Short Discussion
Write a 5-7 sentence response voicing your opinions and reactions the main themes of the
“Disruptive Behavior in Healthcare” article
. What are your thoughts? Do you agree with the article?
The article is attached below, please read it
Here is an example of what you should do:
(do not copy and paste this)
Hello class,
I hope all of you are doing well during these crazy times we are living.
This was a very interesting article, and also one that I am sure most of us can relate to. I believe most people find themselves in a position similar to the on described in the article where we fear to communicate something of importance because of how our managers may react to these; some of us have also been on the other side of the table, where someone might have not communicated something because they were afraid of a possible negative reaction from us.
As mentioned in the article, this is a serious problem regardless of which industry you work in; but when it happens in the healthcare industry it turns even more serious because there are lives at stake. This is an industry where many times it is crucial that individuals put their personal interest behind those of the consumer, as these people are patients that need the best attention they can get.
I definitely agree with this article. I specially agree with it when the author mentions that building a candid culture within an organization takes a lot of work, but that there is no other option if what we want is to do the right thing. Furthermore, in terms of efficiency in any industry, a toxic work environment makes everything go uphill and the results are never optimal. Transitioning to a pleasant work environment is a good way to get things running the way they should. Finally, I truly believe that good communication always translates to better performance.
Thank you for taking the time to read my opinion on the article, I can’t wait to read some of yours.
Regards,
Jose Adrianza.
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Disruptive behavior in healthcare
January 03, 2017 | Print | Email
“What we’ve got here is a failure to communicate.” The memorable line from the 1969 movie, Cool Hand
Luke, could be used to describe the situation in many families and organizations of all kinds, including
healthcare. However, nowhere does it matter more than healthcare because the ultimate business of the
industry is patient welfare and safety.
Researchers from John Hopkins Medicine say in a 2016 article on Health News from NPR that medical errors
take 250,000 lives each year in the US and should be ranked as the third leading cause of death behind heart
disease and cancer that claim about 600,000 each. While it is almost certain that no single cause results in
such an abysmal outcome, failure to communicate is high on the list.
In a video captured incidentally at a healthcare conference, Sorrel King tells the heart-wrenching story of
how her 18-month old daughter died at John Hopkins Hospital in 2001 from medical errors and the refusal of
doctors and nurses to listen to this young mother’s pleas and reasoning. Eventually, Sorrel King and Johns
Hopkins Hospital worked together to create the Josie King Foundation whose purpose is to help create a
culture of patient safety.
The elephant in the room
In any significant medical facility, the healthcare cast is vast, including administrators, department leaders,
physicians, nurses, aides, patients, families, contractors and many more. Yet failure to communicate a crucial
bit of information from any of the parties to any other could affect the safety of a patient or even many
patients. So what’s the problem?
For a number of years in the healthcare industry, certain individuals, especially those in authority, have
tended to exhibit patterns of behavior that are now recognized as intimidating and disruptive. A USA Today
article, “When Doctors Are Bullies, Patients May Suffer,” says, “Every workplace, like every schoolyard, has
its bullies. But when the workplace is a doctor’s office, hospital room or surgical suite — when doctors throw
charts at nurses or nurses throw insults at trainees — it isn’t just a workplace problem. It’s a patient-safety
issue….”
The fault does not lie solely with physicians. A common expression among nurses is that “nurses eat their
young,” referring to the bullying behavior of entrenched nurses toward nursing students or new nurses.
Kathleen Bartholomew, in her book Ending Nurse-to-Nurse Hostility: Why Nurses Eat Their Young and Each
Other, describes this practice as “horizontal hostility” and describes how it makes the environment toxic.
Those who resort to bullying, intimidation and refusal to listen to others may work in any department from
purchasing and housekeeping to administration. Their behavior may range from verbal outbursts and
physical threats to use of a condescending tone or refusal to answer questions. Employees may recognize
where in their organization such behavior occurs but tolerate it because it is entrenched in the culture. There
may be no recognized recourse to safely and effectively refer concerns. As a result, counterproductive
behaviors may have been overlooked or tolerated and, over time, have become “the elephant in the room.”
https://www.beckershospitalreview.com/hospital-management-administration/disruptive-behavior-in-healthcare.html?tmpl=component&print=1&layout=default
https://www.beckershospitalreview.com/component/mailto/?tmpl=component&template=beckers&link=https://www.beckershospitalreview.com/hospital-management-administration/disruptive-behavior-in-healthcare.html
http://www.npr.org/sections/health-shots/2016/05/03/476636183/death-certificates-undercount-toll-of-medical-errors
http://www.usatoday.com/story/news/nation/2013/04/20/doctor-bullies-patients/2090995/
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In sight of the elephant
On July 9, 2008, the Joint Commission issued Sentinel Event Alert, Issue 40: Behaviors that undermine a
culture of safety. The alert officially recognized that “Intimidating and disruptive behaviors can foster
medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost
of care, and cause qualified clinicians, administrators and managers to seek new positions in more
professional environments.” In addition the publication established a new leadership standard on the subject
that set forth, in part “‘zero tolerance’ for intimidating and/or disruptive behaviors….” Then, in September
2016, the Joint Commission issued an update that stated succinctly, “Behaviors that undermine a culture of
safety continue to be a problem in healthcare.”
