Remember as you read this piece, that according to these Doctors who STILL haven't bounced their Fellow Doctors peddling Crackpot informed Political Illnesses out from under their umbrella of Legal Cover, that All of these Screw-ups 'Diagnose' the perpetrators themselves as Incurably 'Mentally Ill', and they Ought to be Stripped of their Licenses, Force Drugged, & Police Registered, ...... Each & Every one of them, ...... Tossed onto SSI Disability for Life, ..... and subjected to their own, Psychiatric Opinions being used to drag them into Pseudo-Medical Incarceration Facilities based Solely on the say so of one of their Own, ..... Psychiatric Psychiatrists.
August 11, 2011
by Kathleen Bartholomew
"I have never met a healthcare executive who wasn't continuously watching his or her bottom line. I also have never met a healthcare executive who could actually see the effect that poor physician-nurse relationships had on that bottom line. They all say the exact same thing: "We have great physician-nurse relationships--only a few problem docs and we're addressing those." What we have here is a failure of perception.
Unfortunately, hospitals only get serious about physician-nurse relationships after the sentinel event. At one hospital the nurse was screamed at by the physician on-call, so she hesitated to call back. The patient died as a direct result. At another hospital, the patient was in severe pain for hours because the nurse was "trying to make it until morning so I didn't upset the physician." At another, the surgeon left the patient open in the operating room for 25 minutes to yell at the circulator because his preference cards weren't right. Self insured?
These sentinel events forced the hospitals involved to take a closer look at the facts. Research tells us that less than 5 percent of physicians are disruptive--so what's the problem? No doubt 5 percent of every profession is dysfunctional? The problem is that simply witnessing rude behavior in the workplace "significantly impairs our ability to perform cognitive tasks" (Porath). Furthermore, one bad apple does spoil the whole bunch (Felps). In groups of humans, when there is a deviant behavior, trust is undermined and the collegial interactive teams we need so desperately to keep our patients safe cannot possibly form.
What do sentinel events involving disruptive physicians have in common? Every physician was clinically competent and the behavior had been tolerated for a long period of time. In addition, administration was "aware" of the previous breeches of conduct and totally unaware of the walking time bomb. But competence (or potential income loss) was used as an excuse that kept leaders from drawing the line in the sand. Another serious detriment to action was that leaders did not perceive that the organization "had their back." The board of directorsmust mean what it says. If the mission, vision, or values include respect, and any disrespect is tolerated, then these are just words on a wall spoken by dead people.
In many cases, the hospital structure itself sets up all parties for failure. Many hospitals still give the burden of responsibility to the Chief Medical Officer (CMO) for getting deviant physicians in line. This is a disastrous system because the CMO is then perceived as betraying his own if he takes any serious action.The burden of responsibility must be on the organized medical staff and the credentialing committee to not renew the privileges of anyone who does not adhere to the intended philosophy, and never a single individual.
If there was some way to measure the damage, hospital leaders would be astounded. As we all know, it's the hallway and elevator conversations after the meeting that determine the real outcome of a meeting. These are also the places where deviant behavior is acknowledged by staff, but not leaders. It's called culture, and there is nothing more powerful than it in any organization. We also know something about the hospital leadership culture: Leaders consistently minimize the damage while allowing these 5 percent to continue to practice after multiple attempts at reform.
So what should leaders do? First, seek support from the board of directors. Help the board to understand that staff who can't think straight make lethal mistakes. Then, follow Dr. Gerry Hickson's steps to professional relationships. Include professional behaviors in evaluations for all staff. And most importantly, have the same rules for all roles. It's called "Institutional Integrity."
In this day and age, where resources are stretched and shrinking, the amount of social capital that can be gained from holding all staff accountable is the best thing you can do for patients and the bottom line.
Kathleen Bartholomew, RN, MN (www.kathleenbartholomew.com) is an author, international speaker and national expert on healthcare culture."
Thank You Hospital Impact.org and Ms Bartholomew