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Coworkers’ Reporting of Disrespectful and Unsafe Behaviors by Physicians and Advanced Practice Professionals Improves Behaviors

Added on March 29, 2016 in Press Releases

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Coworkers’ Reporting of Disrespectful and Unsafe Behaviors by Physicians and Advanced Practice Professionals Improves Behaviors

Article Featured in April 2016 Issue of The Joint Commission Journal on Quality and Patient Safety

(OAK BROOK, Illinois, March 29, 2016) – Joint Commission Resources, Inc., today released the April 2016 issue of The Joint Commission Journal on Quality and Patient Safety. The issue features an article, “Using Coworker Observations to Promote Accountability for Disrespectful and Unsafe Behaviors by Physicians and Advanced Practice Professionals,” by Lynn E. Webb, PhD, and colleagues, on experience with the Co-Worker Observation Reporting System℠(CORS℠) at Vanderbilt University Medical Center (VUMC), Nashville, Tennessee.

VUMC, having implemented methods for using feedback from patients and families to promote physician behavior change, then promoted use of its occurrence reporting system, which was available to all health care team members, including faculty, residents and students. Concerns were reported, primarily by nurse and physician colleagues, about physicians’ and advanced practice professionals’ disrespectful and unsafe conduct—behaviors known to undermine team function.

In developing and assessing CORS, VUMC leaders used a “Project Bundles” readiness assessment, which entailed identification and development of key people, as well as organizational supports and systems. Findings showed that 84 percent of the time, peer messengers shared CORS reports with physicians and advanced practice professionals associated with at least one report. Since CORS inception, 3 percent of medical staff were associated with a pattern of CORS reports and 71 percent of recipients of pattern-related interventions were not named in any subsequent reports in a one-year follow-up period.

The authors conclude that systematic monitoring of documented coworker observations about unprofessional conduct and sharing that information with involved professionals is feasible. This requires organization wide implementation; coworkers willing and able to share respectful, nonjudgmental, timely feedback designed initially to encourage self-reflection; and leadership commitment to be more directive. Follow-up surveillance also indicated that the majority of professionals “self-regulate” after receiving CORS data. The lessons from this study will be very helpful for health care organizations that are striving to create a culture of safety.

The remaining articles from the April 2016 issue are:

Safety Culture

Breaking Through Dangerous Silence to Tap an Organization’s Richest Source of Information: Its Own Staff

Richard C. Boothman, JD

In an editorial on the article, “Using Coworker Observations to Promote Accountability for Disrespectful and Unsafe Behaviors by Physicians and Advanced Practice Professionals,” the author comments on the use of occurrence reporting to overcome a “conspiracy of silence” among coworkers.

Health Professions Education

Competencies for Patient Safety and Quality Improvement: A Synthesis of Recommendations in Influential Position Papers

Kellyn M. Moran, PharmD; Ilene B. Harris, PhD; Annette L. Valenta, DrPH

A literature search was conducted of recommendations for patient safety and quality improvement (QI) competency in position papers from national and international professional associations and other sources. Among the 22 papers meeting the inclusion criteria, 59 competencies were identified for the skill level competent, and 23 competencies for the skill level expert. The findings demonstrate a need to discourage publication of recommendations of yet more competencies and to instead encourage development of an international consensus on the essential competencies for patient safety and QI.

Methods, Tools and Strategies

Engaging Frontline Staff in Real-Time Improvement

Jennifer Phillips, MMC; Linda J. Hebish, MBA; Sharon Mann, RN, MS, NEA-BC; Joan M. Ching, RN, MN, CPHQ; C. Craig Blackmore, MD, MPH

Virginia Mason Medical Center (Seattle) developed a staff engagement approach involving leaders through the daily use of Standard Work for Leaders, as well as staff through Everyday Lean Ideas. Organizationwide, at least 800 staff ideas are in motion at any given time, with implemented ideas posted online.

Performance Measures

Rural Implications of Expanded Birth Volume Threshold for Reporting Perinatal Care Measures

Michelle M. Casey, MS; Peiyin Hung, MSPH; Carrie Henning-Smith, PhD, MSW, MPH; Shailendra Prasad, MBBS, MPH; Katy B. Kozhimannil, PhD, MPA

In 2016 the minimum annual birth volume threshold for required reporting of Joint Commission Perinatal Care measures by accredited hospitals decreased from 1,100 to 300 live births. In Quality Check® data, 67 percent of the 2,396 accredited hospitals with obstetric services reported at least one eligible patient for two of the four reported measures. Expansion of the minimum birth volume threshold nearly doubles the number of hospitals required to report the measures. Although many rural hospitals remain exempt, the measures offer an opportunity for both rural and urban hospitals to assess and improve care.

Medication Safety

Ambulatory Medication Reconciliation: Using a Collaborative Approach to Process Improvement at an Academic Medical Center

Caroline Keogh, MS, RN; Allen Kachalia, MD, JD; Karen Fiumara, PharmD, BCPS; Dorothy Goulart, MS, RN; Jonathan Coblyn, MD; Sonali P. Desai, MD, MPH

An institutional collaborative improvement effort to develop and implement medication reconciliation processes was implemented across Brigham and Women’s Hospital’s (Boston) 148 ambulatory specialty practices, which included 14 primary care practices. After the collaborative was completed, for the percentage of active medications prescribed by that provider that were reconciled, specialty practices improved from 71 to 90 percent; and primary care practice performance improved from 62 to 91 percent.


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