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1. Passionate HealthCare…
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www.RxForSanity.com
2. Bedside Manners; Or
Healing your Relationships
within Healthcare
Patricia L. Raymond MD FACP, FACG
Sentara Bayside Hospital
18 May 2006
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7. Incivility Epidemic: Prevalence
• 6 of 10 Americans say others are rude
• 8 to 9 of 10 say that it has worsened over
the last decade
Inverse relationship between civility and
speed
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8. I’m going to meet people today who talk too
much. People who are selfish, egotistical, and
ungrateful.
But I won’t be surprised or disturbed
because I couldn’t imagine a world without
such people.
-Marcus Aurelius
Roman Emperor A.D. 161-180
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9. Incivility as an Epidemic:
Genotypes of Disease
• Road rage
• Sideline rage
• Workplace rage
• School rage
• “Virtual viciousness”
• Incivility as entertainment
– Media as a vector of infection?
• Howard Stern
• Jerry Springer
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11. Incivility Epidemic:
Clinical Characteristics
Physical Active Direct
Verbal Passive Indirect
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12. Forms of Incivility: Physical
Active Passive
Direct Stabbing, Physically
punching, shooting preventing from a
goal or act
Indirect Setting a booby Refusing to
trap, hiring an perform necessary
assassin tasks
Farrell 1997 J Adv Nurs
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14. Forms of Incivility: Verbal
Active Passive
Direct Insulting or Refusing to speak to
denigrating another another
person
Indirect Spreading malicious Failing to make specific
rumors or gossip comments, failing to
speak in another’s
defense
Farrell 1997 J Adv Nurs
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16. “…nurses aides, nurses, police
officers, and secondary school
teachers ranked among the most
dangerous jobs for women…”
“…assaults occur in health care …
more often than any other industry.”
Williams 1997 Crit Care Nurs Clin
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23. Physicians contribute to the
hospital incivility epidemic
• 2/3 of nurses are abused by physicians at least
once every two to three months
• 92.5% have witnessed disruptive MD behavior
• 2-5% of medical staff exhibit disruptive behavior
• Disruptive behavior was important contributing
factor to erosion of nurse satisfaction and morale
Rosenstein, AJN 2002
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27. Relationships and mortality
• Knaus 1986 Ann Int Medicine
– 5030 patients in 13 ICUs
• Differences in death rates related to interaction and
communication between nurses and MDs
• Shortell 1994 Medical Care
– 17,440 patients in 42 ICUs
• Group culture, leadership, communication,
coordination, conflict management abilities
– Lower risk-adjusted length of hospital stay
– Lower nurse turnover
– Higher technical quality of care
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33. Guidelines for Treatment of
the Rude
1. Rude behavior is not usually personal.
2. I am not going to fundamentally change
the rude person, just their behavior around
me.
3. I have to take action immediately to
change the rude behavior.
– Piddling puppy analogy
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34. People always say I didn’t give
up my seat because I was tired,
but that isn’t true.
No, the only tired I was,
was tired of giving in.
~Rosa Parks
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35. It Just Won’t Work!
• But are the uncivil trainable?
• Zippity- Do- Dah
• Silence Sanctions
– Don’t turn the other cheek
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36. You can please some of the
people some of the time,
and all of the people some of the
time,
but some of the people you can’t
please none of the time.
~ Ziggy (Tom Wilson)
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43. Confront verses “Carefront”
Judith Briles: “Zapping Conflict in the Health Care Workplace”
• When you ________ (specific action)
• I felt ________ (your reaction)
• Because _______ (what it looks, sounds or feels like to you)
• Was it your intent to _______? (repeat what the action was)
– STOP: Wait for response
• In the future, ________ (what behavior do you want?)
• If there isn’t a change, ________ (consequence)
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45. Practice Time
• “Code Pink”
• The Sylvia Technique
• Don’t Mirror, Harmonize
• Whiplash
• “Carefront”
– When you ________, I felt ________
– Because _______ . Was it your intent to _______?
STOP: Wait for response
– In the future, ________ .
– If there isn’t a change, ________ .
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46. The only thing necessary for the
triumph of evil is for good men
to do nothing.
~Edmund Burke
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47. Challenge Offensive Behavior
• Keep those kinds of thoughts to yourself
• You might want to reconsider that.
It doesn’t reflect well on you.
• You can’t mean that
• Do you want to repeat that? (incredulous)
• I’m sure I didn’t hear that right. Do you
want to rephrase that?
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48. A appeaser is one who feeds a
crocodile –
hoping it will eat him last.
~Winston Churchill
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50. ‘You’ Responses
• You need to back off
• You have gone to far
• You need to apologize for being late
• Your calling me names isn’t going to
change my mind
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51. If you put a small value
on yourself,
rest assured that the world
will not raise your price.
~Anonymous
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58. Some Exercises for “Elevation”
• “Make a Change”
• “Pass it on”
• The “put-down, put-up bean jar” exercise
• Are your staff suffering from O.R.?
– “Bell-Ringers”
• “Give Up the Chip”
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59. More Exercises for “Elevation”
• Recognize Positive Behaviors
– NorthShore Regional Medical Center, Slidell Lo.
– Vote for awards for MDs with positive
behaviors and attitudes
– Congeniality, most compassionate, best
dictation, best teacher, best penmanship, best
bedside manner, best phone etiquette
• Begin an epidemic of elevation in your
office or unit!
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60. Few things are harder to put up
with than a good example.
-Mark Twain
1835-1910
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61. We need to act!
• Improved working relationships amongst
staff and between staff and patients
– Enhanced job satisfaction and reduced turnover
of both nurses and MDs
– Reduced LOS and costs of health care
– Better patient outcomes
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62. Bring Kind back into Mankind
Treat everyone with politeness,
even those who are rude to you,
not because they are nice,
but because you are.
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63. Now you are the CFJT of Bayside
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64. B • Belligerent
A • arrogant
Y • yahoos
S • spawn
I • insidious
D • devastation of
E • (self) esteem
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65. B • Behavioral
A • adjustments
Y • yield
• supportive &
S
satisfied staff
I • in
D • delivering daily
E • excellence
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67. Passionate HealthCare…
Love caregiving, just for the health of it!
Sign up today for your FREE newsletter,
with twice monthly medical humor, stories,
and simple tips to love your career!
Delivered via email!
www.RxForSanity.com
