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T EAM STEPPS 05.2 Professional Conduct Toolkit A Short Workshop to Promote Professional Conduct.

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Presentation on theme: "T EAM STEPPS 05.2 Professional Conduct Toolkit A Short Workshop to Promote Professional Conduct."— Presentation transcript:

1 T EAM STEPPS 05.2 Professional Conduct Toolkit A Short Workshop to Promote Professional Conduct

2 T EAM STEPPS 05.2 Professional Conduct Toolkit Your Organization Mission: Vision: Values: 2

3 T EAM STEPPS 05.2 Professional Conduct Toolkit Objectives Recognize professional conduct as a foundation for achieving organizational mission, vision, values Define professional and unprofessional conduct Use two approaches to unprofessional conduct: Enforcement & Engagement Respond to unprofessional conduct using connect and correct Recognize the high conflict personality and seek guidance from human resources when needed 3

4 T EAM STEPPS 05.2 Professional Conduct Toolkit Interprofessional Professionalism “Consistent demonstration of core values evidenced by professionals working together, aspiring to and wisely applying principles of altruism, excellence, caring, ethics, respect, communication, and accountability to achieve optimal health and wellness in individuals and communities” (Interprofessional Professionalism Collaborative, 2010). 4 Interprofessional Professionalism Collaborative. Definition of Interprofessional Professionalism. Retrieved Feb. 14, 2015 from

5 T EAM STEPPS 05.2 Professional Conduct Toolkit The Science 5 Team Leadership Team Orientation Mutual Performance Monitoring Back-up Behavior Adaptability Shared Mental Models Mutual Trust Team Effectiveness Closed Loop Communication (Salas, Sims, Burke; 2005) Big 5 Coord. Mechanism

6 T EAM STEPPS 05.2 Professional Conduct Toolkit Professional Conduct and High-Performing Teams Professional conduct contributes to safe patient care and is a key component of high performing teams. Reinforcing professional conduct expectations within the team: Is a form of self-correction Provides mutual support Reinforces trust Provides needed feedback Is a key component of care coordination 6

7 T EAM STEPPS 05.2 Professional Conduct Toolkit Defining Unprofessional Conduct Unprofessional conduct includes disruptive and intimidating behaviors that interrupt teamwork and undermine safe care. 7 Overt behaviors: Verbal abuse Shaming in front of others Scapegoating Belittling Physical threats/ throwing objects Passive behaviors: Refusing to answer questions or return calls Backstabbing Withholding information Recruiting others to take a side Undermining Retaliation

8 T EAM STEPPS 05.2 Professional Conduct Toolkit Impact of Unprofessional Conduct According to Joint Commission Sentinel Event Alert #40 —Behaviors that Undermine Safe Patient Care: Intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators and managers to seek new positions in more professional environments. 8

9 T EAM STEPPS 05.2 Professional Conduct Toolkit Patterns of Unprofessional Conduct A 2008 statement by the Center for American Nurses defines: Horizontal (lateral) violence as “the physical, verbal, or emotional abuse of a fellow employee” Bullying as “an offensive abusive, intimidating, malicious or insulting behavior, or abuse of power conducted by an individual or group against others, which makes the recipient feel upset, threatened, humiliated or vulnerable, which undermines their self-confidence and which may cause them to suffer stress.” 9

10 T EAM STEPPS 05.2 Professional Conduct Toolkit Two Approaches: Enforcement & Engagement Actions to promote professional conduct occur at both the individual and system levels. Two approaches for promoting professional conduct are: Enforcement (power based) Engagement (collaborative) 10

11 T EAM STEPPS 05.2 Professional Conduct Toolkit Tiered Interventions 11 Majority of professionals—no issues Single unprofessional event Apparent pattern Pattern persists No change Informal conversation— “cup of coffee” Awareness intervention Authority intervention/ PI plan Disciplinary action / termination Hickson, 2007

12 T EAM STEPPS 05.2 Professional Conduct Toolkit Tiered Interventions Very often individuals are not aware of their behavior or the effect it is having on others. Receiving feedback from team members is a form of mutual support. Informal feedback from a trusted colleague is a good first step. 12

13 T EAM STEPPS 05.2 Professional Conduct Toolkit Four Steps for Responding to Unprofessional Conduct Addressing instances of unprofessional behavior in order to improve patient safety is the job of all team members. Four Steps for Responding to Unprofessional Conduct: Assess Adopt a stance Connect & Correct Evaluate 13

14 T EAM STEPPS 05.2 Professional Conduct Toolkit Adopting a Stance: Examples Assertive, competitive: Imminent risk CUS—I’m concerned. I’m uncomfortable. This is a safety issue. Two-Challenge Rule—Assertively voicing a concern at least two times to ensure that it has been heard. Assertive, collaborative: Resistance, non-imminent situation Connect and correct Connect with PEARLA Correct with DESC 14

15 T EAM STEPPS 05.2 Professional Conduct Toolkit Connect & Correct Using the two-stage collaborative process Connect & Correct: Improves the likelihood that the feedback will be received Does not compromise the work relationship Sets the stage for productive problem solving. 15 NOTE: See the Connect & Correct Tip Sheet

16 T EAM STEPPS 05.2 Professional Conduct Toolkit Stage 1 Connect: PEARLA Understand first, explain later… To connect, use the following algorithm: PEARLA Presence Empathy Acknowledgement Reflect/reframe Listen openly Ask questions 16 NOTE: See the PEARLA Tip Sheet

17 T EAM STEPPS 05.2 Professional Conduct Toolkit Acknowledgment: Example 1 Nurse 1: Are you kidding me? I can’t believe this is the assignment you gave me! How am I supposed to take care of this guy who is bleeding and get my other patient ready for OR? How might Nurse 2 respond? Nurse 2: It seems overwhelming. What would help you right now so you can feel more comfortable caring for these two patients? 17

18 T EAM STEPPS 05.2 Professional Conduct Toolkit Acknowledgment: Example 2 Nurse 1: I can’t believe you went ahead and left the clinic early yesterday! You really left us in a bind trying to get all of the patients prepared before the provider saw them. How might Nurse 2 respond? 18 Nurse 2: I can see that my absence caused some difficulty.

