Medical Errors Report #5
A Four-Year Solution Implementation Study
Hospital
Administrations Need to Resolve Management Crisis to Attain Quality Improvement
Hostile communication
among health-care workers remains a giant obstacle to quality improvement. Take two of the
largest groups of key players in health-care, physicians and nurses: Hostility in
communication between these two groups has not contributed to better patient care, nor has
it improved teamwork needed in today’s changing health-care system. Hostility in
health-care services is not limited to these professionals; it extends to all other
employees. Physicians have been observed to be shouting and insulting nurses on the phone
and in operating rooms. Nurses and other health-care workers have been besieged by
continuous abuse and verbal assaults. Due to the limitation of nurses’ power around
physicians, some nurse are turning their hostility towards their patients, visitors and
other health-care professionals. Physicians have been known to call the lab or pharmacy,
yelling. Nurses have also been known to call the lab, yelling or getting angry and very
emotional when discussing concerns with lab or X-ray techs. While this bad communication
is going on, many hospital administrations have refused to address the issue.
The problem
created by such an unprofessional communication style demonstrates aggression caused by
the power of office or professional status. In some situations, hospital administration
officials have verbally abused workers as a way to flex administrative power. Continuous
hostility breeds resentment among workers. Many health-care workers feel helpless in
dealing with this type of abuse. Unfortunately, such situations have contributed to the
demoralization of employees. Many of them express their dissatisfaction over the issue in
terms of being caught between “a rock and a hard place.” Such an atmosphere does
not allow employees to be motivated to do excellent work. Consequently, many of these
workers said they were there to put in their eight or ten hours and go home afterwards.
Their attitude was, if any problem comes up, “let them (administrative system) deal
with it.” The “them” being the administrative system. The goal of the new
administrative design is to destroy the mentality of “us versus them,” replacing
it with “we” as each employee takes ownership under the shared accountability
concept. But, many hospital executives do not understand the implications of their actions
and how employees are affected. Employees do not respect executives because they enshroud
themselves with power to abuse. True respect is usually earned. Without earning
employees’ respect the health-care industry may never attain its goal of quality
improvement.
Discussion of
verbal hostility in hospitals, especially when such a behavior is perpetuated by
physicians or administrative officials, is a taboo subject. “They have power and
think they can do whatever they want and nobody can hold them accountable,” said one
nurse. She quit her job as an OR nurse because of verbal abuse endured from a physician
while working in the operating room. A hostile work environment does not encourage
employees to report systemic failure, let alone to find solutions and improve the quality
of patient care. Many hospital administrative executives do not understand the impact of
hostility on employee performance. Empowering employees to identify systemic failure is
very crucial to the reduction of medical errors. The present management set-up of many
health-care systems do not foster such environment conducive to medical error reduction.
Joan R. Rose, in her article “Job
Satisfaction” (Medical Economics, August 9, 2002) indicates that a lot depends
on the nurses. She discusses the negative impact of physicians’ bad behavior and the
administrators who tolerate it. Over 93 percent of the 1,200 nurses, physicians and
hospital executives surveyed had witnesses or experienced disruptive physician behavior.
About a third knew at least one nurse who had resigned because of such unprofessional
behavior. Many of the nurses had changed their schedule so they could avoid working with a
particular physician. Lois Hamlin reports in
her article, “Perioperative Nurses and Sexual Harassment” (AORN Journal,
Nov, 2002) that recent research in Australia shows that many nurses are being subjected to
sexual harassment, sexual intimidation, physical assault and verbal abuse. These abuses
account for 45 percent of all trauma events reported. One study reports that 82 percent of
the harassment came from physicians. Lisa O’Steen’s article,
“Physicians’ Bad Behavior Affects Retention.” says VHA survey (PR
Newswire, June 6, 2002) outlines VHA study published in the June 2002 issue of American
Journal of Nursing. The study finds physicians’ disruptive behavior and lack of
response by hospital administrations are contributing factors in nurses’ low morale
and their decision to leave their position. This study is repeated here because of the
response of Alan H. Rosenstein, M.D., vice president and medical director of VHA, West
Coast in Pleasanton, California. Disruptive physician behavior is beginning to attract the
attention of health-care executives. Dr. Resenstein says that such behavior is
unacceptable. He further states that if nurses are leaving because of physicians
unprofessional behavior, these physicians are directly reducing the quality of care as
nurse shortage in hospitals has been tied to poor patient care.
What is the
hospital administration doing to resolve conflicts between health-care workers? Physicians
are not the only professionals involved in disruptive behavior in hospitals. Nurses,
medical techs, pharmacists, and other health-care workers are known to be involved in
disruptive behavior. When physicians start yelling at nurses, there is always a need for
the nurses to vent their anger. Fellow employees may be on the receiving end of that
emotional release. Similarly, when the hospital administrator gets angry at the head of a
department (a director), the emotional release of the director falls on the frontline
workers, leading to a dangerous chain reaction of anger. In most cases, employees look
towards the administration for help and in many of the cases, hospital administrators
refuse to intervene. This is part of the consequence of granting unlimited power to some
directors or managers within departments to do whatever they want while employees have no
recourse. This type of situation has increased tension for workers constantly intimidated
by peers or an ego-driven manager. Workers find it difficult to smile if they feel
berated. Such an atmosphere in management does not foster better patient care or fix
systemic failures, let alone prevent medical errors.
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