As we head into the second half of 2020, many of the temporary flexibilities for telehealth allowed during the COVID-19 pandemic have been made permanent. Since its arrival in
Read more »There’s No Room for a Bad Attitude in the Surgical Suite
Why do doctors have such a reputation for being jerks? Is it the better surgeon they are, the bigger the ego? While this perception isn’t always true, dealing with a condescending doctor is something most of us have had to endure at one time or another.
A recent study revealed what fellow clinicians have known for some time: a surgeon with an unprofessional or careless demeanor is more likely to have patients who experience complications and adverse events.
A recent study by Vanderbilt University Medical Center examined the connection between a surgeon’s unprofessional behavior and its effect on surgical teams and the risk for adverse events. William Cooper, MD, MPH, vice president of Patient and Professional Advocacy at VUMC, observed: “Surgical teams require every team member to perform at their highest level. We were interested in understanding whether surgeons’ unprofessional behaviors might undermine culture, threaten teamwork and potentially increase the risk for adverse outcomes of care.” [1]
The study found that surgeons who are rude and unprofessional with their fellow surgical team members are more likely to have complications during and after operations. An analysis of the report states: “Patients of surgeons [with] one to three reports of unprofessional behavior had an 18% higher risk for complications.”[2] If the surgeon had four or more reports, his or her patients had a 32% higher estimated risk for complications than surgeons with no unprofessional behavior reports.
Studies have consistently indicated positive associations between patient experience, patient safety, and clinical effectiveness. Across these studies, it is more common than not to discover positive associations between patient experience and measures of the technical quality of care and adverse outcomes. The evidence demonstrated this when evaluating the patient experience in both self-rated and objectively measured health outcomes in over 55 studies. [3]
Physicians are often the focus of these types of behavioral problems and the typical stereotype of “bad bedside manner”, however nurses are also guilty. While the Magnet Recognition Program® is considered the gold standard for nursing excellence, the American Nurses Credentialing Center (ANCC), who determines this hospital recognition, correlates these hospitals with higher percentages of satisfied nurses, lower RN turnover and vacancy, higher patient satisfaction, and improved clinical outcomes. [4]
Despite these strong indicators, organizations wishing to build a culture of safety and excellence within their nursing units, often struggle to implement a standard review and management process for their nursing staff [5].
Hospitals tend to rely on their peer review systems to catch problematic behaviors. But those programs vary and are protected by state statutes, which can make it challenging to develop a process that’s comprehensive and appropriate for their hospital’s evolving needs where feedback is often provided in a myriad of ways.
So, the question remains: How can organizations empower their peer review process and ensure practitioner-level protection while identifying “red flags”, discovering trends, and reinforcing positive behavior?
Putting people over process
It’s great to see studies validate what care teams have known anecdotally for many years; there is a very real need to build a culture of safety that incorporates the patient and the people that work with that patient as much as the process. In order to drive change, it must be done in an environment where staff feels empowered to report adverse events and unsafe conditions—including unprofessional or threatening behavior.
Success Story
One of the largest nonprofit health systems in the country partnered with Verge Health for its Converge platform. With Converge, data is seamlessly collected and integrated throughout the health system, increasing the efficiency of processes while reducing data loss and improving close calls, or “catches.” The health system now receives 59% of its peer review referrals through the Converge platform, namely adverse events and patient complaints/grievances. Of those referrals, 62% proceed to peer review. This process ensures better, more proactive management of providers, easier identification of system issues and comprehensive action plans to be put in place before safety is compromised.
Verge’s Converge Platform makes it easier for patients, staff, and caregivers to report events, resulting in more information driving a culture of learning from events, near misses, and unsafe conditions. Logic may tell us the fewer events reported, the better. And while that is the ultimate goal, to get to zero adverse events, you need to ensure a broad capture of all events.
With an integrated platform, hospitals can compile data from across the organization, including complaints, grievances, events, and audits, to inform peer review and tie credentialing to real-time safety issues, increasing the efficiency of processes, breaking down silos, and tying practitioners back to safety issues.
[3] https://bmjopen.bmj.com/content/3/1/e001570.short
[4] http://lippincottsolutions.lww.com/blog.entry.html/2016/09/27/history_of_the_magne-PylM.html
[5] https://www.nursingworld.org/organizational-programs/magnet/magnet-model
