Threat Assessment
Hospital Policies Standing Up To Workplace Bullies
Hospital Policies Standing Up To Workplace Bullies
By Michael Schroeder
The Journal Gazette Fort Wayne, Indiana
September, 21, 2008
By his own account, Joseph Doescher literally had his back against the wall.
Expecting to be hit, the former heart-lung machine operator at St. Francis Hospital put his hands up. Heart surgeon Dr. Daniel Raess had come at him quickly "with clenched fists, piercing eyes, beet-red face, popping veins," according to a written opinion from the Indiana Supreme Court quoting Doescher's testimony. Raess who also no longer works at the Indianapolis hospital was screaming and swearing at Doescher.
He didn't hit him. But Raess promised Doescher, who had gone to hospital administration about Raess' treatment of other perfusionists, "You're finished, you're history." Raess' attorneys would later argue that Raess didn't commit assault. Expert witnesses differed; one said a verbal assault didn't constitute a legal assault. But the Indiana Supreme Court in April affirmed a jury award of $325,000 to Doescher. The case got national attention.
Attorneys began considering bullying cases as the implications of the high-profile altercation reverberated across industries. But only the health care sector already at the eye of the storm has an industrywide mandate addressing the perceived problem, according to bullying expert Dr. Gary Namie, a social psychologist who testified in the Indianapolis case. The mandate was laid out by a national accrediting body in July.
"There is a history of tolerance and indifference to intimidating and disruptive behaviors in health care," the Joint Commission wrote in a Sentinel Event Alert. It cited numerous studies illustrating the problem and said that disruptive behavior doesn't just affect morale, it also potentially puts patients in harm's way.
To correct what it described as a prevalent problem, the commission is now requiring hospitals and other health care organizations to have a code of conduct that defines acceptable, disruptive and inappropriate behaviors. Health care leaders must create and implement a process to address behavior problems. Hospitals that don't take these steps by Jan. 1, 2009 could potentially lose accreditation.
Officials at local hospitals are confident their policies adequately address inappropriate behavior and say they enforce them. Still, they've taken notice of the Joint Commission's call to action.
Cheryl Rieves, the chief quality officer at St. Joseph Hospital, says she hasn't found bullying or disruptive behavior to be prevalent in her 11 years at the hospital.
Rieves, a nurse 25 years, says she has worked in other environments where bullying and intimidation were more common. But she says that was early in her career, outside Indiana. Rieves has seen improvements during the past two decades.
In response to the commission's directive, St. Joseph Hospital is devising a medical staff policy specific to physicians who have privileges at the hospital but aren't employees. It will complement the hospital's code of conduct policy for employees.
"We really felt that we were (already) meeting those standards" set forth by the commission, Rieves said. She and Chief Operating Officer Chad Towner owe that to open dialogue with staff and administration who make regular rounds throughout the hospital. There's also a hotline where staff can report problems anonymously.
Towner said that problems do come up emotions run high, and there are many personalities to manage. But problems are handled before they get out of control, he said. Even so, because disciplinary measures are confidential, it can be difficult to assure staff that those problems are addressed when they do arise, Towner said.
Actions could range from a warning to termination. He didn't provide details on specific instances and said he couldn't recall a physician having privileges revoked as a result of disciplinary problems.
Experts and attorneys say doctors and nurses in positions of authority are the usual bullying suspects. But the Joint Commission says the problem isn't limited by position. "Nor are such behaviors confined to the small number of individuals who habitually exhibit them," the commission wrote.
It said intimidating and disruptive actions include outbursts and physical threats but can be passive as well refusing to perform tasks, being uncooperative. Often, people in positions of power are the perpetrators, refusing to answer questions or return phone calls or using condescending language.
Many turn a blind eye to the problem even when it compromises patient care. A survey on intimidation found that 40 percent of clinicians kept quiet or were passive rather than question a known intimidator who was doing something that might compromise the safety of a patient, such as administering the wrong medication. The survey by the Institute for Safe Medication Practices was cited by the Joint Commission in its July alert.
In addition, hospitals' biggest breadwinners often get a free pass, according to another study cited by the commission.
About 39 percent of respondents to a physician behavior survey agreed that "physicians in my organization who generate high amounts of revenue are treated more leniently when it comes to behavior problems than those who bring in less revenue."
The survey was conducted by the American College of Physician Executives. Local hospital officials say they don't tolerate disruptive behavior from staff or physicians irrespective of their positions.
Dr. Tom Gutwein, an emergency room physician and past president of the Fort Wayne Medical Society, agrees with the assessment by some that disruptive behavior is more common among physicians than nurses.
A driven personality, a heavy workload and a high-stress environment can contribute to the problem, he said. So do a god complex, big ego and the sense of being indispensable, others say.
But Gutwein, the medical director of emergency departments for Parkview Health, says hospitals locally have done a great job of reining in disruptive behavior over the past 10 years. Physicians have been reprimanded, and some have even had their hospital privileges revoked, he said, declining to disclose details.
"It's not tolerated that type of behavior," Gutwein said.
He added that most of his colleagues are professional and respectful of other staff and physicians.
Dr. Greg Johnson is familiar with the high stakes and high emotions that come with working in health care. The board-certified internist and board-certified nephrologist practiced for 15 years and is now associate chief medical officer at Parkview Hospital.
Johnson said Parkview Hospital took the bullying issue to heart even before the commission's report. The hospital isn't doing anything different as a result.
Johnson said the hospital often updates its code of conduct policy, which was first put in place in 2002, to make sure it's as clear and effective as it can be to address current issues. "It's not a static document," he says.
He echoed St. Joseph Hospital officials in saying that employees and medical staff are aware of what's expected. The hospital follows its policy to the letter when problems arise, he said. Acting appropriately means following the Golden Rule (treating others as you would have them treat you), Johnson said.
In a high-pressure environment, that starts with taking care of oneself physically, spiritually and mentally, he said. It starts with stress management.
Bullied?
Expert tips on what you should do:
Source: "The Bully At Work" by Gary and Ruth Namie
Bossing Bullies
Not every situation can be handled by simply standing up to a bully. Experts say workplaces can inhibit or accommodate bullying. Here's a long-term plan to root it out at your workplace:
Source: Dr. Gary Namie, principal consultant, Work Doctor® Inc., WorkDoctor.com
Is it You?
Maybe you're the bully. Here are some telltale signs:
Source: Dr. Gary Namie, director of non-profit Workplace Bullying Institute