So the problem is recognized but not resolved.
Why the elephant flourishes
For more than two decades I have worked with healthcare providers to help reduce disruptive behavior in
their organizations and establish a culture of candor. Often I have conducted one-on-one “executive
coaching” sessions with individual physicians or nurses who have been perceived as disruptive toward staff
or patients. Although I have occasionally counseled medical professionals who could not come to terms with
the inevitable demands of the job, I much more often found that the system in which they work was a major
cause of their failure.
For example, one of my clients hired me to conduct a series of coaching sessions with an emergency
physician who had received complaints from a nurse. I was told that the physician had anger management
problems. However in our sessions, my impression was that she had high standards for the quality care of her
patients and she was very complimentary of the nursing staff. The more we discussed the dynamics of her
workplace, the more I concluded this physician did not have anger management problems. She had
frustration management problems. Her frustration was not with individuals but with a lack of efficiency in the
department, including long wait times for patients and families, outdated computer systems, patients in beds
in the hallway waiting to get to a room and customers leaving without being seen at all. While individuals
should be held accountable for their behavior, it is also important to consider whether the system is at least
partially at fault. When talented people are placed in a broken system, they cannot succeed.
Getting the elephant out
The real job then, as described by the Joint Commission, is to establish a culture of candor in which all
employees are empowered, even encouraged, to constructively communicate critical information within an
established system. In such a system, not only is it allowable to address operating deficiencies — that is the
objective. Continually discovering weaknesses allows for continual improvement. The system and those in
it must not have such thin skin that they refuse to hear that deficiencies exist and improvement is mandated.
Such a system can only be possible when mandated and practiced by the officers and leaders of the system.
Although nowhere is a culture of candor more important than healthcare, it is also significant in other sectors
of our economy: aviation, law enforcement, higher education, government and on and on. In fact, it is
important everywhere. One notable success has been Pixar, whose approach may have implications for
healthcare. Pixar is an American computer animation film company that has attained overwhelming
acceptance by the public and astounding financial success, including 14 of the 50 highest grossing films of all
times. In his book, Creativity, Inc., Pixar President Ed Catmull explains how fundamental a culture of candor
https://www.jointcommission.org/assets/1/18/SEA_40.PDF
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is to their success. He said, “Candor could not be more critical to our creative process. Why? Because early
on, all of our movies suck. … Pixar films are not good at first, and our job is to make them so — to go, as I
say, from ‘from suck to non-suck.'”
Admittedly, achieving a culture of candor in an organization for the first time is a monumental challenge. But
really what choice is there?
I recently came across an exceptional healthcare team that decided to transform their organization to a culture
of safety and well-being. This innovative team led by Creative Health Care Management developed a “code
of conduct” for their team. It was entitled “Commitment to My Co-Workers.” The following is a synopsis.
As your co-worker and with our shared organizational goal of excellent service to our customers, I commit to
the following:
I will accept responsibility for establishing and maintaining healthy interpersonal relationships with
you and every member of this team.
I will talk to you promptly if I am having a problem with you. The only time I will discuss it with
another person is when I need advice or help in deciding how to communicate with you appropriately.
I will not engage in the “3B’s” (bickering, back-biting and blaming).
I will practice the “3 C’s” (caring, committing and collaborating) in my relationship with you and ask
you to do the same with me.
I will accept you as you are today, forgiving past problems and ask you to do the same with me.
I will be committed to finding solutions to problems rather than complaining about them or blaming
someone for them, and ask you do the same.
I will affirm your contribution to the quality of our service.
I will remember that neither of us is perfect, and that human errors are opportunities, not for shame and
guilt, but for forgiveness and growth.
In today’s volatile, complex and competitive healthcare culture employees are often spending more time at
work than home, more time with colleagues than family. Therefore it is imperative that we create workplaces
where well-being, safety, trust and respect for differences all lead to patient safety and achieve high patient
satisfaction.
More articles on leadership and management:
6 thoughts on leadership from Dr. Michael Ugwueke, president and CEO of Methodist Le Bonheur
Healthcare
2017 Predictions from healthcare leaders across the country
Cleveland Clinic’s Dr. Toby Cosgrove turns down VA role to keep CEO post
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