OR Manager August 2022 - 14

Ramifications of unprofessional behavior on patients, staff
Human Resources
ynn Webb, PhD, assistant dean of
the Vanderbilt School of Medicine,
Nashville, Tennessee, shared an
anecdote about unprofessional behavior
with attendees of the recent OR Business
Management Conference in San
Antonio, Texas.
A nurse reported that a surgeon
was performing a transverse colon resection,
and at the appropriate point,
they told him: " You need to regown
and glove per our bundle. " The surgeon
replied: " I don't really agree with that element
of the bundle, and I'm not stopping
now to change gown and gloves, "
and continued with the procedure.
After recounting the incident, Webb
asked the attendees to take out their
phones and respond to a live poll. Did
the attendees believe the doctor's refusal
was a threat to patient safety?
And would their staff be likely to report
the doctor's unprofessional behavior?
The results were telling. Although
L
the majority of attendees reported they
felt the doctor's actions compromised
the patient's safety, they also indicated
there was less than a 50% chance that
an employee who witnessed that behavior
would speak up in the moment
or report the event in the organization's
occurrence reporting system.
Ignoring bad behavior
It is very common, said Webb during the
presentation, for OR team members to
look the other way when it comes to a
surgeon's unprofessional behavior. This
can include rude and disrespectful language,
refusal to adhere to guidelines,
poor handoffs, ignoring timeouts and
agreed-upon protocols, and failure to
respond when needed.
Staff supporting the surgeon might
be afraid to speak up out of fear of
retaliation or a sense of loyalty. Unless
the organization shows that such feedback
is actively encouraged, they may
believe that this behavior is implicitly
supported by the organization because
of the surgeon's status and experience.
14
OR Manager | August 2022
If the OR team is afraid to speak
up, said Webb, there is a high likelihood
that they do not actually feel safe
or supported in their organization. And
those are the very same nurses, technicians,
and physician assistants who
are more likely to leave to seek employment
elsewhere-this is just one of the
ways that a surgeon's unprofessional
conduct leads to big financial losses.
" At a safe organization, what do people
have to fear? " Webb asked during
the presentation. " It's important that
we have a culture where our colleagues
feel safe to speak up in the moment,
if they observe or witness something
that's inconsistent with [an organization's]
values. " He added: " Employees
trust that if they do speak up or report
something, that we have their backs
and will address the issue. "
A small number of surgeons
represent the majority of issues
At the Vanderbilt Center for Patient and
Professional Advocacy (CPPA), Webb
and his team oversee a national database
called Patient Advocacy Reporting
System, or PARS® (sidebar, p15).
According to Webb, hospitals want to
understand why patients are unhappy
and have a chance to fix it. " We know
from research that for every patient who
tells us something and gives us the
chance for service recovery, there may
be somewhere between 20 and 40 who
just leave, " he said.
Through data collected by PARS®,
CPPA has made a number of striking
observations related to physician complaint
and malpractice risk. PARS® receives
about 6,000 patient complaints
per year, and 35-50% of doctors never
get a single patient complaint in a
4-year period and are the subject of
very few malpractice claims, Webb said.
About 5% of physicians account for a
third of patient complaints and are associated
with as many as 50% of malpractice
claims, he added.
Those same doctors who receive
BY BRITA BELLI
high numbers of patient complaints are
also more likely to have poor surgical
outcomes, according to a 2017 study
led by Vanderbilt researchers that appeared
in JAMA Surgery. The study involved
reports from 32,125 patients in
the National Surgical Quality Improvement
Program from seven health systems
along with data on unprofessional
behaviors related to each of these patients
from Vanderbilt's CPPA.
A follow-up study
in 2019 in JAMA Surgery
looked at data on
13,653 patients treated
by 202 surgeons at
two academic medical
centers from 2012 to
2016. The researchers
came to similar conclusions
associated with
William
Cooper,
MD, MPH
co-worker reports of unprofessional behavior,
including reports collected via
CPPA's Co-Worker Observation Reporting
System (sidebar, p15). Unprofessional
conduct cited included doctors
wiping equipment on the bedsheets before
use on patients, doctors trivializing
safety procedures, and outright bullying
and rudeness by surgeons directed
at hospital staff. When the researchers
looked at patient outcomes in the
months following their surgeries, they
found that for those patients who had
surgeons who had been reported at
least four times, 14.1% had medical or
surgical complications, including infections
and lung/kidney complications,
compared to 10.7% of patients whose
surgeons had no negative reports.
" Patients whose surgeons had more
co-worker concerns describing unprofessional
behavior were significantly more
likely to have a complication than patients
whose surgeons had very few
concerns, " says William Cooper, MD,
MPH, vice president for Patient and Professional
Advocacy at Vanderbilt University
Medical Center and co-author of the
study. " Improving safety and outcomes
for our patients will require us to conwww.ormanager.com
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OR Manager August 2022

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