Promoting Professional Conduct

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Promoting Professional Conduct Module 3
Supporting Engagement
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Professional Conduct Toolkit Overview
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Video The Role of Leaders in Addressing
Unprofessional Conduct
Click box to start and pause video
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Introductory Scenario

• Promotion of professional conduct requires system
  supports that enable health professionals to
  engage effectively.

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Module 3 Learning Objectives

• Describe the role of organizational leaders in
  the promotion of professional conduct across the
  system.
• Describe the Joint Commission leadership
  standards and recommendations for addressing
  conflict and unprofessional conduct.
• Describe how enforcement and engagement are
  complementary approaches for responding to lapses
  in professional conduct.
• Identify how to use a tiered approach for
  responding to unprofessional conduct.
• Identify assessment tools that can be used at
  both the individual and group levels.
• Describe the role of the leader/coach in
  promoting professional conduct.
• Identify how health professionals can develop
  conflict competence.

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Role of Leaders

• Promoting professional conduct occurs at both the
  individual and system levels.
• Leaders are responsible for creating system
  supports that enable health professionals to
  engage collaboratively and address conflict
  effectively.

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Sentinel Event Alert 40 Behaviors that
Undermine a Culture of Safety

• Recommendations within The Joint Commission
  Sentinel Event Alert 40Behaviors that
  Undermine Safe Patient Care
• Develop an organizational process for addressing
  intimidating and disruptive behaviors (LD.3.10 EP
  5) that solicits and integrates substantial input
  from an inter-professional team including
  representation of medical and nursing staff,
  administrators and other employees. Document all
  attempts to address the behavior.
• Provide skills-based training and coaching for
  all leaders and managers in relationship-building
  and collaborative practice, including skills for
  giving feedback on unprofessional behavior, and
  conflict resolution.

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Joint Commission Leadership Standards

• LD.03.01.01
• Standard
• Leaders create and maintain a culture of safety
  and quality throughout the organization.
• Elements of Performance
• EP 4 The hospital/organization has a code of
  conduct that defines acceptable and disruptive
  and inappropriate behaviors.
• EP 5 Leaders create and implement a process for
  managing disruptive and inappropriate behaviors.
• http//jointcommission.com

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Codes of Conduct

• Uniform across the organization and across all
  disciplines
• Developed with input from an inter-professional
  team
• Be specific and descriptive as to expectations
  for desirable behavior and what is considered
  disruptive or unprofessional
• Aimed at ensuring high quality and safe care for
  patients and orderly operation of the facility
• Should include or accompany a policy outlining a
  process

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Enforcement and Engagement

• Policies should integrate enforcement
  (power-based approaches) with engagement
  (collaborative approaches) to effectively promote
  professional conduct.
• Processes should include options for informal
  feedback and opportunities for self-correction.
• Enforcement options are important when there are
  recurring patterns of disruption or serious
  incidents. They are also important in situations
  where there are abuses of power.

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Avoidance and Engagement

• There is an underlying tendency among health
  professional to avoid feedback conversations with
  colleagues.
• Moving from avoidance to engagement requires
  support from leaders.

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Exercise Enforcement and Engagement

• From Module 1
• Actions to promote professional conduct occur at
  both the individual and system levels.
• Two approaches for promoting professional conduct
  are
• Enforcement (power based)
• Engagement (collaborative)

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Exercise Enforcement and Engagement

• Scenario 1
• You are a supervisor on a unit and one of the
  staff come to you and complain about a patients
  family member who is upset and yelling at one of
  the other staff. You are asked to go to the
  patients room to deal with the situation.

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Exercise Enforcement and Engagement

• Scenario 2
• You are a supervisor on a unit and you overhear a
  senior staff person telling a junior staff
  person, You just need to suck it up if you are
  going to make it working here. We all had to
  learn the hard way, and you do too.

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Tiered Interventions
No change
Disciplinary action / termination
Authority intervention/ PI plan
Pattern persists
Awareness intervention
Apparent pattern
Single unprofessional event
Informal conversation cup of coffee
Majority of professionalsno issues
Hickson, 2007
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Tiered Interventions

• Very often individuals are not aware of their
  behavior or the effect it is having on others.
• Receiving feedback from team members is a form of
  mutual support.
• Informal feedback from a trusted colleague is a
  good first step.

