Bedside mannersRAYMOND
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This document contains information about a newsletter called "Rx for Sanity" that provides medical humor, stories, and tips for healthcare workers. It aims to help people love their career in healthcare. The newsletter is free and delivered by email twice monthly. It also contains information about workshops and presentations on improving relationships and civility in healthcare settings.
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- 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! www.RxForSanity.com
- 2. Bedside Manners; Or Healing your Relationships within Healthcare Patricia L. Raymond MD FACP, FACG Sentara Bayside Hospital 18 May 2006 www.RxForSanity.com
- 3. News Report: CFJT www.RxForSanity.com
- 5. Disease Model of Rudeness • Definition and prevalence • Subtypes • Clinical characteristics • Outcomes if untreated • Treatment options • Prevention www.RxForSanity.com
- 6. Healthy State: Civility • Respect • Restraint • Responsibility www.RxForSanity.com
- 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 www.RxForSanity.com
- 8. I’m going to meet people today who talk too much. 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 www.RxForSanity.com
- 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 www.RxForSanity.com
- 11. Incivility Epidemic: Clinical Characteristics Physical Active Direct Verbal Passive Indirect www.RxForSanity.com
- 12. Forms of Incivility: Physical Active Passive Direct Stabbing, Physically punching, shooting preventing from a goal or act Indirect Setting a booby Refusing to trap, hiring an perform necessary assassin tasks Farrell 1997 J Adv Nurs www.RxForSanity.com
- 14. Forms of Incivility: Verbal Active Passive Direct Insulting or Refusing to speak to denigrating another another person Indirect Spreading malicious Failing to make specific rumors or gossip comments, failing to speak in another’s defense Farrell 1997 J Adv Nurs www.RxForSanity.com
- 16. “…nurses aides, nurses, police officers, and secondary school teachers 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 www.RxForSanity.com
- 21. An apple a day? www.RxForSanity.com
- 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 www.RxForSanity.com
- 25. Outcome if Untreated, or So people in medicine are rude- Why should I care? 1. Nursing Shortage 2. Patient Outcomes www.RxForSanity.com
- 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 www.RxForSanity.com
- 28. Rx for facility incivility www.RxForSanity.com
- 30. I have no power to change the rude behavior of others. I just need to put up with it. www.RxForSanity.com
- 31. People treat you the way you teach them to treat you. ~Jack Canfield www.RxForSanity.com
- 32. Your medical colleagues are trainable. The proof? MCMC www.RxForSanity.com
- 33. Guidelines for Treatment of the Rude 1. 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 www.RxForSanity.com
- 34. People always say I didn’t give up my seat because I was tired, but that isn’t true. No, the only tired I was, was tired of giving in. ~Rosa Parks www.RxForSanity.com
- 35. It Just Won’t Work! • But are the uncivil trainable? • Zippity- Do- Dah • Silence Sanctions – Don’t turn the other cheek www.RxForSanity.com
- 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) www.RxForSanity.com
- 38. Treatments for the Rude • Stay calm: “Code Pink” www.RxForSanity.com
- 39. Treatments for the Rude Skills for the Job of Living • The Sylvia Technique • Don’t Mirror, Harmonize • Whiplash • Confront www.RxForSanity.com
- 41. A memorandum is written not to inform the reader, but to protect the writer. ~Dean Acheson “What was that you said?” www.RxForSanity.com
- 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) www.RxForSanity.com
- 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, ________ . www.RxForSanity.com
- 46. The only thing necessary for the triumph of evil is for good men to do nothing. ~Edmund Burke www.RxForSanity.com
- 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? www.RxForSanity.com
- 48. A appeaser is one who feeds a crocodile – hoping it will eat him last. ~Winston Churchill www.RxForSanity.com
- 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 www.RxForSanity.com
- 51. If you put a small value on yourself, rest assured that the world will not raise your price. ~Anonymous www.RxForSanity.com
- 53. You Must Be: • Insistent • Persistent • Consistent • If it doesn’t work… www.RxForSanity.com
- 54. Some cause happiness wherever they go. Others, whenever they go. -Oscar Wilde 1854-1900 www.RxForSanity.com
- 56. Prevention: “Elevation” J. Haidt, UVa www.RxForSanity.com
- 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” www.RxForSanity.com
- 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! www.RxForSanity.com
- 60. Few things are harder to put up with than a good example. -Mark Twain 1835-1910 www.RxForSanity.com
- 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 www.RxForSanity.com
- 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. www.RxForSanity.com
- 63. Now you are the CFJT of Bayside www.RxForSanity.com
- 64. B • Belligerent A • arrogant Y • yahoos S • spawn I • insidious D • devastation of E • (self) esteem www.RxForSanity.com
- 65. B • Behavioral A • adjustments Y • yield • supportive & S satisfied staff I • in D • delivering daily E • excellence www.RxForSanity.com
- 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! www.RxForSanity.com