How Hospitals Benefit From Being Nice: A Guest Post
Rudeness isn’t new to the medical profession. In the original charter of the American Medical Association, approved more than 150 years ago, physicians were warned to “avoid all contumelious and sarcastic remarks.”
But now the medical community acknowledges that bad behavior isn’t just about manners. It can harm patients and result in serious financial consequences for hospitals through loss of efficiency and decreased productivity.
Last week the Joint Commission on Accreditation of Hospitals issued a “sentinel event alert,” which warned that “rude language and hostile behavior among health care professionals goes beyond being unpleasant and poses a serious threat to patient safety and the overall quality of care.” By January 1, 2009, the 15,000 hospitals, nursing homes, and other health agencies monitored by the Joint Commission will be required “to create a code of conduct that defines acceptable and unacceptable behaviors and to establish a formal process for managing unacceptable behavior.”
This week the American Hospital Association’s Hospital and Health Networks published an article on the subject under this headline: “The right culture can result in the right outcomes and help avoid costly litigation.”
The New York Times recently reported that doctors are being advised to apologize to patients as a way to fend off malpractice suits.
Momentum has been building. Three years ago a publication from the National Institutes of Health reported, “Dysfunctional nurse-physician communication has been linked to medication errors, patient injuries, and patient deaths.”
About that time, Maimonides Medical Center in Brooklyn began a program to encourage employees to follow the hospital’s Code of Mutual Respect, whose provisions include this one: “The Medical Staff agrees to refrain from any behavior that is deemed to be intimidating, including but not limited to using foul language or shouting, physical throwing of objects …”
The program coincided with the year I spent immersed at the hospital to write a book. During that time, a senior nurse explained,
Think about it. You can’t do surgery without your instruments. Our instrument techs make thirty thousand dollars a year, and we expect them to be these highly skilled, ambitious people who are going to make sure the tray is going to be built exactly the way the surgeon wants it. But they don’t have the same drive the surgeon has. It’s not the same drive even a nurse may have.
How do you motivate someone who makes twelve dollars an hour? By saying, “Your next raise you’re getting another twelve cents?” I think what beats them down is the hierarchy — the respect they’re given or not given. Everyone beats down on the one below.
Here is the hospital’s “respect survey” and how people have responded over the past three years:
The Joint Commission might urge medical people to follow the advice of Maimonides, the 12th century philosopher and physician who wrote: “The perfect man needs to inspect his moral habits continually, weigh his actions, and reflect upon the state of his soul every single day.”
Will more self-scrutiny help avoid litigation and improve patient care?