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Standing Up to the Bully

Maureen Larkin, for HealthLeaders Magazine, December 11, 2008
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"We know from risk management literature that such physicians are involved in a disproportionate number of malpractice claims, so there's a financial impact to the institution, as well as to patients and their families," Hickson says.

Some leaders may hesitate to call a bullying clinician out on his or her behavior, Hickson says, because that person is a revenue generator for the hospital. But no revenue brought in by this individual is worth the money that his or her behavior may cost your organization down the line, he says.

"No one contributes such a large amount in every metric that it's worth tolerating behaviors or creating unnecessary risk," Hickson says. "That's not at all what we want to exemplify in the practice of medicine."

Beyond policies
To change bad behavior, Hickson says hospitals need more than a code of conduct. They need a strategy. "I like to frame it that way because having a policy to promote professional conduct and discourage unprofessional conduct is just one element of that strategy. You need more than just a policy," he says. Vanderbilt University Medical Center has been using such a strategy for more than 10 years, Hickson says, creating a hospital environment that rejects disruptive behavior. The following five elements are part of that strategy:

1. Leadership. The most important course of action for leaders is to make sure your organization's code of conduct applies to everyone, Hickson says—even those clinicians who bring in the most revenue.

2. Appropriate responses. There's a big difference between an employee who behaves badly on a regular basis and one who has an isolated episode of bad behavior, Hickson says. By creating a model to help staff match the right level of intervention with the behavioral event or series of events, staff members have a guide to deal with offenders.

3. A credo, or doctrine, that all professionals believe in and live out. If those who work at your organization follow this credo, they won't be afraid to tell a colleague who has stepped out of line that their behavior is inconsistent with the organization's beliefs.

4. Surveillance systems. Hickson says surveillance methods can be anything from patient complaints, an employee satisfaction survey, or even a "tip line" that allows employees to report a colleague's actions anonymously.

5. Training resources. Few people enter the workplace trained to talk with colleagues about bad behavior, so it's up to the CEO and other hospital leaders to make sure an organization's managers have the tools to have such talks.

The real cause
Since The Joint Commission issued its alert, there's been increased interest in the Professionals Program at Elmhurst (IL) Memorial Healthcare, one of a handful of initiatives created to modify the behavior of medical professionals. The eight-week program gets to the root of bad behaviors, says Glenn Siegel, MD, a psychiatrist and medical director of the program.

"We're giving someone the opportunity to change how they manage themselves or react to others," Siegel says. "Most people who are treating others disrespectfully in the workplace aren't feeling very good about themselves. We give them the opportunity to change that."

Some come willingly, while others come simply to save their professional livelihood or license. "Many of them come in kicking and screaming because they feel like someone has forced them to be here if they're going to continue to practice," says Mary Pittman, RN, MS, administrator of the Professionals Program. "But within days most people see the value with them being here."

Maureen Larkin

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