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Nurturing a Culture of Civility in Health Care

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Nurturing a Culture of Civility in Health Care

Nurturing a Culture of Civility in Health Care

Johns Hopkins Medicine leaders share stories and solutions at their annual retreat.

Karen Nitkin

Date: 07/11/2018

Thirty years later, Eric Dobkin still remembers the “steady diet of insults and intimidation” that characterized his residency at a Texas hospital. As a surgeon, Dobkin said, he took the lessons of his training with him, becoming “obnoxious and arrogant” to residents and other members of his care team.

Dobkin is now vice president of medical affairs for Suburban Hospital, working to break the cycle of rudeness that marked the early years of his medical career. 

Speaking at a civility in health care retreat, he said dramatic cases of incivility, such as doctors publicly berating nurses, are “the tip of the iceberg.” Everyone in health care, including executives, can be guilty of condescending comments, impatience with questions or inadequate responses to pages or calls, he said.

“We’ve all done these things,” Dobkin said to an audience of about 150 health care professionals at the Johns Hopkins Medicine event, held June 8 at the Chevy Chase Club. It was the sixth annual retreat for medical staff leadership. The outings, organized by Diane Colgan, chair of the medical staff at Suburban Hospital, have in previous years focused on topics including communication and burnout.

Stephen Paskoff, a lawyer and founder of Employment Learning Innovations, an Atlanta-based company that helps organizations create civil environments, said people get uncomfortable when they experience or witness rude behavior.  

For patients and families, that discomfort can damage trust in the institution, prevent communication with clinicians and detract from the patient experience. For employees, it may result in higher turnover, more burnout and less joy on the job.

The implications for patient safety are enormous. “We can’t be experts in everything,” Dobkin said. “We need our wingmen and women, but they’re not going to speak up if they are intimidated or think we’re disrespectful.”

Though conference attendees agreed that civility benefits patients and employees, nearly all also indicated that they encounter rudeness on the job at least occasionally.

“Incivility is a highly contagious and communicable disease,” said Renee Blanding, vice president of medical affairs at Johns Hopkins Bayview Medical Center. “Recognition that you have the disease is the first step.”

Attendees broke into groups to discuss real and hypothetical situations, with an eye toward both immediate and systemic solutions.      

One such example was a doctor who cursed at nurses when they telephoned with questions, making the nurses hesitant to call again. Participants agreed that the first goal was making sure nurses got the answers they needed, and the second goal was informing the doctor that the behavior was not acceptable. “I never want to tell a nurse not to call a physician,” said Jacky Schultz, president of Suburban Hospital. “We have to identify the behaviors that we have zero tolerance for, because they can harm patients.”

Thomas Matthew, director of the Johns Hopkins Cardiothoracic Surgery Program at Suburban Hospital, proposed a longer-term solution, saying nurses should call only when necessary and have all relevant information ready for the doctor’s questions. “Sometimes people call before they go through the roster of what they could do,” he said.  

“Hopkins is a leader in medicine, and we have to lead on this, too,” said Paul Rothman, dean of the medical faculty and CEO of Johns Hopkins Medicine. “It’s easy to say we’re very stressed, and everyone is working very hard, and we’re tired, but I don’t think those are excuses.”