These tips can help you implement training and reporting that drive the incident rate to zero.
This story appears in the November/December edition of HCPro's Patient Safety & Quality Healthcare (PSQH), a sibling publication to HealthLeaders.
By Megan Headley
The #MeToo movement has encouraged a wide range of industries that once looked at sexual harassment as "part of the job" to start taking steps to improve working conditions. Healthcare is among those industries that are not only finally recognizing the extent of the problem but looking for ways to prevent this behavior in the future.
And the behavior is widespread. When Medscape surveyed 6,200 physicians and clinicians in 2018 about sexual harassment incidents over the prior three years, it found 7% of physicians and 11% of nurses, nurse practitioners, and physician assistants had experienced sexual harassment. Reported harassment ranged widely from sexual comments or leering (reported by 52%) to the offer of a promotion in exchange for sexual favors (reported by 3%). Nearly half (47%) of the perpetrators were physicians.
Perhaps most notably, more than half (55%) of those harassed did or said nothing to confront the perpetrator. Among residents, silence was even more common (78%). As Susan Strauss, EdD, RN, an expert in the topic, commented in the report, "Most places don't know how to conduct an investigation, and many HR departments don't recognize the nuances of sexual harassment issues."
Scott Cormier, vice president of emergency management, environment of care, and safety for healthcare facilities service provider Medxcel, is among those professionals ready to help healthcare organizations recognize those nuances. "What healthcare [providers] are doing and need to continue to do is to let our associates know no matter what their gender is, no matter how they identify, that [sexual harassment] is absolutely wrong and is intolerant," he says.
That starts with a sexual harassment program that includes ongoing training and awareness initiatives. According to Cormier, "Many times, sexual harassment programs are already in place because of the regulatory requirements but spin up or spin down based upon an event." That type of reactionary response means that other team members are missing out on the benefits of active promotion and training. And that's important to address. Consider that the Medscape survey found that of the 2% of physicians who reported having been accused of sexual harassment, only 2% felt the accuser was accurate in their accusation. Health systems may need more impactful education on what constitutes appropriate behavior to help bridge that disconnect.
Get an accurate handle on training
For a first step, Cormier suggests outsourcing the creation of organizational sexual harassment training.
"Engage professionals who do this for a living," he encourages. "We all try to do things internally … we want to try to save costs. That's not the right way to do something this important. Make sure that you put together a professional program."
Next, organizations must provide training to all associates and staff, as well as the people who are going to be managing the program and investigating complaints. "That training can't be just one and done. There has to be some sort of baseline training and then continuing education," Cormier insists.
That baseline training is particularly important. "When you put these programs in place, you're going to see a couple hundred percent in reported events and you're going to think, 'We're getting worse.' But you have to realize you never had a baseline and it's going to take a year or two or maybe three to develop that," Cormier notes.
With a baseline in place, organizations can more accurately begin to drive toward the goal of zero incidents. "The only acceptable number when it comes to sexual harassment is zero," Cormier points out. "If you're driving for something other than zero, then you don't have an effective program."
While Cormier notes that this approach will cost more in development and maintenance, it also may help reduce turnover and burnout by creating a safer place to work. Given recent research indicating that anywhere from 44% to 78% of American physicians suffer from burnout, training can be a valuable component in creating a better culture for your employees.
Remove barriers to safe reporting
The next step is to establish a culture where employees feel safe enough to report incidents of sexual harassment. Clearly, reporting should never make employees feel as though they're at risk of compromising their jobs. But it's not enough today to simply have a system in place. The long history of sexual harassment in healthcare—something Florence Nightingale openly dealt with in the 1800s—puts the impetus on the organization to make employees feel safe in reporting incidents or concerns.
"The way we do that is to continuously remind them they're not going to be punished or feel degraded or feel demeaned for reporting it and going through this process," Cormier says. He adds that this is one reason establishing a feedback loop with supervisors is important. In other words, once an incident is reported to an individual's direct supervisor and the supervisor investigates the complaint, that supervisor has not completed the investigation until he or she has relayed the findings to the person who initiated the complaint. Cormier says this is an area many people tend to miss, but it's an important part of making victims feel heard and supported.
Safety in reporting is a critical step, but Cormier suggests that reporting must also be simple. After all, physicians and nursing staff are severely overworked as it is. Setting up hurdles to reporting is likely to deter victims of sexual harassment—who have perhaps too long viewed harassment as a part of their job—from speaking up.
"If it takes me 30 minutes of my day to report this, I'm not going to take the time," Cormier says. "In healthcare, we have dedicated people who are focused on our patients, and they're not going to take 30 minutes away from their patients to do this."
Once a report comes in, the onus must be on the system to gather information and analyze it to resolve the allegation. Speed, again, is key. As Cormier puts it, there's someone feeling vulnerable and insecure waiting upon your actions to gain some sense of closure. "To close that gap of insecurity, we want to make sure that we have a method of doing this thoroughly," he says. "We don't just want to make assumptions that it did or didn't happen. We don't want to rely on what people think about this person or that person. We want to have a thoroughly trained investigation team to take appropriate action, whether it's counseling or another form of process, to deal with the issue. Then we have to make sure to review that process and make sure it continues to be effective."
Ongoing improvement is another key, Cormier suggests. There needs to be constant accountability all the way to executive leadership to improve the investigation, review, and support processes.
Instill organizationwide accountability
Many healthcare organizations struggle with creating a program that works and driving the changes necessary to improve their culture. The first step is to understand how your staff feels about the current culture so that you know where to improve.
Working with an experienced third party can help ensure you're not missing organizational blind spots. "Look for somebody with experience," Cormier suggests. "Look at the programs that they've helped with, and look specifically to see if they're effective and have had a reduction in the amount of sexual harassment incidents."
The most critical thing, however, is to ensure the entire organization knows they have a responsibility to drive the culture forward. Everyone must understand appropriate behavior, report incidents, and investigate rapidly. Healthcare workers are tasked with doing more with less, so it's more critical than ever that their employers do more to eliminate hostile working environments.
Megan Headley is a freelance writer and owner of ClearStory Publications. She has covered healthcare safety and operations for numerous publications. Headley can be reached at firstname.lastname@example.org
“Most places don't know how to conduct an investigation, and many HR departments don't recognize the nuances of sexual harassment issues.”
Susan Strauss, EdD, RN
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A survey found that a majority of physicians and clinicians who experienced sexual harassment said nothing to confront the perpetrator.
Once a report comes in, the onus must be on the system to gather information and analyze it to resolve the allegation.
Working with an experienced third party can help ensure you're not missing organizational blind spots.