Professional Documents
Culture Documents
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
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 organizationin 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
Medical errors & adverse outcomes Reduced staff performance, innovation Increased staff turnover Patient dissatisfaction Lack of information sharing Processing delays
> 90% have witnessed disruptive behavior by MDs 30% - knew nurses who left hospital as a result of disruptive
behavior
Disruptive and Inappropriate behavior can negatively impact your work environment too. The policy applies to all UMHS personnel
Q29We hold ourselves and others appropriately accountable if we fail to meet our commitments Q30We treat each other with mutual respect even when we have clear differences of opinion
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.
I would like to see people written uppeople dont take things seriously. Supervisors hate confronting people.
From 2007 UMHS Employee Engagement Focus Groups
Systemic factors increased productivity demands changes in shifts cost containment requirements rotations of interdepartmental support staff
Our Strategic Principles include: Integration, Collaboration & Team Work Taking Care of Our Own Cultural Competency Integrity and Trust
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
Definitions Examples of Appropriate and Inappropriate Conduct Policy Standards Procedures General Guidelines, including related policies Exhibits A. guidelines for reaction in the moment B. reporting form C. reporting process flowchart References used in creating the policy
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
From Defusing Disruptive Behavior: A Workbook for Healthcare Leaders. Joint Commission on Accreditation of Healthcare Organizations Resources. 2007
Procedure
Encourages reporting at department level Strongly encourages individuals subjected to or witnessing disruptive behavior to report it Requires the reporters supervisor to act: Document Resolve May include involving the next administrative level and HR in the investigation/resolution
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) 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
to appropriate department
2) Per Disruptive Behavior policy, the
b) Department c) Unit/Division
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].
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
RESPECT
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.
Questions??
Manager Resources
The following slides are additional resources for supervisor/manager for use in preparing for the presentation.
Resources
(Place in Slide Show Mode and mouse over program name to view resources for each area.)
In addition to exploring resources in your own area, the following sources provide some or all of the following:
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:
APPROPRIATE
Demonstrates clear, direct, honest and respectful communication Responds to pages in a timely, civil manner Responds to requests in a cooperative manner Demonstrates respect for patients, their family members and staff Clarifies points of agreement and seeks to partner to resolve points of disagreement in patient-care or other work-related matters Accepts and provides feedback in a constructive and civil manner Respects need for privacy Handles problems or dilemmas in a cooperative, respectful manner Chooses appropriate timing to bring up problems for discussion Offers appreciation and affirmation to peers-coworkers when they function well Accepts the inevitability of mistakes as a learning opportunity Reliably demonstrates patient care in adherence to agreed-upon standards
INAPPROPRIATE
Threatening or abusive language regardless of medium directed at patients, their guests, or UMHS personnel (e.g., belittling, berating, screaming and/or non-constructive criticism that intimidates, undermines confidence, or implies incompetence); Threatening or abusive behavior (e.g. throwing items, slamming doors); Degrading or demeaning comments or nonverbal communication regarding patients or their guests, UMHS personnel, or the Health System Profanity or similarly offensive language while on Health System sites and/or while speaking with UMHS patients, their guests or personnel; Physical contact with another individual that is or appears threatening or intimidating; Derogatory comments (as opposed to constructive criticism) about the quality of care being provided by the Health System, a medical staff member, or any other individual outside of appropriate medical staff and/or administrative channels; Medical record entries impugning the quality of care being provided by the Health System, medical staff members or any other individual; Imposing unreasonable requirements on fellow UMHS personnel; Refusal to abide by University of Michigan Policies, including UMHHC Medical Staff Bylaws, U-M Medical School Bylaws, Practices, Agreements and Policies (e.g. Hand Hygiene and Smoke-Free Environment).
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 situationsso that my behavior is not viewed as inappropriate? My teammates always yell at eachthats how we get our work done. Thats 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?
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 patients 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
Scenarios for Group Discussion Enhancing 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
Scenarios for Group Discussion Enhancing a Culture of Quality, Safety & Respect: Addressing Disruptive Behavior ~ contd
Scenario IV: Office Administrator and Environmental Services Staff Scenario V: Faculty Nurse
Scenarios for Group Discussion Enhancing a Culture of Quality, Safety & Respect: Addressing Disruptive Behavior ~ contd
Scenario VII: Physician and Nurse Scenario VIII: Two office workers Scenario IX: Allied Health Professional Faculty
Resources
Nursing Health & Safety Committee Educational Services for Nursing Educational Plans for Management of Aggressive Behavior 734-615-9721
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Resources
UMHS Human Resource Services Human Resource Consultants Human Resources Organizational Effectiveness Consultants Mediations Services Fernando Caetano 734 647 5538
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Resources
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Resources
Michigan Healthy Community Understanding U Website Assistance in Managing the Ups / Downs of Life Featuring tools, strategies, tutorials and resources
http://hr.umich.edu/mhealthy/programs/mental _emotional/understandingu/
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Resources
UMHS Employee Assistance Program Supervisory, Staff and Team Consultations 763-5409
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Resources
Health System Security Services Full 24-hour coverage Emergencies: 911 Non Emergencies: 936-7890
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Resources
Heather Wurster Policy Lead , Resource for Staff, and Medical School Point Person Maureen Naszradi - Medical Staff Peer Review Coordinator 232 - 1687
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