Respect promotes better outcomes
Recent academic research demonstrates there is a correlation between disrespectful behaviour by practitioners within medical teams and poorer patient outcomes. We talk to Dr Sarah Michael, a psychiatrist at St Vincent’s Hospital in Sydney, about the Ethos Program which aims to encourage respectful behavior between colleagues to support better patient outcomes.
What is the Ethos Program?
The Ethos program is a St Vincents Australia initiative based on a research-backed culture change program developed by the Vanderbilt University Medical Centre. It aims to generate positive workplace culture which supports patient safety. It does this by encouraging direct intervention through conversation with individuals whose behaviour has been identified by colleagues as rude or discourteous. The Ethos program, funded by a grant from the National Medical Health and Research Council, was launched in Sydney in 2018 and in Melbourne in 2017.
Dr Sarah Michael, says the Ethos program enables staff at St Vincent’s to anonymously report negative behavior about a colleague. This allows an individual, such as junior medical staff, who may not be comfortable directly approaching the person who is modelling poor behavior, to take action to support a positive workplace culture. A report does not result in any formal action by St Vincents. It does, however, trigger a conversation between the staff member and an Ethos messenger who has been trained to encourage personal insight into the impact of their behavior on others and team performance.
Examples of negative behaviour include speaking disrespectfully to a junior medical colleague on the phone or speaking condescendingly to a colleague in front of others.
‘Where there is team dysfunction, patient outcomes will be compromised,’ Dr Michael says.
Does rudeness between colleagues really impact patient safety?
New research by the team at Vanderbilt University Medical Center published in June this year supports and reinforces the thread that underpins medical culture change programs such as Ethos. The findings indicate there is a correlation between complaints by coworkers about surgeon behavior and an increased risk of surgical and medical complications. Of particular interest was the increase in the risk of complaints the surgeon had received.
For surgical teams, in particular, optimal performance was found to be highly dependent on effective communication and mutual respect. On the other hand, surgeons who model unprofessional behaviour undermine a culture of safety and threaten teamwork, creating an increased risk of medical errors. “It would seem organisations interested in ensuring optimal patient outcomes should focus on addressing surgeons whose behaviour toward other medical professionals may increase their patients’ risk for adverse outcomes”.
Does this extend beyond surgery?
Israeli researchers assessed the performance of the Neonatal Intensive Care Unit (NICU) teams subjected to discourteous behaviour. This study found that even “mild” incivility had adverse effects on diagnostic and procedural performance. The potential effects were profound with the authors finding that poor behaviour interferes with working memory, the epicentre of planning and analysis. Rudeness was also found to prevent teams from sharing information and collaborating.
Clearly then there are consequences for a broad range of medical teams.
Individual doctors, nurses, patients and others can always able to make a complaint to the Medical Council or Health Care Complaints Commission if they think the performance or conduct of a doctor is putting patients or the public at risk.
While rude behaviour may appear benign, there are demonstrable consequences for patient safety.
St Vincents Australia is due to provide a report National Medical Health and Research Council on the effectiveness of the Ethos program in 2021.
Interested in finding out more?
- Riskin A, Erez A, Foulk T.A, Kugelman A, Gover A, Shoris I, Riskin K.S, and Bamberger P.A, 2015, The Impact of Rudeness on Medical Team Performance: A Randomized Trial, originally published online August 10, 2015; Pediatrics 2015;136;487
- Cooper W et al, Association of coworker reports about unprofessional behavior by surgeons with surgical complications in their patients JAMA Surg 2019; DOI:10.1001/jamasurg.2019.1738.