Behavior Patient Safety Connection Behavior Patient Safety - PDF document

Behavior Patient Safety Connection Behavior Patient Safety Connection Does Any Doubt Remain? Charlotte Jefferies Horty, Springer & Mattern Those Who Provide Care “ Impact and implications of disruptive behavior in the perioperative arena ” Journal of the American College of Surgeons, July 2006 “ Disruptive behavior in “ When good doctors go obstetrics: a hidden threat to bad: a Leape of faith ” patient safety ” Annals of Surgery, June 2008 American Journal of Obstetrics and Gynecology, June 2007 K:\PRES\HANDOUT\EPI\1112\03Naples\Charlotte\Behavior_Patient_Safety.ppt 1

Behavior Patient Safety Connection “ Managing disruptive physician “ Disruptive physicians: sound behavior: impact on staff more familiar than you thought? ” relationships and patient care ” Ear, Nose and Throat Journal Neurology, April 2008 “ Physicians ’ ‘ disruptive ’ “ Don ’ t Tolerate Disruptive behavior: consequences for Physician Behavior ” medical quality and safety ” American Nurse Today, March 2008 American Journal of Medical Quality, May 2008 “ It is the health care equivalent of road rage. ” Dr. Peter B. Angood Chief Patient Officer 177 disruptive Joint Commission Survey of health care workers at 102 nonprofit hospitals physician events reported between 18% “ …[D]isruptive behaviors … may have May 2007 and said they knew of a mistake that occurred because of an contributed to delays in pain control, obnoxious doctor. October 2009 increased risk of healthcare-associated infections or increased risk of burns. ” K:\PRES\HANDOUT\EPI\1112\03Naples\Charlotte\Behavior_Patient_Safety.ppt 2

Behavior Patient Safety Connection Institute for Safe Medication Practices surveyed 2,000 health care workers 50% said they 2 out of 5 felt pressured admitted they into dispensing held their or giving a tongues rather drug when than risk they harbored setting off a serious doubts known about its intimidator safety. No Doubt From… 7% reported they ’ d been The Joint Commission involved in a medication error during the past year as a direct result. K:\PRES\HANDOUT\EPI\1112\03Naples\Charlotte\Behavior_Patient_Safety.ppt 3

Behavior Patient Safety Connection The Joint Commission 2007/2008 Credentialing & Privileging Standards The Joint Commission ACGME General Competencies Sentinel Event Alert • Patient Care • Medical/Clinical Knowledge July 9, 2008 • Practice-Based Learning and Improvement Behaviors that undermine a • Interpersonal and Communication Skills culture of safety. • Professionalism • Systems-Based Practice The Joint Commission In 2012, the term “ disruptive ” will “ Behaviors that undermine a be deleted in Standard L.D. 03.01.01, culture of safety. ” EPs 4 and 5. The Joint Commission 2009 L.D.03.01.01 A survey of the impact of disruptive behaviors and communication defects on patient safety “ The hospital has a code of conduct that defines Joint Commission Journal Quality and acceptable, disruptive, and Patient Safety, August 2008 inappropriate behaviors. ” K:\PRES\HANDOUT\EPI\1112\03Naples\Charlotte\Behavior_Patient_Safety.ppt 4

Behavior Patient Safety Connection No Doubt From… Rationale The Courts “ Safety and quality thrive in an environment that supports teamwork and respect for other people, regardless of their position in the organization. ” Tip • Many view themselves as “ courageous champions for quality ” • Don ’ t ignore quality concerns — investigate and document • Thwart whistleblower allegations! Dr. Leal and the Leal v. HHS Terrible, • Dr. Leal ’ s use of an operating room was delayed (for 20 minutes, as it turned out) Horrible, • “ He pitched a fit. ” No Good, Very Bad Day K:\PRES\HANDOUT\EPI\1112\03Naples\Charlotte\Behavior_Patient_Safety.ppt 5

Behavior Patient Safety Connection According to the hospital, According Dr. Leal ’ s Leal v. HHS Dr. Leal became so enraged: affidavits: The hospital suspended his R) he accidentally broke a A) he broke a telephone telephone when he privileges for 60 days and tripped on its cord reported the suspension to the A) shattered the glass on R) closed the lid of a copy a copy machine machine with ‘ some Data Bank. force ’ and the glass cracked A) shoved a cart into the Dr. Leal sued to have the doors of the operating R) moved a cart that was report removed. blocking the doors of the suite so hard that it operating suite damaged one of them The Court Said: According to the hospital, According to Dr. Leal ’ s Dr. Leal became so enraged: affidavits: “ In other words, this urological surgeon, who A) he threw jelly beans R) he ate jelly beans, some earns his living wielding a razor-sharp scalpel down the hallway in of which fell on the the surgical suite floor when he tried to on some of the most delicate parts of the body, throw away flavors he does not have a bad temper – did not like he is just clumsy. ” A) flung a medical chart R) dropped some loose to the ground papers when he was handed a chart “ …Disruptive and abusive behavior by a physician, even if not resulting in actual or immediate harm to “ …A hospital is one place where no one can do his a patient, poses a serious threat to patient health or job alone, where better teamwork means better care, welfare. A physician must work collaboratively and where disruptive behavior threatens lives. ” with other members of a medical staff in order to provide quality care to patients. K:\PRES\HANDOUT\EPI\1112\03Naples\Charlotte\Behavior_Patient_Safety.ppt 6

Behavior Patient Safety Connection Step 1 Step 1 Step 2 Step 2 Gather Information Adopt a Code of Conduct • Understand current incident • Review chronology of past incidents Step 3 Step 3 Shooting from the hip Set an agenda (and stick to it) Step 4 Step 4 Meet with the physician Sending mixed messages K:\PRES\HANDOUT\EPI\1112\03Naples\Charlotte\Behavior_Patient_Safety.ppt 7

Behavior Patient Safety Connection Ignoring quality concerns Stay focused on the inappropriate behavior, Requesting psychiatric not its cause. examination Collegial Intervention Continuum Step 5 Step 5 Performance Improvement Plans aka Personalized Code “ Cup of Coffee ” of Conduct Conversations Use progressive steps. Educational letters of Written Warnings counsel or guidance & Reprimands ! K:\PRES\HANDOUT\EPI\1112\03Naples\Charlotte\Behavior_Patient_Safety.ppt 8

Behavior Patient Safety Connection PIP Options for Conduct • “ Charm School ” Physician Development • Behavior Coach Program P.U.L.S.E • Behavior Modification Course • “ Personal Code of Conduct ” • (Continued Appointment/Conditional Reappointment) Step 6 Step 6 “ Discipline ” is last resort! Formal, planned follow-up with physician K:\PRES\HANDOUT\EPI\1112\03Naples\Charlotte\Behavior_Patient_Safety.ppt 9