Bedside mannersRAYMOND


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Bedside mannersRAYMOND

  1. 1. Passionate HealthCare…Love caregiving, just for the health of it! Sign up today for your FREE newsletter, with twice monthly medical humor, stories, and simple tips to love your career! Delivered via email!
  2. 2. Bedside Manners; OrHealing your Relationships within HealthcarePatricia L. Raymond MD FACP, FACG Sentara Bayside Hospital 18 May 2006
  3. 3. News Report:
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  5. 5. Disease Model of Rudeness• Definition and prevalence• Subtypes• Clinical characteristics• Outcomes if untreated• Treatment options• Prevention
  6. 6. Healthy State: Civility• Respect• Restraint• Responsibility
  7. 7. Incivility Epidemic: Prevalence• 6 of 10 Americans say others are rude• 8 to 9 of 10 say that it has worsened over the last decade Inverse relationship between civility and speed
  8. 8. I’m going to meet people today who talk toomuch. People who are selfish, egotistical, and ungrateful. But I won’t be surprised or disturbed because I couldn’t imagine a world without such people. -Marcus Aurelius Roman Emperor A.D. 161-180
  9. 9. Incivility as an Epidemic: Genotypes of Disease• Road rage• Sideline rage• Workplace rage• School rage• “Virtual viciousness”• Incivility as entertainment – Media as a vector of infection? • Howard Stern • Jerry Springer
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  11. 11. Incivility Epidemic: Clinical CharacteristicsPhysical Active DirectVerbal Passive Indirect
  12. 12. Forms of Incivility: Physical Active PassiveDirect Stabbing, Physically punching, shooting preventing from a goal or actIndirect Setting a booby Refusing to trap, hiring an perform necessary assassin tasks Farrell 1997 J Adv Nurs
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  14. 14. Forms of Incivility: Verbal Active PassiveDirect Insulting or Refusing to speak to denigrating another another personIndirect Spreading malicious Failing to make specific rumors or gossip comments, failing to speak in another’s defense Farrell 1997 J Adv Nurs
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  16. 16. “…nurses aides, nurses, police officers, and secondary schoolteachers ranked among the most dangerous jobs for women…” “…assaults occur in health care … more often than any other industry.” Williams 1997 Crit Care Nurs Clin
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  21. 21. An apple a day?
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  23. 23. Physicians contribute to the hospital incivility epidemic• 2/3 of nurses are abused by physicians at least once every two to three months• 92.5% have witnessed disruptive MD behavior• 2-5% of medical staff exhibit disruptive behavior• Disruptive behavior was important contributing factor to erosion of nurse satisfaction and morale Rosenstein, AJN 2002
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  25. 25. Outcome if Untreated, orSo people in medicine are rude- Why should I care? 1. Nursing Shortage 2. Patient Outcomes
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  27. 27. Relationships and mortality• Knaus 1986 Ann Int Medicine – 5030 patients in 13 ICUs • Differences in death rates related to interaction and communication between nurses and MDs• Shortell 1994 Medical Care – 17,440 patients in 42 ICUs • Group culture, leadership, communication, coordination, conflict management abilities – Lower risk-adjusted length of hospital stay – Lower nurse turnover – Higher technical quality of care
  28. 28. Rx forfacility incivility
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  30. 30. I have no power to change the rude behavior of others. I just need to put up with it.
