Pulse – July 2019
This month’s Pulse with Kevin Sowers focuses on the Johns Hopkins civility initiative. Civility has an impact on healthcare quality, safety and overall outcomes, and a team has been assembled to identify expected behaviors in the workplace to which all will be held accountable. The initiative also will develop interventions that are appropriate, with the aim of creating a culture where all at Johns Hopkins can thrive.
0:20 Civility in the workplace
1:20 Peer to peer conflict at times
2:20 What are the expected behaviors?
3:20 More embedded in who they are
4:24 Documented well in the healthcare workplace
5:24 Patient interactions
6:30 Manage our emotions to have a fact-based conversation
00:00 Elizabeth Tracey: Welcome to this month's Pulse, I'm Elizabeth Tracey..
00:02 Kevin Sowers: Thank you. I'm Kevin Sowers, it's a pleasure to be with you today.
00:06 ET: It's wonderful to be with you. Talk to me about civility. We have a new institutional initiative going forward that is really emphasizing that in the workplace.
00:16 KS: You know, when you think about civility in the workplace, it really is an opportunity for us to step back and understand how, not just the outcomes that we achieve every day make this organization successful, but how we treat each other in getting there and civility has been shown multiple times to have an impact in the workplace on quality and safety and just overall outcomes. And so creating an environment where we feel supported for who we are and what we bring to the table and respected is incredibly important.
00:49 ET: In fact, I just saw a study, it was looking at surgeon behavior and the OR and it showed that when a surgeon acted out during a procedure, it had a deleterious effect, not just on the staff, but also on a patient.
01:02 KS: That's correct. And it's not just in the OR. It's in the ICUs, it's in any type of unit where there may be work culture issues and behavior issues between individuals and it's not always just physician related. In nursing, there is peer to peer conflict at times and so we need to think about how we treat each other when we come to work each day.
01:23 ET: It seems like common sense, doesn't it?
01:26 KS: It does, but for some managing your emotions in the midst of a chaotic or a stressful day can sometimes be difficult and so understanding when it's important to step back to, to take a couple of deep breaths and really think through what you're going to do next instead of reacting. Be more proactive in learning how to manage yourself.
01:48 ET: Well. That sounds like a short prescription then for how to do this. Do we have a plan in place institutionally to make this happen?
01:55 KS: Actually, there's a group that we've accounted that's being led by Inez Stewart, who is our chief human resource officer of Johns Hopkins Medicine, and also Jennifer Nichols, who is our chief of staff. Jen and Inez are working on a group and the first step, if you've looked at how most organizations have dealt with this, is really sit back and really think through what are the expected behaviors that we expect from everybody when they come to work and then how do we hold people and evaluate people to those behaviors on an ongoing basis?
02:27 ET: Are there specific tools that right now you would say to folks, "Hey, here's what I think I need you to do if you're feeling like there's a situation developing that might result in this incivility."
02:39 KS: The sensibility thing is a little bit more complex than just a tool. I'll share with you in my experience.
Sometimes people have these moments in the workplace where they're stressed on that particular day and they just can't hold it together. On that situation, you sit down with the person and say, "Here's what I saw you do. Here's what I heard you say. I need you to know that that wasn't appropriate and here's how I'd like to see you to manage it the next time."
At times that's the only intervention you need to do and that person will change their behavior. In others situations, people have had things that have happened in their personal lives that have led to the behavior that you might see in the workplace. That's a lot more embedded in who they are. That sometimes takes a different level of intervention. Sometimes it's a coach, an ongoing coach, to look at what are the things that trigger the behavior in the workplace. Sometimes it's someone sitting down with the counselor because there's a lot of either grief or anger that's built in from life experiences that they have to work through to deal with that.
And then the last piece is really in some instances there are situations where people have substance abuse issues, have had difficult marital situations, a lot more complex social type experiences that require a different level of intervention.
So for me, as I've gone through this in my career, it's not one tool that will help everyone. You have to sit and understand to make sure you understand the complexities of what's driving the behavior in the workplace.
04:15 ET: Would you say see that the healthcare environment is peculiarly prone to this?
04:20 KS: I would say that it's documented well in the healthcare workplace. Do I think that it's only healthcare? Absolutely not. It's human behavior. So I think this exists in other disciplines and other types of organizations, but I would say the thing that's unique about healthcare is it's still based upon human interactions. Both from a patient perspective but from care coordination perspective of a plan of care.
And it's in those delicate interactions of where we can't lose sight of what those interactions mean in the lives of the people we're serving. And so that's why civility becomes really important because if I'm a provider and I just had a bad interaction with somebody, there's now research to show that that impacts the rest of my day and how I feel about myself and how I question myself for the rest of the day. So it does have an impact.
05:16 ET: Some of the examples that you cited, having borne witness, and I know you have abundant experience with this also, interactions with patients and caring for patients can be incredibly emotionally charged. How can we deal with that aspect of the healthcare environment so that it doesn't bleed then into our interactions with our colleagues?
05:35 KS: So, I think having the ability to have peer conversations are critically important.
As a nurse, I've been in situations before where I as a nurse may differ in my view of what should happen to a patient than a provider may feel. But in those situations, I've also found that I may not understand completely everything that providers thinking. What they're seeing, I might not be seeing. But the ability to not become immediately emotional, but to be able to have a fact based conversation with the provider to say, "Here's what I see. Here's what I understand. Obviously you're thinking something different. Can you help me understand?"
That's not always where we start. We start with the emotion of can you believe this? Look what they're doing. And so how do we make sure that we are able to manage our emotions in a way that allow us to have a fact-based conversation to learn someone else's perspective? That becomes incredibly important as we learn to partner together around civility.
And so we need to make sure that we have all the vehicles in place in our institution to support people through what's going on with them personally, what's going on with them in their work environment, and then also having programs that if they do have problems, that they need psychological support for a variety of different reasons that we have those programs in place to support them.
07:04 ET: It sounds like the common denominator in all of this is something that you identified about really listening and then compassionately saying, "How can I help?"
07:15 KS: That's correct. I think I would say to anyone working in an organization, if you see a colleague that you think is acting differently than they have been before, you should sit down with them to make sure that they're okay. We owe that to each other because it's not just about caring for our patients or loved ones, but it really is about us caring for each other too. That will make us a better organization.
07:41 ET: Thank you so very much.
07:41 KS: Thank you for having me today.