Embed Size (px)
Citation preview
Presented at the Middle East Patient Safety & Quality Congress Abu Dhabi 11th – 13th May 2015
Presented By
Krishnan Sankaranayanan MS, MBA, CPHQ, FASHRM, LHRM
Senior Safety Officer / Tawam Hospital
Disruptive Behavior- “its impact on Staff & Patient Safety”
Disclosure
The presenter has nothing to disclose, nor has any commercial interest with any of those information's displayed in this presentation.
2015/5/14 2
About Tawam Hospital
• Tawam is a 466-bed tertiary care facility located in the garden city Al Ain in the middle of the desert, and one among the largest healthcare facilities in the United Arab Emirates.
• In 2006 the General Authority of Heath Services now called as the Abu Dhabi Health Services Company PJSC (SEHA) entered in to a ten year affiliation contract with Johns Hopkins Medicine.
• Tawam Hospital has current status with
• Joint Commission International Accreditation (2006; 2009; 2012),
• College of American Pathology (CAP; 2011) and
• American College of Graduate Medical Education- International (ACGME; Program Accreditation)
2015/5/14 3
Learning Objectives
Attendees will be able to demonstrate knowledge on:-
• The definition and the types of disruptive behavior.
• Ways to identify and mitigate them.
• Creating support mechanism to help staff affected by disruptive behavior.
Disruptive Behavior -Definition
• Conduct by a health care professional that intimidates others working in the organization to the extent that quality and safety are compromised. (Joint Commission) • One of the requirements under Standard GLD.(Governance Leadership and
Direction)
Examples of these behaviors
• Abusive language
• Humiliating someone in front of others
• Rolling eyes in disgust
• Refusing to help others
• Throwing items
• Physically assaulting
Some facts
• Incivility can lead to social isolation or exclusion, the devaluation of someone else’s work, verbal threats, and even physical confrontations. The costs associated with incivility in the OR can be substantial. (Physicians Weekly Incivility in Surgery March 27, 2012)
• Disruptive and disrespectful behavior by physicians has also been tied to nursing dissatisfaction and likelihood of leaving the nursing profession, and has been linked to adverse events in the operating room.
• In a survey of 1,565 nurses, intimidation by physicians was found to have a negative impact on patient care (Institute for Safe Medication Practices, 2009)
Source: Rosenstein AH, O'Daniel M. A survey of the impact of disruptive behaviors and communication defects on patient safety. Jt Comm J Qual Patient Saf. 2008:34;464-471.
Reported
Not reported
Key strategies for improving the behavioral culture in ORs:• 1. Recognize the power of civility. Developing clear, consistent code
for all staff—regardless of stature within the organization.
• 2. Eliminate anonymity. staff needs to know each other. When recruiting assess social skills and personality traits that will nurture a culture of civility.
• 3. Get leadership “buy-in.” Administrative leaders should help model the behavioral culture for the team working in the OR.
Ten commandments to deal with disruptive behavior 1. Recognition and awareness- assess the frequency and significance
of disruptive behaviors.
2. Cultural commitment/leadership/champions- Commitment and endorsement from the board, administration, and clinical leadership.
3. Policies and procedures- establish a zero-tolerance policy, code of conduct agreement as part of their employee contracts.
4. Incident reporting- adopt a uniform approach to event reporting
5. Structure and process- uniform methodology for addressing the issues. Trained multidisciplinary team approach.
Ten commandments to deal with disruptive behavior 6. Initiating factors- to understand the background as to why these
events might occur.
7. Education and training- raising awareness, role play.
8. Communication tools- Body language and voice inclination have a greater impact. Providing scripted messages.
9. Discussion forums- encouraging staff interaction during patient rounds or joint conferences.
10. Intervention strategies- implement a “code-white” or debriefing to discuss constructive suggestions.
2.2 Tawam Hospital has a zero-tolerance stand and approach to vertical and
horizontal bullying, violence, and demeaning behaviors. This approach applies
to employees, visitors, patients and family members.
Our data- PSN’s on Disruptive Behavior
5
3 3
2
1
0
1
0
1
2
3
4
5
6
7
8
2013 2014 2015
No
of
PSN
's
Year
PSNs on Disruptive Behavior
Doctor Vs Nurse Nurse Vs Porter Nurse Vs Nurse
“Plans for 2015 to achieve- Team brain storming”- Sticky Notes
Raise awareness
• Created video case study with scenarios
• Presented it at the OR staff meeting.
Staff major concern
• Staff appreciated the video
• Wanted assurance of strict & timely enforcement of “Zero Tolerance”
Approach
• Pilot Create task force (Multidisciplinary- Surgeon, Anesthetist, Nursing) • SWORD Team - Supporting Workers in the Operating Room
Affected by Disruptive Behavior.• The main functions
• Respond• Support• Mediate • Deescalate• Facilitate• Monitor
Approach –Contd…..
• Create frame work/guidelines for the functioning of the SWORD Team.
• Aim:-• To reinforce “ Zero Tolerance” to disruptive behavior• To address the concerns logically and objectively
• Staff involved in disruptive behavior situations can call SWORD Team.
• SWORD Team to meet within 24 hours with the staff involved.
• At the end SWORD Team to de-brief and monitor.
Most Important variable!!
• Leadership support
Conclusion
• Leadership must enforce “Zero tolerance” to such behaviors.
• “if senior management fail to challenge unsafe behaviors they unwittingly reinforce the notion that this behavior is acceptable to the organization.”
safety matters a guide to health & safety at work leadership and organizational safety culture
References
• Rosenstein AH, Naylor B. Incidence and impact of physician and nurse disruptive behaviors in the emergency department. J Emerg Med. 2012;43(1):139–148.
• Rosenstein AH, O’Daniel M. A survey of the impact of disruptive behaviors and communication defects on patient safety. Jt Comm J Qual Patient Saf. 2008;34(8):464–471.
• Rosenstein AH, O’Daniel M. Disruptive behavior and clinical outcomes: perceptions of nurses and physicians. Am J Nurs. 2005;105(1):54–64.
• Rosenstein AH, O’Daniel M. Impact and implications of disruptive behavior in the perioperative arena. J Am Coll Surg. 2006;203(1):96–105.
• McLaren K, Lord J, Murray S. Perspective: delivering effective and engaging continuing medical education on physicians’ disruptive behavior. Acad Med. 2011;86(5):612–617.
