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8/2/2019 Disruptive Behavior Toolkit
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Enhancing a Culture of Quality, Safety & Respect:Addressing Disruptive Behavior
Preparation Notes—long versionPlease review note pages before presenting materials
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Enhancing a Culture of Safety:Addressing Disruptive Behavior
Presentation to:Add Your Unit/Department Name
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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
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ObjectivesAfter 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 throughoutthe organization—in clinical and non-clinical areas
Be able to provide examples of appropriate and inappropriatebehavior
Understand recommended guidelines for reacting in the moment todisruptive or inappropriate behavior
Use paper or on-line reporting tools to report inappropriate behavior
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Disruptive Behavior defined
Any conduct that interferes with the effective
operation of UMHS or suggests a threat to UMHS
personnel or to patient care . That a person’sbehavior is unusual, unorthodox, or different is not
alone sufficient to classify it as ―disruptive
behavior‖.
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Lateral Violence defined
Inappropriate behavior, confrontation or conflict
between coworkers that humiliates, degrades or
otherwise indicates a lack of respect for the dignity
and worth of an individual – often caused by
communication mishaps.
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Disruptive Behavior Linked To
Medical errors & adverse outcomes
Reduced staff performance, innovation
Increased staff turnover Patient dissatisfaction
Lack of information sharing
Processing delays
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Too Often, Often UnreportedWith Negative Consequences
Studies with similar findings across several Health Care
organizations
> 90% have witnessed disruptive behavior by MDs
30% - knew nurses who left hospital as a result of disruptivebehavior
> 70 % of nurses witnessed disruptive behavior among nurses
14% aware of actual adverse consequences
―serious problem within and across disciplines‖
Voluntary Hospital Association 2002, 2005 studies (Rosenstein)
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―But I Don’t Work In Clinical Area.‖
Disruptive andInappropriate behaviorcan negatively impact
your work environmenttoo.
The policy applies to allUMHS personnel
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UMHS Survey Measures Respect
UMHS asks questions about respect inour workplace in our EmployeeEngagement survey.
Q29—We hold ourselves and othersappropriately accountable if we failto meet our commitments
Q30—We treat each other withmutual respect even when we haveclear differences of opinion
We are making some improvementsand have opportunity for more What are our unit’s survey
results?
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It Does Happen Here!Quotes on Inappropriate Behavior
―The doctors can be disrespectful to the nurses who can bedisrespectful to techs who are disrespectful to housekeepers, etc.)
―There are no consequences for these behaviors so you becomedemoralized and they just continue.‖
―Surgeons are very belittling—they call you names . . .‖
―There is a director who screams at his supervisors all the time and no one does anything because they are afraid of him.‖
―I would like to see people written up—people don’t take things seriously. Supervisors hate confronting people.‖
From 2007 UMHS Employee Engagement Focus Groups
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Causes of Disruptive Behavior
Individual factors high stakes
high emotion personal problems fatigue substance abuse lack of interpersonal, coping or
conflict-management skills lack of tolerance or understand
of workplace diversity
Historical factors tolerance and indifferenceto disruptive behavior
Systemic factorsincreased productivity demandscost containment requirements
changes in shiftsrotations of interdepartmental
support staff
Leaders who fail to addressunprofessional conduct through formalsystems are indirectly promoting it.
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We See ItBut We Don’t Speak Up
Because:
That’s the way it’s always been.
Who will listen? I don’t want to get in trouble.
I can take it.
We can overlook it because of the person’s
technical expertise, rank, etc.
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UMHS Strategic Principles/Values
UMHS values include: RESPECT, TRUST, INTEGRITY
Our Strategic Principles include:
Integration, Collaboration & Team Work
Taking Care of Our Own
Cultural Competency
Integrity and Trust
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UMHS Policy 04-06-047-- Disruptive or
Inappropriate Behavior by UMHS Personnel
States UMHS commitment to addressing disruptive/ inappropriate behavior by UMHS personnel
Expresses importance of collaboration, communication andcollegiality to patient care, education, research & effective
operation
Acknowledges that reporting can be intimidating, thereforeprovides support and process• Outlines who to report to• Allows for anonymous reporting
Identifies the procedure for reporting
Specifies outcomes, including potential consequence of formalcorrective action
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UMHS Policy 04-06-047-- Disruptive or
Inappropriate Behavior by UMHS Personnel
The policy also provides:
Definitions Examples of Appropriate and Inappropriate Conduct
Policy Standards Procedures General Guidelines, including related policies Exhibits
A. guidelines for reaction in the momentB. reporting form
C. reporting process flowchart References used in creating the policy
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Conduct
Appropriate Conduct
Demonstrates clear,direct, honest and
respectfulcommunication
Accepts and providesfeedback in a
constructive and civilmanner
Inappropriate Conduct
Threatening or abusivelanguage (e.g.belittling, berating,screaming . . .)