  31. 31. People treat you the way you teach them to treat you. ~Jack Canfield
  32. 32. Your medical colleagues are trainable. The proof? MCMC
  33. 33. Guidelines for Treatment of the Rude1. Rude behavior is not usually personal.2. I am not going to fundamentally change the rude person, just their behavior around me.3. I have to take action immediately to change the rude behavior. – Piddling puppy analogy
  34. 34. People always say I didn’t giveup my seat because I was tired, but that isn’t true. No, the only tired I was, was tired of giving in. ~Rosa Parks
  35. 35. It Just Won’t Work!• But are the uncivil trainable?• Zippity- Do- Dah• Silence Sanctions – Don’t turn the other cheek
  36. 36. You can please some of the people some of the time,and all of the people some of the time,but some of the people you can’t please none of the time. ~ Ziggy (Tom Wilson)
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  38. 38. Treatments for the Rude• Stay calm: “Code Pink”
  39. 39. Treatments for the Rude Skills for the Job of Living• The Sylvia Technique• Don’t Mirror, Harmonize• Whiplash• Confront
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  41. 41. A memorandum is written not toinform the reader, but to protect the writer. ~Dean Acheson “What was that you said?”
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  43. 43. Confront verses “Carefront” Judith Briles: “Zapping Conflict in the Health Care Workplace”• When you ________ (specific action)• I felt ________ (your reaction)• Because _______ (what it looks, sounds or feels like to you)• Was it your intent to _______? (repeat what the action was) – STOP: Wait for response• In the future, ________ (what behavior do you want?)• If there isn’t a change, ________ (consequence)
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  45. 45. Practice Time• “Code Pink”• The Sylvia Technique• Don’t Mirror, Harmonize• Whiplash• “Carefront” – When you ________, I felt ________ – Because _______ . Was it your intent to _______? STOP: Wait for response – In the future, ________ . – If there isn’t a change, ________ .
  46. 46. The only thing necessary for thetriumph of evil is for good men to do nothing. ~Edmund Burke
  47. 47. Challenge Offensive Behavior• Keep those kinds of thoughts to yourself• You might want to reconsider that. It doesn’t reflect well on you.• You can’t mean that• Do you want to repeat that? (incredulous)• I’m sure I didn’t hear that right. Do you want to rephrase that?
  48. 48. A appeaser is one who feeds a crocodile – hoping it will eat him last. ~Winston Churchill
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  50. 50. ‘You’ Responses• You need to back off• You have gone to far• You need to apologize for being late• Your calling me names isn’t going to change my mind
  51. 51. If you put a small value on yourself,rest assured that the world will not raise your price. ~Anonymous
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  53. 53. You Must Be:• Insistent• Persistent• Consistent• If it doesn’t work…
  54. 54. Some cause happiness wherever they go. Others, whenever they go. -Oscar Wilde 1854-1900
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  56. 56. Prevention:“Elevation” J. Haidt, UVa
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  58. 58. Some Exercises for “Elevation”• “Make a Change”• “Pass it on”• The “put-down, put-up bean jar” exercise• Are your staff suffering from O.R.? – “Bell-Ringers”• “Give Up the Chip”
  59. 59. More Exercises for “Elevation”• Recognize Positive Behaviors – NorthShore Regional Medical Center, Slidell Lo. – Vote for awards for MDs with positive behaviors and attitudes – Congeniality, most compassionate, best dictation, best teacher, best penmanship, best bedside manner, best phone etiquette• Begin an epidemic of elevation in your office or unit!
  60. 60. Few things are harder to put up with than a good example. -Mark Twain 1835-1910
  61. 61. We need to act!• Improved working relationships amongst staff and between staff and patients – Enhanced job satisfaction and reduced turnover of both nurses and MDs – Reduced LOS and costs of health care – Better patient outcomes
  62. 62. Bring Kind back into Mankind Treat everyone with politeness, even those who are rude to you, not because they are nice, but because you are.
  63. 63. Now you are the CFJT of Bayside
  64. 64. B • BelligerentA • arrogantY • yahoosS • spawnI • insidiousD • devastation ofE • (self) esteem
  65. 65. B • BehavioralA • adjustmentsY • yield • supportive &S satisfied staffI • inD • delivering dailyE • excellence
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  67. 67. Passionate HealthCare…Love caregiving, just for the health of it! Sign up today for your FREE newsletter, with twice monthly medical humor, stories, and simple tips to love your career! Delivered via email!