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Depth of Engagement
Negotiate future behavior
Address behavior and code of conduct
expectations for the future. Address
consequences for failing to perform.
Address impact of behavior on others, address
broken trust, consider apology, acknowledge
relational needs of respect, trust, reputation,
identity, etc. Allow for emotional processing
of the event if serious or a pattern.
Address Impact of Behavior
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Video Simulation Exercise

• Bedside Manners Scene 5 To Explain or Not to
  Explain (2.06 min)

Click the icon to begin the videos then use the
controls on the video screen to stop and restart
as needed.
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Reporting and Surveillance

• Safe reporting systems help detect patterns of
  disruptive behavior.
• Reporting can come from health professionals or
  patients and their families.
• Recurring incidents of unprofessional behavior
  may indicate system issues that are creating
  undue stress for teams or individuals.

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Reporting and Surveillance Example

• Several reports were filed by the L D staff
  regarding a physician who was angry and throwing
  equipment onto the floor during C-sections.
• In meeting with the physician, it was discovered
  that a new vendor was providing one of the
  surgical devices and it was consistently
  breaking. The physician and nursing staff
  attempted several times to get the issue
  corrected using appropriate channels with no
  results. He considered the situation a safety
  issue and was increasingly frustrated by an
  ineffective response.

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Exercise Reporting and Surveillance

• Review your current reporting system
• Brainstorm ways for assessing work environment
• Develop plan for creating loop backs with
  collected data

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Leaders as Coaches

• Health professionals identify lack of leadership
  support as a key barrier to engaging in difficult
  conversations with colleagues.
• Developing coaching skills among leaders can
  facilitate better levels of support for staff

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Leaders as CoachesCore Competencies

• Effective coaching is a combination of personal
  qualities and core competencies
• Core coaching competencies include
• Communication skills
• Performance improvement skills
• Relationship skills
• Process management (execution) skills

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Exercise Coaching Self-assessment

• Review the 13 coaching competencies identified in
  the ASTD Coaching Self-assessment.
• What areas of development have been identified by
  your group?

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The Need for Conflict Competency

• Developing conflict competency is a necessary
  step in the promotion of professional conduct and
  the creation of healthy work environments
• Conflict competence can be developed across the
  team and can positively impact the quality of
  patient care, job satisfaction, levels of team
  trust, and effective team performance.
• Resource Conflict Training for Health
  Professionals 2010 whitepaper, available at
  http//ehcco.com/news.php

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Joint Commission Leadership Conflict Standards

• LD.02.04.01
• Standard
• Senior managers and leaders of the organized
  medical staff work with the governing body to
  develop an ongoing process for managing conflict
  among leadership groups.
• Leadership groups refers to the senior
  administration/ management, the organized medical
  staff and the governing body.
  http//jointcommission.co
  m

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Conflict Competent Leaders

• Four distinct areas are required of conflict
  competent leaders
• Understanding the dynamics of conflict
• Understanding your own reactions to conflict
• Fostering constructive responses to conflict and
  reducing destructive responses and
• Creating conflict competent organizations.
• Runde, C., Flanagan, T. (2007) Becoming a
  Conflict Competent Leader How you and Your
  Organization Can Manage Conflict Effectively.
  Center for Creative Leadership.

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Conflict Competent Leaders

• Leaders are able to facilitate conflict
  resolution. This involves engaging in personal
  conflicts effectively and also having the
  capacity to facilitate conflicts between others.
• Leaders at all levels support conflict competence
  and are able to demonstrate their own competence,
  particularly during high profile situations.
• Conflict competence spans the continuum from
  novice to expert.

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Conflict Engagement Specialists

• Conflict engagement specialists are professionals
  with advanced training, education, and experience
  addressing conflict situations.
• They may be internal or external to the
  organization.

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Conflict Competent Organizations

• Developing conflict competence across the
  organization requires
• Developing collaborative mindsets and cognitive
  models for making sense of conflict
• Conflict skills development
• Conflict management processes that are integrated
  across the system and aligned with overall
  mission
• Integration into performance evaluation systems

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Conflict Competence Checklist

• Use the checklist to evaluate the presence of
  factors that contribute to conflict competence in
  your work area.
• What areas are in the red, yellow, and green
  zones for your team?

NOTE See the Cultivating Conflict Competence
Tipsheet in Toolkit Additional Resources
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Module 3 Summary

• Supporting and promoting professional conduct
  across the system to ensure safe patient care is
  the role of organizational leaders.
• Developing conflict competency is a necessary
  step in the promotion of professional conduct and
  the creation of healthy work environments.