Disruptive Behavior Among Staff: Now What Do We Do?

1. Disruptive Behavior Among Staff: Now What Do We Do? Lela Holden, Ph.D., RN, CPPS Patient Safety Officer May 20, 2013

2. Let’s begin with a story....

3. Behaviors that Undermine a Culture of Safety • Overt actions • Verbal outbursts and physical threats • Passive activities • Refusal to perform assigned tasks, or unacceptable attitudes.. Including reluctance or refusal to answer questions, return calls or page, condescending language, voice intonation and impatience with questions • Intermittently disruptive behaviors can: • Foster medical errors • Decrease satisfaction and outcomes • Increase cost • Decrease retention • Degrade teamwork • Occur across all disciplines and among all staff Joint Commission, Sentinel Event Alert -- July 9, 2008 - Issue # 40:Behaviors that Undermine a Culture of Safety

4. Current Process at MGH 3-Stages: • SURVEILLANCE: Encourage reporting of these events in electronic safety reporting system. Surveillance method is essential • ANALYSIS: Investigation by Quality Assessment Chairs in the respective departments; collaborate across departments; involve HR as determined by leaders • INTERVENTION: Encourage and facilitate the interaction of individuals involved: come to the table

6. Evaluation of the model • Touched a nerve---number of reports steadily increased • Staff Satisfaction with Model 356 individuals surveyed using REDCAP* 145 responses – 41% response rate * Harris PA et al, 2009

7. Staff perceptions of the model

8. What have we learned? • We are making progress… • The model is useful in: • Advancing a culture of patient safety • Building relationships across disciplines/departments/QA Chairs • Focusing attention on the impact of teamwork in the delivery of quality care • A policy is needed for those involved with repeated professional conduct issues . . .under development in collaboration with senior leaders