Daniel O’Connell, PhD Seattle, WA 98119 [email protected] 206 282-1007.

Daniel O’Connell, PhDSeattle, WA [email protected]

206 282-1007

The Problem:

Behaviors such as condescension (verbal, tone, body), disparaging, intimidating, patronizing, angry outbursts, reluctance or refusal to answer questions, unwillingness to cooperate/collaborate or provide reasonable help, threatening body language and physical contact, unwillingness to participate in resolution of an interpersonal problem

The emotional impact of abusiveness demoralizes people who feel attacked, devalued, or humiliated as well as the witnesses.

Prevalence and Impact Verbal abuse reported by 80-97% of nurses by doctors or other nurses/staff. 16% of nursing turnover was found to be associated with verbal abuse. Physicians have been recognized as the primary perpetrators of verbal abuse;

however they are not the only source. Patients, families, peers, supervisors and other colleagues have demonstrated abusive behaviors as well.

“Relational aggression” a particular problem for women (cf Cheryl Dellasega 2005 Mean Girls Grown Up)

Intimidating, abusive behaviors impact patient safety. (49%) of all 2000 respondents reported that their experiences with intimidation had altered the way they handle clarifications or questions about medication orders increasing the risk of incorrect interpretation and occurrences of medication errors. Only 39% felt that their organization dealt effectively with intimidating behavior. (Intimidation. Institute for Safe Medication Practices March, 2004)

Multiple studies have shown that the negative effect of abuse on productivity, morale, nursing care delivery, workload and errors.

Research confirms evidence-based prevention strategies as well as enforceable zero-tolerance policies can significantly reduce the occurrence

Code of ConductTreat all persons with respect, courtesy,

caring, dignity and a sense of fairnessCommunicate openly, respectfully and

directly with team members… to promote mutual trust and understanding

Encourage, support and respect the right and responsibility of al individuals to assert themselves to ensure patient safety and the quality of care

BMC Medical Dental Staff Policy Regarding Unprofessional Relationships

Boston Medical Center (“BMC”) is committed to having a work environment that is professional, collegial, supportive of all personnel, and conducive to providing optimum patient care

BMC PolicyAll members of the Medical and Dental Staff (“Medical

Staff”) are expected to treat one another and all other individuals of the BMC community with respect and dignity.

2. BMC is committed to assuring that the workplace environment at the BMC is a positive and supportive one and without disruptive, intimidating, or abusive behavior. Harassment of any kind, conduct that is disrespectful and/or abusive, and unprofessional relationships are not acceptable behavior at BMC.

3. BMC takes seriously any and all allegations of unprofessional relationships and disrespectful and/or abusive conduct seriously, and will respond promptly to complaints. When an allegation has been made that undesirable behavior has occurred, BMC will act promptly to investigate the alleged conduct and address behaviors that are found to be unprofessional or disrespectful. Moreover, retaliation of any kind will not be tolerated against an individual who has made a complaint or allegation under this policy or who has participated in an investigation of said complaint or allegation

Courageous Conversations by Colleagues and SupervisorsCourage of convictions

We need to do better than thisCourage of role

It is my role to raise these concernsCourage in the face of conflict

I/we are not so fragile that we cannot tolerate some conflict if we are skillful in how we approach it

Courage of persistenceI can come back again and again if needed until we get

this rightI can/we can ask for help to get this resolved

Having the Courageous ConversationGood resources:Crucial Conversations by K. Patterson et al

2002Crucial Confrontations by K. Patterson et al

2004Difficult Conversations by D. Stone et alFierce Conversations by Susan Scott 2004

Key perspectives in promoting civility and collegialityTeamwork requires investment, civility and collegiality“Both/and” replaces “Either/or”Empathy is essential for real civility and collegiality“Contribution” replaces blameSeparate the people from the problem The “reasonable person” testDescribe behavior and impact, not theorized intentions

Yet consider psych/sa contribution in light of behaviorPeople are pre-disposed to certain kinds of problems

So monitor and maintain to prevent or manage relapseZero tolerance does not always mean discipline “Bully effect” means help is reasonable often

necessary

Bully EffectBullying behavior is usually directed at

someone towards whom one feels dome impunity. Someone for whom respect is already diminished and from whom one does not fear retaliation.

That means that the receiver of bullying will often not have the clout to confront the bully effectively enough to end the behavior.

So… be quick to often assistance through coaching, facilitation, mediation

Empathy with ClarityI want to help you be successfulYou are a valuable member of the

department and I want to help you have the constructive impact you intend and not the destructive impact that your behavior sometimes causes

Zero tolerance does not require capital punishmentCreate pathways to recovery whenever

possibleBe creative about how recovery could occur.4 Steps of Apology

Acknowledge wrong and its impactExpress remorse/regretExplain how it occurred and steps to prevent

recurrenceOffer restitution

Reasonable Person TestUltimately, one must make a judgmentWas this behavior such that a “reasonable

person” would have it offensive, disrespectful, disruptive to the safe and effective conduct of teaching, research, clinical work and collegiality

Focus on Behavior and Its ImpactAvoid getting stuck in IntentionsMost your people will defend their intentions

(because it reflects on their identity)Focus on impact

When you behave like this_______________, I am hearing/observing/learning that is has these unwanted impacts.____________________. Because I do not think that is your intention, I want to help you have the constructive impact you are intending. Let’s talk about how that could be achieved.

Contribution replaces BlameThe way in which you______________

contributes to others feeling__________which unfortunately has the consequence at times of ______________.

Separate the People form the ProblemYou are not the problem. He/She/They are

not the problem. The Problem is the problem. So let’s talk about the problem that we are seeing.

Both/And replaces Either/OrBoth high quality clinical direction, teaching

and research rigor AND doing it in a way, in a demeanor with a clear intention of building and maintaining respect, collegiately, and attention to the emotional impact on others

Progressive Intensity/Discipline“Diagnosis and Treatment” progresses through levels

of increasing intensity appropriate to resolving the problem

Encourage conversation by individuals involved“Supervisor” to clarify/investigate, affirm

expectations, facilitate and/or obtain resources Supervisor takes on issue directly within progressive

discipline structure focusing on promoting resolutionProcess is aimed at getting and maintaining individual’s

attention on problem resolution, creating/offering plans to understand and resolve problem and clarifying consequences of unwillingness or inability to behavior appropriately

Expect Slips and be Ready for RelapseBehavior issues often emerge from underlying

vulnerabilities that predispose their happening in the first place and recurring in the future.

That means that slips into misbehavior need not be seen as total failures. They may not call for draconian action. They do call for intervention.

So… put in place a “treatment and monitoring plan” that lasts longer (1+ years), continue to gather data about behavior, have regular feedback meetings and do all this transparently