19 T EAM STEPPS 05.2 Professional Conduct Toolkit Reflect and Reframe: Example Person 1: It figures that the new person was involved in this medication error. It seems like every time something bad happens, he’s had something to do with it. How might Person 2 respond? Person 2: Rarely is one person to blame for everything that goes wrong. What do you think contributed to this particular situation? OR— So you’re saying you’re concerned about medication safety on this unit. What concerns you most? OR— It’s hard to say what happened since he’s not here. Have you spoken to him directly about your concerns? 19

20 T EAM STEPPS 05.2 Professional Conduct Toolkit Sample Clarifying Questions Tell me—what would help you right now? Where would be a better place to have this conversation? What does respect look like to you? What is going on that has you so upset? What do you think is the impact of your behavior? What do you hope to accomplish by talking this way? How is this helping you get what you need? 20

21 T EAM STEPPS 05.2 Professional Conduct Toolkit Acknowledgement and Clarifying: Example 2 Nurse 1: I can’t believe you went ahead and left the clinic early yesterday! You really left us in a bind trying to get all of the patients prepared before the provider saw them. How might Nurse 2 respond? 21 Nurse 2: I can see that my absence caused some difficulty (acknowledgement). We had discussed that I needed to leave early. How could we better prepare for a staff absence the next time (clarifying question)?

22 T EAM STEPPS 05.2 Professional Conduct Toolkit Stage 2: Correct Using the TeamSTEPPS ® DESC script is one way to seek correction of unprofessional behaviors. DESC: Describe the specific behavior Express how it makes you feel and what your concerns are Suggest alternatives and seek agreement Clarify the consequences in terms of the impact on goals of the team 22

23 T EAM STEPPS 05.2 Professional Conduct Toolkit Stage 2: DESC Script Sample Describe: When you don’t answer pages or return phone calls … Explain: I am worried that I won’t be able to give safe care to the patient. Seek alternatives and agreement: I need for you to respond or have someone call for you if you are busy. Is that something you could try? Clarify Consequences: If not, it is going to have an impact on patient care and how much I can trust you. 23

24 T EAM STEPPS 05.2 Professional Conduct Toolkit Practice Exercise: Using Connect & Correct You will be assigned one of the video scenarios to work with Using the Connect (PEARLA) and Correct (DESC) techniques, develop a response to one of the individuals who is behaving unprofessionally In pairs, practice your response with a partner st&p=2643A7B123CC8F01&index=2 24

25 T EAM STEPPS 05.2 Professional Conduct Toolkit Exercise Debrief Which of the two stages, Connect or Correct, feels easier? What makes it easier for you? Which of the skills would you like to be better at? What steps could you take to improve your skills? What could help you feel more comfortable using these in your daily work? 25

26 T EAM STEPPS 05.2 Professional Conduct Toolkit Practice Exercise: Using Connect & Correct Think of a conflict scenario you have recently or commonly face at work, or one you need to address. In pairs, practice your response with a partner: Connect first using PEARLA Debrief with group Correct using DESC Debrief with group Goal: develop a response to one of the individuals who is behaving unprofessionally 26

27 T EAM STEPPS 05.2 Professional Conduct Toolkit 27 High-conflict people are those individuals who have a life-long pattern of high-conflict behavior and who typically exhibit long- term traits of those with personality disorders and who engage in ongoing high-conflict thinking. Eddy, W. It’s All Your Fault: 12 Tips for Managing People Who Blame Others for Everything. (2008). Janis Publications. High-Conflict Personalities

28 T EAM STEPPS 05.2 Professional Conduct Toolkit Destructive Conflict Behaviors For high-conflict people, the ability to self-reflect and self-correct is limited or nonexistent. They default to destructive conflict behaviors and they seem unable to make different choices. 28

29 T EAM STEPPS 05.2 Professional Conduct Toolkit Tips for Managing High-Conflict People 1. Use empathy and create connection repeatedly. 2. Acknowledge their fears and emotions as real to them without agreeing with their conclusions or beliefs. 3. Listen openly to their concerns without being taken in by misinformation or inaccurate conclusions. 4. Consistently set clear limits on behavior and create structures to contain their impact on others. 29

30 T EAM STEPPS 05.2 Professional Conduct Toolkit Tips for Managing High-Conflict People 5. Don’t fall for the drama and don’t adopt high-conflict behavior yourself 6. Recognize that a single intervention will not be sufficient—they will require continued interventions and limit setting 7. Do not take their attacks personally or feel you are to blame for the situation 30

31 T EAM STEPPS 05.2 Professional Conduct Toolkit Summary Professional conduct is consistent with your organization’s mission, vision, values Know when to enforce and when to engage using connect and correct Manage the high conflict personality; DON’T let them manage you 31


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