1. Promoting a Culture of Quality, Safety and Respect: Addressing Inappropriate & Disruptive Behavior Continuous Quality Improvement Brown Bag July 21, 2009 Presented by Veretta Nix, M.A. Director, Organizational Effectiveness & Diversity Patricia Whitfield, M.A., SPHR Human Resources Consultant

2. Objectives  To provide information on giving feedback to address inappropriate behavior  To provide strategies to defuse disruptive behavior  To help leaders engage staff as a part of the solution

3. Agenda  Background Culture of Safety Revised Disruptive Behavior Policy  Appropriate Vs. Inappropriate Behavior Definitions, examples  Triggers for Inappropriate Behavior  Strategies for Defusing and Addressing Inappropriate Behavior  Leaders’ Role

4. Culture of Safety, Quality and Respect Disruptive and Inappropriate Behavior negatively impacts:  Willingness to speak up to errors  Willingness to share new ideas  Employee engagement  Employee retention  Patient satisfaction  Impacts clinical and non-clinical areas

5. UMHS Policy 04-06-047-- Disruptive or Inappropriate Behavior by UMHS Personnel  States UMHS commitment to addressing disruptive/ inappropriate behavior by UMHS personnel  Expresses importance of collaboration, communication and collegiality to patient care, education, research & effective operation  Acknowledges that reporting can be intimidating, therefore provides support and process Outlines who to report to Allows for anonymous reporting  Identifies the procedure for reporting  Specifies outcomes, including potential consequence of formal corrective action http://www.med.umich.edu/i/policies/umh/04-06-047.htm

6. Manager Toolkit  To assist leaders in communicating the importance, feature of new policy Today’s focus is on addressing behavior

7. Disruptive Behavior defined Any conduct that interferes with the effective operation of UMHS or suggests a threat to UMHS personnel or to patient care. That a person’s behavior is unusual, unorthodox, or different is not alone sufficient to classify it as “disruptive behavior”.

8. Conduct Appropriate Conduct  Demonstrates clear, direct, honest and respectful communication  Accepts and provides feedback in a constructive and civil manner  Demonstrates respect for patients, their family members and staff Appropriate Conduct  Demonstrates clear, direct, honest and respectful communication  Accepts and provides feedback in a constructive and civil manner  Demonstrates respect for patients, their family members and staff Inappropriate Conduct  Derogatory comments (as opposed to constructive criticism) about the quality of care...  Abusive language— directed at patients, their guests or UMHS personnel (e.g., belittling, berating, screaming... Inappropriate Conduct  Derogatory comments (as opposed to constructive criticism) about the quality of care...  Abusive language— directed at patients, their guests or UMHS personnel (e.g., belittling, berating, screaming... Excerpts from examples provided page 2 of UMHS Policy 04-06-047

9. Inappropriate Behavior cont’d Excerpts from language page 2 of UMHS Policy 04-06-047  Threatening or abusive language  Threatening or abusive behavior  Degrading or demeaning comments of nonverbal communications  Profanity of similarly offensive language  Physical contact that is or appears threatening  Derogatory comments  Medical record entries impugning the quality of care given  Imposing unreasonable requirements on fellow personnel  Refusal to abide by University policies

10. Causes of Disruptive Behavior Individual factors  high stakes  high emotion  personal problems  fatigue  substance abuse  lack of interpersonal, coping or conflict-management skills  lack of tolerance or understand of workplace diversity Historical factors  tolerance and indifference to disruptive behavior Systemic factors  increased productivity demands  cost containment requirements  changes in shifts  rotations of interdepartmental support staff  Leaders who fail to address unprofessional conduct through formal systems are indirectly promoting it.

11. Addressing Inappropriate Behavior  Reporting Is Key As is  Verbal communication

12. One Size Does Not Fit All There’s no script. When there is opportunity for dialogue:  Check for Safety  Check Environment  Set the Tone  De-escalate  State Your Interest  Problem Solve

13. 1 st Step--Check for Safety  If a violent act occurs or immediate assistance is needed, contact a supervisor, call Security—dial 911  If you feel physically or emotionally threatened: move closer to other staff; and alert others of a meeting Every situation is unique. Assess YOUR situation.

14. Check Environment  Are you in an appropriate place to talk?  Are patients/families/customers nearby?  Will it interrupt co-workers?  Can customers overhear on the phone?  Is the location too isolated?

15. Set Tone  Model professional behavior  Use calm voice; lower voice  Try sitting

16. De-escalate  Watch body language  Focus on behavior; not the person  Acknowledge strengths, good performance  Don’t engage in escalating behavior, e.g. raised voice  Avoid:  You always  You never

17. State Your Interests  Invite engaged conversation “Can we talk?” or “Are you willing to talk to me?  Find common ground The patients, the team, the project ….  Clearly, concisely state your concerns  Explain the impact of the negative behavior

18. Problem Solve  How can we work together differently?  Ask clarifying questions  Look for root causes “..consider problems solving around processes or others issues they’ve identified outside of their control”  Use active listening  Don’t jump to conclusions My Interests!! Our team’s interests

19. Leaders’ Role  Supervisor may need to address the situation immediately  Supervisor will need to investigate  Seek HR support, as needed Then  Plan follow up conversation  Involve your employee in problem solving  Look for root cause/triggers—address as needed  Set clear behavior expectations  Offer support—coaching, EAP, etc.  Follow up

20. Leaders’ Role  Document your efforts Capture key elements as outlined in:  UMHS Policy 04-06-047- Exhibit B Promote work culture expectations during staff meetings Continue to monitor root cause/triggering incidents for improvement Acknowledge individual improvement in communication styles Arrange additional intervention as needed

21. Resources  EAP  HR Consultants Mediation Expect Respect  Security