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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