Behavior Patient Safety Connection Behavior Patient Safety - - PDF document

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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


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Behavior Patient Safety Connection

Behavior Patient Safety Connection

Charlotte Jefferies Horty, Springer & Mattern

Does Any Doubt Remain? 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

  • bstetrics: a hidden threat to

patient safety”

American Journal of Obstetrics and Gynecology, June 2007

“When good doctors go bad: a Leape of faith”

Annals of Surgery, June 2008

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Behavior Patient Safety Connection

“Disruptive physicians: sound more familiar than you thought?”

Ear, Nose and Throat Journal

“Managing disruptive physician behavior: impact on staff relationships and patient care”

Neurology, April 2008

“Physicians’ ‘disruptive’ behavior: consequences for medical quality and safety”

American Journal of Medical Quality, May 2008

“Don’t Tolerate Disruptive Physician Behavior”

American Nurse Today, March 2008

“It is the health care equivalent of road rage.”

  • Dr. Peter B. Angood

Chief Patient Officer Joint Commission

Survey of health care workers at 102 nonprofit hospitals

18%

said they knew of a mistake that occurred because of an

  • bnoxious doctor.

177 disruptive physician events reported between May 2007 and October 2009

“…[D]isruptive behaviors … may have contributed to delays in pain control, increased risk of healthcare-associated infections or increased risk of burns.”

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Behavior Patient Safety Connection

Institute for Safe Medication Practices surveyed

2,000

health care workers 50% said they felt pressured into dispensing

  • r giving a

drug when they harbored serious doubts about its safety. 2 out of 5 admitted they held their tongues rather than risk setting off a known intimidator 7% reported they’d been involved in a medication error during the past year as a direct result.

No Doubt From… The Joint Commission

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Behavior Patient Safety Connection

The Joint Commission 2007/2008 Credentialing & Privileging Standards

ACGME General Competencies

  • Patient Care
  • Medical/Clinical Knowledge
  • Practice-Based Learning and

Improvement

  • Interpersonal and Communication Skills
  • Professionalism
  • Systems-Based Practice

The Joint Commission Sentinel Event Alert July 9, 2008

Behaviors that undermine a culture of safety.

The Joint Commission

In 2012, the term “disruptive” will be deleted in Standard L.D. 03.01.01, EPs 4 and 5.

“Behaviors that undermine a culture of safety.”

A survey of the impact of disruptive behaviors and communication defects on patient safety

Joint Commission Journal Quality and Patient Safety, August 2008

“The hospital has a code of conduct that defines acceptable, disruptive, and inappropriate behaviors.”

The Joint Commission 2009 L.D.03.01.01

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Behavior Patient Safety Connection

Rationale

“Safety and quality thrive in an environment that supports teamwork and respect for other people, regardless of their position in the organization.”

No Doubt From… The Courts

Tip

  • Many view themselves as “courageous

champions for quality”

  • Don’t ignore quality concerns —

investigate and document

  • Thwart whistleblower allegations!
  • Dr. Leal and the

Terrible, Horrible, No Good, Very Bad Day

  • Dr. Leal’s use of an operating room was

delayed (for 20 minutes, as it turned out)

  • “He pitched a fit.”

Leal v. HHS

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Behavior Patient Safety Connection

The hospital suspended his privileges for 60 days and reported the suspension to the Data Bank.

  • Dr. Leal sued to have the

report removed.

Leal v. HHS

A) he broke a telephone A) shattered the glass on a copy machine A) shoved a cart into the doors of the operating suite so hard that it damaged one of them According to the hospital,

  • Dr. Leal became so enraged:

R) he accidentally broke a telephone when he tripped on its cord R) closed the lid of a copy machine with ‘some force’ and the glass cracked R) moved a cart that was blocking the doors of the

  • perating suite

According Dr. Leal’s affidavits: A) he threw jelly beans down the hallway in the surgical suite A) flung a medical chart to the ground R) he ate jelly beans, some

  • f which fell on the

floor when he tried to throw away flavors he did not like R) dropped some loose papers when he was handed a chart According to the hospital,

  • Dr. Leal became so enraged:

According to Dr. Leal’s affidavits:

“In other words, this urological surgeon, who earns his living wielding a razor-sharp scalpel

  • n some of the most delicate parts of the body,

does not have a bad temper –

The Court Said:

he is just clumsy.”

“…Disruptive and abusive behavior by a physician, even if not resulting in actual or immediate harm to a patient, poses a serious threat to patient health or

  • welfare. A physician must work collaboratively

with other members of a medical staff in order to provide quality care to patients. “…A hospital is one place where no one can do his job alone, where better teamwork means better care, and where disruptive behavior threatens lives.”

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Behavior Patient Safety Connection

Adopt a Code of Conduct

Step 1 Step 1

  • Understand current incident
  • Review chronology of past incidents

Gather Information

Step 2 Step 2

(and stick to it)

Step 3 Step 3

Set an agenda Shooting from the hip Meet with the physician

Step 4 Step 4

Sending mixed messages

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Behavior Patient Safety Connection

Ignoring quality concerns Requesting psychiatric examination Stay focused on the inappropriate behavior, not its cause. Use progressive steps.

Step 5 Step 5

Performance Improvement Plans aka Personalized Code

  • f Conduct

Collegial Intervention Continuum

!

Educational letters of counsel or guidance “Cup of Coffee” Conversations Written Warnings & Reprimands

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PIP Options for Conduct

  • “Charm School”
  • Behavior Coach
  • Behavior Modification Course
  • “Personal Code of Conduct”
  • (Continued Appointment/Conditional

Reappointment)

Physician Development Program P.U.L.S.E Formal, planned follow-up with physician

Step 6 Step 6

“Discipline” is last resort!