Issue link: https://beckershealthcare.uberflip.com/i/1468749
52 QUALITY IMPROVEMENT & MEASUREMENT illness cases in 2020. As a result, we're seeing high rates of burnout and people leaving the healthcare profession altogether. Workforce safety and patient safety are co- equal and interdependent — you can't have one without the other. In order to maintain and grow our workforce, the physical and psychological safety of personnel needs to be a top priority for all healthcare leaders. Hilary Babcock, Chief Quality Offi cer at BJC HealthCare (St. Louis): During COVID-19 surges, when staffi ng was tight, hospital censuses were high, and patients were very sick and complicated, we all did our best to continue to deliver safe and high quality care, but the situation was defi nitely a challenge. Now that our patient census is more manageable, we are better able to provide ad- ditional focused attention on critical measures to prevent healthcare-associated infections, pressure injuries and other quality outcomes. Jeremy Cauwels, MD. Chief Physician at Sanford Health (Sioux Falls, S.D.): e pan- demic has placed extraordinary stress on our healthcare teams and contributed to higher rates of mental health challenges. As we con- tinue to move forward, supporting employee well-being is an imperative that deserves more attention from a quality improvement standpoint. Sanford Health has led eff orts to combat work-related stress and burnout through resiliency groups, training, a clinical assistance program, counseling, a physician wellness council and comprehensive mental health resources to help our employees take care of themselves physically and emotion- ally while caring for our patients. We know a burned-out physician has a statistically higher risk of adverse outcomes related to medical errors, which is why we are also comparing employee satisfaction data to patient satisfac- tion and outcomes. We will continue to be deliberate and purposeful in how we invest in and support our clinicians. n Rudeness: A care quality issue By Mackenzie Bean and Erica Carbajal F or many people, rude behavior is no more than an unwelcome nuisance. But for those in healthcare, the consequences can be far more detrimental. From impolite behavior to violence, rudeness is on the rise, The Atlantic's Olga Khazan reported March 30. This is likely driven by increased stress and isolation from society — which the ongoing pandemic doesn't help. The healthcare industry is not im- mune to this trend. Hospitals across the country are reporting an uptick in disrespectful, discriminatory or vi- olent behaviors from patients. Nearly 24 percent of physicians have ex- perienced workplace mistreatment in the past year, including verbal mistreatment or abuse, according to a study published May 6 in JAMA Network Open. Rude or inappropriate behavior from patients, family members or col- leagues is not only linked to burnout among clinicians but may also hinder their performance, a growing body of research shows. The Joint Commission has routinely warned of the effect poor behaviors can have on healthcare teams' per- formance and urged organizations to address and prevent workplace violence. "Workplace violence is not merely the heinous, violent events that make the news; it is also the everyday occurrences, such as verbal abuse, that are often overlooked," The Joint Commission said in a June 2021 sentinel event alert. "Intimi- dating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to pre- ventable adverse outcomes, increase the cost of care, and cause qualifi ed clinicians, administrators and man- agers to seek new positions in more professional environments," it said in a separate alert. A study published in Pediatrics involv- ing 24 neonatal intensive care unit teams across four hospitals in Israel found being exposed to rudeness adversely affected team members' diagnostic and procedural perfor- mance. The NICU teams participated in a training simulation involving a preterm infant whose condition acutely deteriorated due to necro- tizing enterocolitis. Team members were then randomly subjected to either rudeness, which included mildly rude statements unrelated to their clinical performance from an outside expert, or a control group, in which they were exposed to neutral comments from the outside expert. After the outside expert review, the team members continued treating the infant in the training simulation. Team members exposed to rude- ness had lower scores for diagnos- tic and procedural performance. Researchers said rudeness alone accounted for nearly 12 percent of the variance in clinical performance between the two cohorts. A separate study published in BMJ Quality & Safety found clinical teams exposed to incivility in simulated operating room situations scored lower on every performance metric compared to a control group. Incivil- ity affected clinical teams' vigilance, diagnosis, communication and patient management. It's worth noting that both studies were published before the pandemic and the increasing politicization of medicine. Since then, encounters with poor behavior have only become more common, especially in the era of mask mandates, vaccine require- ments and other public health rules. "Although the rude behaviors regularly experienced by medical practitioners can seem benign, our fi ndings indicate that they may result in iatrogenesis, with potentially devas- tating outcomes," the authors of the Pediatrics study said. "In taking steps to enhance patient safety, policy mak- ers should begin to consider the role played by the subtle and seemingly benign verbal aggression to which medical professionals are subjected on a routine basis." n