Derogatory comments(as opposed toconstructive criticism)
about the quality ofcare being provided bythe Health System . . .
Excerpts from examples provided in UMHS Policy 04-06-047.
See page 2 of policy
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Exhibit A: Guidelines for Reacting inthe Moment to Disruptive Behavior
1. Address the situation at the time it occurs
2. Redirect the focus onto the patient’s needs to
depersonalize
3. Move the conflict away from patient areas—ifneeded closer to other staff
4. If you witness verbal abuse, signal to co-workersto act as a witness
5. If a violent act occurs (immediate assistanceneeded), contact a supervisor and dial 911
From Defusing Disruptive Behavior: A Workbook for Healthcare Leaders. Joint Commission on Accreditation of Healthcare
Organizations Resources. 2007
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Procedure
Encourages reporting at department level
Strongly encourages individuals subjected to orwitnessing disruptive behavior to report it
Requires the reporter’s supervisor to act:
• Document
• Resolve
May include involving the next administrative leveland HR in the investigation/resolution
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Reporting Options
Complete a Behavior Report Form or report verballyto the supervisor who will document the form
• fax to Risk Management 734 763 5300 or on-line (indevelopment)
Call the University Compliance Hotline
• at 866 990-0111 or
• submit on-line to https://www.tnwinc.com/WebReport/
If a violent act occurs or immediate assistance isneeded, contact a supervisor or dial 911
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Behavior Report Form
Strongly Encouraged to Report!
1) Print Page in Policy (Exhibit B) & Fax to RiskManagement
- or -
2) Online submission
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Behavior Form Follow Through
1) Risk Management forwards online reportsto appropriate department
2) Per Disruptive Behavior policy, thereporter’s supervisor follows up:
a) Resolves with his/her own departmentb) Relays report to disruptive person’s supervisor
3) Per departmental policy, appropriateaction is determined at the local level
4) Data tracked through the RiskPro system.Reports produced by:a) Individualb) Departmentc) Unit/Division (Faxed forms are inputted by Risk Management )
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Joint Commission StandardLD.03.01.01
Sentinel Event Alert #40 issued July 2008The 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 .03.01.01Leaders create and maintain a culture of safety
and quality throughout the [organization].
UMHS Policy 04-06-047— Disruptive or Inappropriate Behaviors by UMHS Personnel
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Importance to Our Work Area
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RESPECT
Can I Avoid All Conflict?
No. Conflict can not always be avoided.
Conflict is a normal and can be a healthy part ofteam interactions
Conflict handled appropriately allows teammembers to:
• Share ideas
• Voice concerns
• Improve team relationships
Managing conflict in a respectful manner is key.
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Key Considerations
We (our patients and our co-workers) are worth theinvestment• Intervention leads to insight which leads to changed
behavior.
The better the Patient Safety Culture, the better the HealthSystem performance
Every health system employee has a role to play.
Leadership engagement and oversight critical. Report yourconcerns to me.
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Questions??
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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 providesome or all of the following:
• Consultation• Assessment• Intervention
• Training Programs
• Referrals
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Department Services,Books, Videos
Books & Articles Dutton, Jane. Energize Your Workplace: How To Create & Sustain high Quality Connections at Work.
San Francisco. Jossey-Bass. 2003. Farber, June. Smart Nursing: How to Create a Positive Work Environment that Empowers and Retains
Nurses . New York. Springer Series on Nursing Management and Leadership. 2005. Frederickson, Barbara. Positivity. Groundbreaking Research Reveals How to Embrace the Hidden
Strength of Positive Emotions, Overcome negativity and Thrive. New York. Crown. 2009. Tarkan, Laurie. ―Arrogant, Abusive and Disruptive and a Doctor.‖ New York Times. December 2, 2008.
Rosenstein, A.H., O’Daniel, M. ―Managing Disruptive Physician Behavior: Impact on Staff Relationshipsand Patient Care.‖ Neurology. 70. 2008. 1564-1570.
