Creating a Culture of Mutual Respect in the OR

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Creating a Culture of Mutual Respect in the OR
David L. Feldman, MD Pamela Mestel, RN Kathryn
Kaplan, PhD Maimonides Medical Center Brooklyn,
New York
2007 Executive Symposium July 17, 2007
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Ask yourself
How many of you have observed others being
treated disrespectfully in the last week?
How many of you have been treated disrespectfully
in the last week?
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So What?

• .respect is like air. If you take it away, its
  all people can think about.

Patterson K., Grenny J., McMillan R, Switzler A.
Crucial Conversations. 2002 McGraw-Hill. pp.
71.
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Creating a Culture of Mutual Respect in the OR

• Our current state
• Background
• Design
• Implementation
• Measuring results
• Moving forward

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The spectrumof disrespectful behavior

• Put downs
• Nasty comments
• Swearing
• Bullying
• Sexual innuendo
• Yelling and Screaming
• Physical abuse

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Perceptions

• Nursing staff feel that surgeons have no regard
  for anything but getting their case done
• Anesthesiologists feel they are not taken
  seriously by their surgeon colleagues and are
  taken for granted by the staff
• Surgeons feel that staff are here only to work a
  shift

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History

• Harvard conference on Trust
• Discussions with
• Peer Review Committee
• Department Chairs
• Nurse focus groups
• Endorsed by EMC 6/2004

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Design

• Part of LD initiative and steering committee
  (based on needs assessment)
• Research
• Silence Kills
• Crucial Confrontations/Conversations
• Level 3 change
• OR Pilot

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Pilots Key Components

• Leaders (MD/RN) as champions
• Code Users, Advocates, Trainers Behavior/Belief
  matrix
• Mediated conversations
• Tracking of systems issues
• Skills training
• Measurement respect survey
• Phases of culture change

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You got to be kidding!

• Initial Engagement vs. Rolling Eyes
• All staff knowledgeable about Code and Continuum
  of Behavior (under the radar)
• Expect skepticism, negativity, ridicule

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Who Me?

• Work with the Program vs. Wringing Hands
• People raise questions and concerns during
  training
• Using terminology We need to have a Crucial
  Conversation
• Having mediated conversations
• Identifying system catalysts

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What about them?!

• Beginning to internalize vs. Public Hanging
• Holding people accountable
• Becoming aware of emotional hijacks
• Staff going to advocates to handle issues, not
  only the leaders
• Fixing system issues

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Get with the program or

• Changing the Culture vs. Jump ship!
• Fewer mediated conversations
• Positive attitudes about conditions for providing
  safe patient care
• Department seen as a great place to
  workrespectful environment

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Implementation

• OR logistics
• 9/05 launch with CEO
• Three reasons not to believe
• Personal Ill just get it worse the next time
• Social Hell never change
• Structural Administration will never do
  anything about it
• Video
• Training began 1/06
• Large group (200) v. multiple smaller groups (50)
• Customization of training (role play)
• Awareness

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Mediated Conversations

• The involved parties
• Someone that each feels supports their
  point-of-view
• Mediator

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Props!

• Mirrors
• CRIB cards
• Whats your story buttons
• Change purse/pad with STATE and AMPP

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Measurement

• Attendance
• Qualitative
• Initial and follow-up interviews
• Stories of surgeons behavioral change
• Quantitative
• Baseline, mid-point, post-training surveys

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Respect Survey Response By title
responding
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Results by Year - General Questions(Top 2
Ratings)
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Response by roleOverall, I am treated with
respect by those with whom I work
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Response by specialtyOverall, I am treated with
respect by those with whom I work
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Response by category Physicians
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Response by category Nurses and Surgical Techs
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Response by category Ancillary Staff
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Moving Forward

• Other departments requested pilots
• 2007-2008
• OB/GYN
• Pediatrics
• Continued updates in Perioperative Services at
  Quarterly Meetings

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Moving Forward

• Back to the Medical Staff Peer Review Committee
• Rewriting the appendix
• A twofold process
• Holding physicians (and ultimately everyone)
  accountable!

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Vision

• The Medical Staff encourages all members of the
  hospital community to work together in a
  collaborative fashion such that unfavorable
  interactions can be either avoided, or addressed
  by the parties involved in a professional,
  productive manner.

Maimonides Code of Mutual Respect
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Thank You!
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Attendance Trends

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Creating a Culture of Mutual Respect Through
Individuals Changing What They Do and How They
Think

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Payback!