1. 1 Behaviors that Undermine a Culture of Safety

2. 2 Presence Health’s Commitment Consistent with its Mission, Vision, Values and Ethical and Religious Directives for Catholic Health Care, Presence Health is committed to providing a safe environment of care for patients and an optimum practice environment for physicians and other clinicians. The presence of intimidating and disruptive behaviors in an organization, however, erodes professional behavior and creates an unhealthy or even hostile work environment.

3. 3 Intimidating and Disruptive Behavior…. Puts patients at risk – can foster medical errors and impede patient safety Is contrary to our mission of providing compassionate holistic care with a spirit of healing and hope in the communities we serve Diminishes the culture of service and organizational excellence based in our values of Honesty, Oneness, People and Excellence Lowers clinician and employee morale and satisfaction Must be reported to appropriate leaders to correct the problem Contributes to poor patient satisfaction and preventable adverse outcomes Increases the cost of care Can be exhibited by both physician and non-physician staff

4. 4 Examples of Intimidating and Disruptive Behaviors Overt actions such as verbal outbursts and physical threats, as well as passive Demeaning others (patients, families, nurses, physicians, other hospital personnel), or the hospital itself Blaming or shaming other for adverse outcomes Inappropriate medical record entries concerning the quality of care provided by the hospital or any other individual

5. 5 Examples of Intimidating and Disruptive Behaviors ooooooooooo------- Activities such as refusing to perform assigned tasks or quietly exhibiting uncooperative attitudes during routine activities Reluctance or refusal to answer questions, return phone calls or pages; condescending language or voice intonation Impatience with questions

6. 6 Definition of inappropriate words/actions: Sexual comments, jokes or innuendos Flirtation, sexual harassment Seductive, aggressive or assaultive behavior (inappropriate physical contact with another individual that is threatening or intimidating) Racial, ethnic, socioeconomic or religious bias or slurs Lack of regard for personal comfort and dignity of others

7. 7 What Can You Do? Organizational staff, including hospital employees, who observe or are subjected to, inappropriate behavior by a physician or non-physician staff member are responsible for communication with their supervisor about the incident following their initial chain-of-command process. Students shall notify their instructor if such behavior occurs.

8. 8 What Can You Do? Documentation of disruptive behavior is critical. Medical Staff members, nurses, and other hospital employees who observe behavior by a physician or non- physician that is disruptive to the hospital, shall document each incident. Such documentation shall include: – The date and time of the questionable behavior – If the behavior affected or involved a patient in any way, then the name of medical record number of the patient – The circumstances that precipitated the situation – A description of the behavior limited to factual, objective language as much as possible – The consequences, if any, of the disruptive behavior – Record of any action to remedy the situation including date, time, place, action and name(s) of those intervening.