Videos—See Employee Resources-Audio/Visual Resource Inventory http://www.med.umich.edu/i/umhshr/avinventory.htm#Conflict
MANAGING CONFLICT VIDEOS Self-Discipline and Emotional Control:How to Stay Calm and Productive
Under Pressure, Volume 1 (Brief video description) Self-Discipline and Emotional Control:How to Stay Calm and Productive
Under Pressure, Volume 2 (Brief video description) Dealing With Conflict (Brief video description)19 Min Communicating Non-Defensively (Brief video description)20 Min Managing Stress (Brief video description)26 Min Dealing With Conflict and Confrontation, Volumes 1, 2, and 3 (Brief video description)
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To aid in the clarity, examples of "appropriate" conduct, and "inappropriate or disruptive" conductinclude, but are not limited to:
APPROPRIATE INAPPROPRIATE
Demonstrates clear, direct, honest and respectfulcommunication•Responds to pages in a timely, civil manner•Responds to requests in a cooperative manner•Demonstrates respect for patients, their family membersand staff•Clarifies points of agreement and seeks to partner toresolve points of disagreement in patient-care or other
work-related matters•Accepts and provides feedback in a constructive and civilmanner•Respects need for privacy•Handles problems or dilemmas in a cooperative, respectfulmanner•Chooses appropriate timing to bring up problems fordiscussion•Offers appreciation and affirmation to peers-coworkers
when they function well•Accepts the inevitability of mistakes as a learningopportunity•Reliably demonstrates patient care in adherence toagreed-upon standards
Threatening or abusive language – regardless of medium – directed at patients, their guests, or UMHS personnel (e.g.,belittling, berating, screaming and/or non-constructive criticismthat intimidates, undermines confidence, or impliesincompetence);•Threatening or abusive behavior (e.g. throwing items,slamming doors);•Degrading or demeaning comments or nonverbal
communication regarding patients or their guests, UMHSpersonnel, or the Health System•Profanity or similarly offensive language while on HealthSystem sites and/or while speaking with UMHS patients, theirguests or personnel;•Physical contact with another individual that is or appearsthreatening 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 ofappropriate medical staff and/or administrative channels;•Medical record entries impugning the quality of care beingprovided by the Health System, medical staff members or anyother individual;•Imposing unreasonable requirements on fellow UMHSpersonnel;•Refusal to abide by University of Michigan Policies, includingUMHHC Medical Staff Bylaws, U-M Medical School Bylaws,Practices, Agreements and Policies (e.g. Hand Hygiene andSmoke-Free Environment).
From U-M Health System Policies and ProceduresUMHS Policy 04-06-047, Disruptive or Inappropriate Behavior by UMHS PersonnelSection IV. Examples of Conduct
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Frequently Asked Questions
Can I avoid all conflict?
What if I am afraid to report because I fearretaliation?
What resources are available to me if I want moreskills in handling difficult situations—so that mybehavior is not viewed as inappropriate?
My teammates always yell at each—that’s how weget our work done. That’s okay, right?
What if the person I want to report is my supervisoror another manager?
Can I report a single occurrence of inappropriate ordisruptive behavior?
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Scenario Activity
Purpose: To practice effective ways of responding to offensive language andbehavior 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 patient’s 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
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Scenarios for Group DiscussionEnhancing 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
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Scenarios for Group DiscussionEnhancing a Culture of Quality, Safety & Respect:
Addressing Disruptive Behavior ~ cont’d
Scenario IV: Office Administrator and EnvironmentalServices Staff
Scenario V: Faculty – Nurse
Scenario VI: Manager (Jane) & Outpatient Assistant (John)
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Scenarios for Group DiscussionEnhancing a Culture of Quality, Safety & Respect:
Addressing Disruptive Behavior ~ cont’d
Scenario VII: Physician and Nurse
Scenario VIII: Two office workers
Scenario IX: Allied Health Professional – Faculty
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Resources
Nursing Health & Safety Committee
Educational Services for Nursing
Educational Plans for Management ofAggressive Behavior
734-615-9721
Click to return
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Resources
Compliance Office
Information: 734-615-4400
Compliance Questions or Concerns24 hour Compliance Hotline:
866-990-0111
Click to return
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Resources
Michigan Healthy Community
Understanding U WebsiteAssistance in Managing the Ups / Downs of Life
Featuring tools, strategies, tutorials and resources
http://hr.umich.edu/mhealthy/programs/mental _emotional/understandingu/
Click to return
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Resources
UMHS Employee Assistance Program
Supervisory, Staff and Team Consultations
763-5409
Click to return
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Resources
Health System Security Services
Full 24-hour coverage
Emergencies: 911
Non Emergencies: 936-7890
Click to return
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Resources
Heather Wurster – Policy Lead ,
Resource for Staff, and Medical School PointPerson
Maureen Naszradi - Medical Staff Peer ReviewCoordinator232 - 1687
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