSafety2008;34(8):464-471.
Whatexactlyis“DisruptiveBehavior”?§ JusticePotterStewartwrote(aboutpornography):"IshallnottodayattemptfurthertodefinethekindsofmaterialIunderstandtobeembracedwithinthatshorthanddescription;andperhapsIcouldneversucceedinintelligiblydoingso.ButIknowitwhenIseeit...“
§ Bullying§ Similartobeingan“Asshole”:theAsshole ...
1. Allowshimselftoenjoyspecialadvantagesanddoessosystematically
2. Doesthisoutofanentrenchedsenseofentitlement
3. Isimmunizedbyhissenseofentitlementagainstthecomplaintsofotherpeople
Reference.JamesA.Assholes:ATheory.©2012;AnchorBooks;p.5.
§ Useoforal,writtenorgesturedlanguagethatmayincludedisparagingorderogatorytermsdirectedtoanotherperson.
§ Engaginginharassmentofanyemployee,patient,physician,visitor,volunteerorotherpersononthebasisoftheindividual’srace,sex,color,nationalorigin,religion,age,maritalstatus,sexualorientation,disabilitystatusorotherwise,includingverbalharassment,non-consensualorunwelcomephysicalcontact.
§ Non-constructivecriticismaddressedtoanindividualinsuchatoneorcontentsoastointimidate,undermineconfidence,belittle,orimplystupidityorincompetence,ordisparagethenameandreputationofaperson.
§ BlatantprofanityorsimilarlyoffensivelanguagewhileintheHospitalanddirectedatmedicalstaff,nurses,otherHospitalpersonnel,orpatientsandvisitors.
§ InappropriatemedicalrecordentriesconcerningthequalityofcarebeingprovidedbytheHospitaloranyotherindividualorotherwisecriticaloftheHospital,otherMedicalStaffmembersorpersonnel
1. RecognitionandAwareness2. CulturalCommitment/Leadership/Champions3. PoliciesandProcedures4. StandardizedIncidentReporting5. ConsistentUniformStructureand
Methodology6. UnderstandInitiatingFactors7. ImplementEducationandTraining8. ImplementCommunicationTools9. InitiateDiscussionForums10. InterventionStrategies
https://www.docsmb.org/rounds-february-2016/the-5-fundamentals-of-civility-for-physicians