1 / 43

Enhancing a Culture of Quality, Safety & Respect: Addressing Disruptive Behavior

Enhancing a Culture of Quality, Safety & Respect: Addressing Disruptive Behavior. Preparation Notes—long version Please review note pages before presenting materials. Enhancing a Culture of Safety: Addressing Disruptive Behavior. Presentation to: Add Your Unit/Department Name. Agenda.

quincy
Download Presentation

Enhancing a Culture of Quality, Safety & Respect: Addressing Disruptive Behavior

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Enhancing a Culture of Quality, Safety & Respect: Addressing Disruptive Behavior Preparation Notes—long version Please review note pages before presenting materials

  2. Enhancing a Culture of Safety: Addressing Disruptive Behavior Presentation to: Add Your Unit/Department Name

  3. 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

  4. Objectives After 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

  5. 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”.

  6. 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.

  7. Disruptive Behavior Linked To Medical errors & adverse outcomes Reduced staff performance, innovation Increased staff turnover Patient dissatisfaction Lack of information sharing Processing delays

  8. 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)

  9. “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

  10. UMHS Survey Measures Respect UMHS asks questions about respect in our 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 improvements and have opportunity for more What are our unit’s survey results?

  11. 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

  12. 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 • Leaders who fail to address unprofessional conduct through formal systems are indirectly promoting it. Systemic factors • increased productivity demands • cost containment requirements • changes in shifts • rotations of interdepartmental support staff

  13. 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.

  14. 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

  15. 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

  16. 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 guidelines for reaction in the moment reporting form reporting process flowchart References used in creating the policy

  17. Conduct 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 . . . Excerpts from examples provided in UMHS Policy 04-06-047. See page 2 of policy

  18. 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 patient 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 From Defusing Disruptive Behavior: A Workbook for Healthcare Leaders. Joint Commission on Accreditation of Healthcare Organizations Resources. 2007

  19. 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

  20. 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

  21. Behavior Report Form Strongly Encouraged to Report! 1) Print Page in Policy (Exhibit B) & Fax to Risk Management - or - 2) Online submission Anonymous option Person reporting Employee/Staff Behavior

  22. 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)

  23. Joint Commission Standard LD.03.01.01 Sentinel Event Alert #40 issued July 2008 The 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 .03.01.01 Leaders create and maintain a culture of safety and quality throughout the [organization]. UMHS Policy 04-06-047— Disruptive or Inappropriate Behaviors by UMHS Personnel

  24. Importance to Our Work Area

  25. 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. RESPECT

  26. 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.

  27. Questions??

  28. Manager Resources The following slides are additional resources for supervisor/manager for use in preparing for the presentation.

  29. Resources (Place in Slide Show Mode and mouse over program name to view resources for each area.) NURSING M HEALTHY In addition to exploring resources in your own area, the following sources provide some or all of the following:  HR EAP • Consultation • Assessment • Intervention • Training Programs • Referrals COMPLIANCE SECURITY Office of Clinical Affairs

  30. Department Services, Books, Videos Books & 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 ProductiveUnder Pressure, Volume 1 (Brief video description) Self-Discipline and Emotional Control:How to Stay Calm and ProductiveUnder 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)

  31. 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 To aid in the clarity, examples of "appropriate" conduct, and "inappropriate or disruptive" conduct include, but are not limited to:

  32. 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?

  33. Scenario Activity Purpose: 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

  34. 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

  35. 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)

  36. 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

  37. Resources NURSING M HEALTHY Nursing Health & Safety Committee Educational Services for Nursing HR EAP Educational Plans for Management of Aggressive Behavior 734-615-9721 COMPLIANCE SECURITY Office of Clinical Affairs Click to return

  38. Resources NURSING M HEALTHY UMHS Human Resource Services Human Resource Consultants HR EAP Human Resources Organizational Effectiveness Consultants Mediations Services – Fernando Caetano 734 647 5538 COMPLIANCE SECURITY Office of Clinical Affairs Click to return

  39. Resources NURSING M HEALTHY Compliance Office Information: 734-615-4400 HR EAP Compliance Questions or Concerns 24 hour Compliance Hotline: 866-990-0111 COMPLIANCE SECURITY Office of Clinical Affairs Click to return

  40. Resources NURSING M HEALTHY Michigan Healthy Community Understanding U Website HR EAP Assistance in Managing the Ups / Downs of Life Featuring tools, strategies, tutorials and resources http://hr.umich.edu/mhealthy/programs/mental_emotional/understandingu/ COMPLIANCE SECURITY Office of Clinical Affairs Click to return

  41. Resources NURSING M HEALTHY UMHS Employee Assistance Program Supervisory, Staff and Team Consultations HR EAP 763-5409 COMPLIANCE SECURITY Office of Clinical Affairs Click to return

  42. Resources NURSING M HEALTHY Health System Security Services Full 24-hour coverage HR EAP Emergencies: 911 Non Emergencies: 936-7890 COMPLIANCE SECURITY Office of Clinical Affairs Click to return

  43. Resources NURSING M HEALTHY Heather Wurster – Policy Lead , Resource for Staff, and Medical School Point Person Maureen Naszradi - Medical Staff Peer Review Coordinator 232 - 1687 HR EAP COMPLIANCE SECURITY Office of Clinical Affairs Click to return

More Related