Disrespect among workers is “a threat to patient safety because it inhibits collegiality and cooperation essential to teamwork, cuts off communication, undermines morale, and inhibits compliance with and implementation of new practices.”

- Lucian L. Leape, MD

Editor’s Note
This is the first in a two-part series about Virginia Mason’s focus on Respect for People. This effort involves all 5,000 staff members and is aimed at significantly advancing Virginia Mason’s work toward the perfect patient experience. In this entry, we report on the origins of Respect for People. In an upcoming post, we’ll report from leaders in various areas and their experiences with the impact of Respect for People at the front lines of care.

There aren’t many truly iconic figures in health care today, but Dr. Lucian Leape is certainly one of them. More than 20 years ago, Dr. Leape and his colleagues conducted breakthrough research revealing nearly 4 percent of hospital patients suffered an injury that prolonged their hospital stay or caused disability, that 14 percent of those injuries were fatal, and that 69 percent of injuries were the result of what Dr. Leape believed were clearly preventable errors.

This landmark work set Dr. Leape on a crusade to improve the safety of American medicine that has lasted more than two decades. His impact is immense.

When Dr. Leape visited Virginia Mason in May 2011, he was impressed with the VM safety record, but he pushed us to improve even more by focusing on how VM employees treat each other on a day-to-day basis.

Lynne Chafetz,
VM Senior VP & General Counsel

“We had done mandatory service training for all our people and there was some staff feedback that it was great training but that we also needed to work on how we treat each other,” says Lynne Chafetz, VM senior vice president and general counsel, who coordinated the work. “We invited Dr. Leape to visit us, and he helped call out for us work we needed to do to improve our teams feeling safe to raise concerns.”

Dr. Leape’s essential point is the way people treat each other in health care – and are treated by leaders of their organization – has an enormous impact not only on the workers, but also on the safety and well-being of patients.

“A substantial barrier to progress in patient safety is a dysfunctional culture rooted in widespread disrespect [including] … disruptive behavior; humiliating, demeaning treatment of nurses, residents, and students; passive-aggressive behavior; passive disrespect; dismissive treatment of patients; and systemic disrespect.”

Dr. Leape views disrespect among workers as “a threat to patient safety because it inhibits collegiality and cooperation essential to teamwork, cuts off communication, undermines morale, and inhibits compliance with and implementation of new practices.”

The result of the discussion with Dr. Leape by Chafetz and other VM executive leaders is the ongoing, organizationwide initiative we call “Respect for People.” It has been an overall organizational goal at VM throughout this year and will continue to be so throughout 2013.

“What Dr. Leape had to say about respect for people really resonated in our organization – what respect really means, what its impact can be on our workforce and on our patients,” Chafetz says.

Chafetz and her team received clear feedback from VM staff members that “we need exceptional service for patients, but we also need to work on how we treat each other.” She organized an advisory group “to define foundational behaviors of respect,” and out of that emerged a mandatory two-hour course for all VM team members.

In an unusual wrinkle, part of the training involved employees viewing a theatrical production, staged by professional actors and representing a variety of different scenarios of behavior in health care. A key focus was to understand that there is obvious disruptive behavior and also passive disrespect that is more subtle and just as unacceptable.

“It was very effective at showing scenes where people were feeling disrespected  while other scenes showed what it was like to have great team work and respect,” says Chafetz.

Her view is the work thus far has generally gone well, but there is much more to do, and the challenge of behavior is an unusually broad one.

“We tend to sort goals into quality or service or innovation, and this was the first goal that explicitly crossed all the pillars of our strategic plan,” says Chafetz. “This influences our culture, the way we do our work, our patients – everything.”

The foundational behaviors of Respect for People include:

1. Listen to understand. Good listening means giving the speaker your full attention. Non-verbal cues like eye contact and nodding let others know you are paying attention and are fully present for the conversation. Avoid interrupting or cutting others off when they are speaking.
2. Keep your promises. When you keep your word you show you are honest and you let others know you value them. Follow through on commitments and if you run into problems, let others know. Be reliable and expect reliability from others.
3. Be encouraging. Giving encouragement shows you care about others and their success. It is essential that everyone at VM understand their contributions have value. Encourage your co-workers to share their ideas, opinions and perspectives.
4. Connect with others. Notice those around you and smile. This acknowledgement, combined with a few sincere words of greeting, creates a powerful connection. Practice courtesy and kindness in all interactions.
5. Express gratitude. A heartfelt “thank you” can often make a person’s day and shows you notice and appreciate their work. Use the VM Applause system (an internal recognition program), a handwritten note, verbal praise, or share a story of “going above and beyond” at your next team meeting.
6. Share information. When people know what is going on, they feel valued and included. Be sure everyone has the information they need to do their work and know about things that affect their work environment. Sharing information and communicating openly signals you trust and respect others.
7. Speak up. It is our responsibility to ensure a safe environment for everyone at VM; not just physical safety but also mental and emotional safety. Create an environment where we all feel comfortable to speak up if we see something unsafe or feel unsafe.
8. Walk in their shoes. Empathize with others; understand their point of view, and their contributions. Be considerate of their time, job responsibilities and workload. Ask before you assume your priorities are their priorities.
9. Grow and develop. Value your own potential by committing to continuous learning. Take advantage of opportunities to gain knowledge and learn new skills. Share your knowledge and expertise with others. Ask for and be open to feedback to grow both personally and professionally.
10. Be a team player. Great teams are great because team members support each other. Create a work environment where help is happily offered, asked for and received. Trust that teammates have good intentions. Anticipate other team members’ needs, and clearly communicate priorities and expectations to be sure the work load is level loaded.

Citations:
Paul O’Neill quotes from his article Truth, Transparency, and Leadership by Paul H. O’Neill Public Administration Review, Vol. 72, Iss. 1, pp. 11–12. © 2011 by The American Society for Public Administration. DOI: 10.111/j.1540-6210.2011.02487.x.

Leape et al: “A Culture of Respect, Part 1: The Nature and Causes of Disrespectful Behavior by Physicians.”  Academic Medicine: July 2012 – Volume 87 – Issue 7 – p 845–852 – Leape, Lucian L. MD; Shore, Miles F. MD; Dienstag, Jules L. MD; Mayer, Robert J. MD; Edgman-Levitan, Susan PA; Meyer, Gregg S. MD, MSc; Healy, Gerald B. MD