Tuesday, May 28, 2013

Tip 21: When patients are in the line of fire


Is incivility causing your organization to be less compassionate? And what impact does it have on safety and overall patient experience?

A recent Harvard Business Review article titled, The Price of Incivility, by Christine Porath and Christine Pearson suggests rudeness at work is on the rise, and their findings are quite consistent with what we see in the organizations who call us for help.

Over the past 14 years Porath and Pearson polled thousands of workers about how they're treated on the job, and 98% have reported experiencing uncivil behavior. In 2011, half said they were treated rudely at least once a week—up a quarter since 1998. We can only conclude that these uncivil behaviors, exchanges and experiences are chipping away at our organizations' ability to prevent harm, improve quality and build trust in our communities. The authors point out that most managers believe incivility is harmful, but many leaders do not recognize the widespread affects and tangible costs. The authors' research of 800 managers and employees in 17 industries including healthcare, demonstrate the widespread effects of these actions. Among workers who've been on the receiving end of incivility:

  • 12% said that they left their job because of the uncivil treatment.
  • 38% intentionally decreased the quality of their work.
  • 47% intentionally decreased the time spent at work.
  • 48% intentionally decreased their work effort.
  • 63% lost work time avoiding the offender.
  • 66% said that their performance declined.
  • 78% said that their commitment to the organization declined.
  • 80% lost work time worrying about the incident.

Arguably the most concerning finding for our industry might be that 25% of respondents admitted to taking their frustration out on customers. It goes without saying that our organization's culture has a tremendous influence on improving safety. These are just a few of the challenges we must begin giving more attention to as an industry if we are to get a a better handle on preventable patient harm.

The authors interviewed employees, managers, HR executives, presidents, and CEOs. They administered questionnaires, ran experiments, led workshops, and spoke with doctors, lawyers, judges, law enforcement officers, architects, engineers, consultants, and coaches about how they've faced and handled incivility. They collected data from more than 14,000 people throughout the United States and Canada in order to track the prevalence, types, causes, costs, and cures of incivility at work. They concluded two things: Incivility is expensive, and few organizations recognize or take action to curtail it.

Let's remind ourselves that incivility doesn't have to be a mad surgeon throwing a scalpel in the OR to harm the patient, but a simple rude comment that creates the conditions for one staff member to avoid the other, impairing communication and setting the stage for patient harm.

While this article offers a number of valuable findings on incivility and the effect disruptive cultures have on organizational performance, I wanted to concentrate on one specific finding we are all to familiar with. The authors share that only 11% of organizations report considering civility at all during the hiring process, and many of those only investigate it in a cursory fashion. These findings are consistent with our experiences working with healthcare systems across the country. The good news for our patients on the receiving end, is that we are starting to see more organizations connecting the dots... recognizing just how much collateral damage and patient harm can occur when we don't hire the right folks. Many organizations neglect to see hiring and recruitment as the first line of defense in their patient safety infrastructure.

The authors share that incivility leaves a trail of some sort, which can be uncovered if someone's willing to look. Here's one example, "One hospital had a near miss when bringing on a new radiologist. It offered the job to Dirk, a talented doctor who came highly recommended by his peers and had aced his interviews. But one assistant in the department had a hunch that something was off. Through a network of personal contacts, she learned that Dirk had left a number of badly treated subordinates in his wake—information that would never have surfaced from his CV. So the department head nixed the hire. Dirk doesn't realize the impact his behavior is having on patients and it's one that I illustrate in my upcoming book, Heroes Need Not Apply: How to build a patient accountable culture without adding more to your plate, where a Dr. Hartley, an oncologist makes a few harmful comments that wind up creating a trail of destruction for one of his patients: His incivil behavior toward his transcriptionist resulted in his surgical notes being incorrect, which ultimately led to the death of a patient. He instilled such fear that his transcriptionist threw in the towel and guessed on one word... which happened to be the difference between life and death.

CL Tip 21: Civility: Screen for it and coach with it

What happens when you leave aligning what matters most to our patients and culture to chance? We get an organization that is less likely to be compassionate with the increased risk of incivility.

Porath and Pearson share, "We're always amazed by how many managers and employees tell us that they don't understand what it means to be civil. One quarter of the offenders we surveyed said that they didn't recognize their own behavior as uncivil."

But why is there such a disconnect in healthcare where compassionate people come to work? We are an industry that has a long history of rewarding the T.E.D. attributes (see image on left), and neglecting the human side of our business... the actions and behaviors that matter most to patients (T.R.U.S.). If you've been in healthcare long enough, you've been exposed to a number of living examples and products of healthcare culture. You know, the talented, well trained nurse/doctor/leaders who get the results, but don't play well with others. They seem to create a "windchill effect" when they come into the room as they are often disrespectful and unapproachable. They don't recognize the effect they have on their staff and/or colleagues and how their tone starts a chain reaction that put's the patient's life on the line. The article describes how targets of incivility often punish their offenders and the organization, suggesting that most hide or bury their feelings and don't necessarily think of their actions as revenge. For a moment, consider how this cycle can and does impact our patients? This is a critical problem that doesn't need initiatives or huge budgets to repair. As someone wise once told me, "I'd rather have someone nice and teach them to be smart than have someone smart and teach them to be nice."

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