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Kathleen Bartholomew: Standing Up to Physician Bad Behavior

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   December 02, 2010

"Our patients will never be safe until all caregivers feel safe enough to communicate—to challenge, question, advocate, and ask for clarification."
— Kathleen Bartholomew

In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is Kathleen Bartholomew's story.

For decades, there was a dirty little secret in healthcare. Everyone knew it existed, but no one wanted to talk about it. The secret was that bad behavior and bullying were rampant. In a supposedly caring profession, some caregivers were not caring at all, to the point that they made lives miserable and disrupted patient care.

Today, the secret is out. Everyone has heard that bad behavior, bullying, and poor communication are serious safety concerns that lead to medical errors, poor patient care, and high staff turnover. Even The Joint Commission has issued a mandate for organizations to have a policy in place to deal with bad behavior.

One of the people who exposed the secret is a nurse named Kathleen Bartholomew, RN, MN. Her hard work and strong voice shone a light on the problem, focusing attention on its critical impact on patient safety. She has made it her life's work to end bullying and bad behavior by physicians and nurses.

Bartholomew first encountered physician bad behavior as a brand new nurse in the early 1990s. No stranger to difficult situations, she would not conform to the culture of submissiveness that pervaded nursing, and instead challenged the behavior and found her calling.

This was not a road she expected to find herself traveling. The journey began in 1991, when she was out of a job, separated from her husband, and the mother of five children, all younger than 11. She was introduced to a lawyer who offered to handle her divorce for free—if she agreed to become a nurse. Never one to turn down a good deal, and recognizing her dire straits, Bartholomew accepted the deal.

She packed her five kids into the car and drove to North Carolina so family could watch the children while she attended school and studied. Eventually, her hard work paid off and she started her first position as a nurse. Almost immediately, she witnessed the perverse hierarchies involved when physicians and nurses talk to each other.

"Every time the nurse would call to report a temperature, the physician would slam the phone down, even though we had guidelines to call if the patient's temperature was above 102 degrees," says Bartholomew.

She knew that the belittling, demeaning, and hostile behavior she witnessed throughout healthcare was a serious problem.

"I realized it was something that carried over" and affected patient care, because a person cannot perform cognitive tasks when his or her emotional state is compromised, says Bartholomew. "No human being can think clearly when they are upset. When you create healthy relationships, you are providing a safety net. Our patients will never be safe until all caregivers feel safe enough to communicate—to challenge, question, advocate, and ask for clarification."

As Bartholomew progressed in her career, becoming manager of a 57-bed orthopedic unit in a downtown Seattle hospital, she worked on improving nurse-physician communication and she experienced amazing results.

She turned her attention outside her organization and began to talk about the issue to others. What she was saying struck a nerve. As she presented to hospitals and conferences, nurses would come up to her, weeping, and tell her their stories. She added the need to improve nurse-to-nurse horizontal hostility to her mission and became a celebrated author, speaker, and educator on the topic of bad behavior and the patient safety imperative for changing culture.

"It's just absurd that the two people who are providing the care are not required or expected to communicate on a daily basis," says Bartholomew, noting that poor communication "is the No. 1 cause of errors."

When she started talking about this dirty little secret, no one else was acknowledging that healthcare culture could and should change. And yet the Institute for Healthcare Improvement clearly stated that the greatest barrier to patient safety is culture.

"At the time, there were only a few articles on this topic," she says. "It was not at all a priority anywhere. No one saw the impact and no one had demonstrated the impact."

Bartholomew focuses on the critical importance for healthcare to learn how to create collegial teams, just as has been done in other professions, such as aviation and nuclear power.

"Until we get there, patients will never be safe," says Bartholomew. "Allowing one person to behave badly undermines trust. You can't have collegial teams without trust and everyone on board. An institution cannot have integrity when there are different rules for different roles."

"We will look back in 20 years and wonder how we possibly thought we could deliver care when the physician doesn't think it's necessary to read the nurse's notes or even speak to the nurse," she says. "It's absurd that two people delivering care are not required to communicate."

Bartholomew now works on delivering her message to all levels across healthcare, from staff nurses to boards of directors.

"Right now, I'm thrilled to be able to have an impact on a much larger scale," she says. "I speak to boards of directors at hospitals and get to spend a whole day explaining culture and the impact of that culture on quality and safety. I teach them about nurse-to-nurse and physician-to-nurse communication and it's been profound. Boards are now adopting behavior rules. Now senior nurses are being given the clout they need from the boards of directors. They are saying, 'It doesn't matter how much money that physician brings in, he screamed at and demeaned the nurse!'"

Rebecca Hendren is a senior managing editor at HCPro, Inc. in Danvers, MA. She edits and manages The Leaders' Lounge blog for nurse managers. Email her at

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