Disruptive Behavior Toolkit

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



Enhancing a Culture of Safety:Addressing Disruptive Behavior

Presentation to:Add Your Unit/Department Name



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



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



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‖.



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.



Disruptive Behavior Linked To

Medical errors & adverse outcomes

Reduced staff performance, innovation

Increased staff turnover Patient dissatisfaction

Lack of information sharing

Processing delays



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)



―But I Don’t Work In Clinical Area.‖

Disruptive andInappropriate behaviorcan negatively impact

your work environmenttoo.

The policy applies to allUMHS personnel



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?



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



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.



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.



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



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



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



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



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



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



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

https://www.tnwinc.com/WebReport/

https://www.tnwinc.com/WebReport/



Behavior Report Form

Strongly Encouraged to Report!

1) Print Page in Policy (Exhibit B) & Fax to RiskManagement

- or -

2) Online submission



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 )



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



Importance to Our Work Area



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.



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.



Questions??





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



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)

http://www.med.umich.edu/i/umhshr/avinventory.htm




http://www.med.umich.edu/i/umhshr/videos/SELF-DISCIPLINE%20AND%20EMOTIONAL%20CONTROL.pdf



http://www.med.umich.edu/i/umhshr/videos/DEALING%20WITH%20CONFLICT.pdf

http://www.med.umich.edu/i/umhshr/videos/COMMUNICATING%20NON-DEFENSIVELY.pdf

http://www.med.umich.edu/i/umhshr/videos/MANAGING%20STRESS.pdf

http://www.med.umich.edu/i/umhshr/videos/DEALING%20WITH%20CONFLICT%20AND%20CONFRONTATION.pdf

http://www.med.umich.edu/i/umhshr/videos/DEALING%20WITH%20CONFLICT%20AND%20CONFRONTATION.pdf

http://www.med.umich.edu/i/umhshr/videos/MANAGING%20STRESS.pdf

http://www.med.umich.edu/i/umhshr/videos/COMMUNICATING%20NON-DEFENSIVELY.pdf

http://www.med.umich.edu/i/umhshr/videos/DEALING%20WITH%20CONFLICT.pdf






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



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?



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



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



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)



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



Resources

Nursing Health & Safety Committee

Educational Services for Nursing

Educational Plans for Management ofAggressive Behavior

734-615-9721

Click to return





Resources

Compliance Office

Information: 734-615-4400

Compliance Questions or Concerns24 hour Compliance Hotline:

866-990-0111

Click to return



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



Resources

UMHS Employee Assistance Program

Supervisory, Staff and Team Consultations

763-5409

Click to return



Resources

Health System Security Services

Full 24-hour coverage

Emergencies: 911

Non Emergencies: 936-7890

Click to return



Resources

Heather Wurster – Policy Lead ,

Resource for Staff, and Medical School PointPerson

Maureen Naszradi - Medical Staff Peer ReviewCoordinator232 - 1687

Documents

Disruptive Behavior Toolkit