SDS Accreditation Update: Steps to developing a code of conduct
SDS Accreditation Update
Steps to developing a code of conduct
When developing a code of conduct and addressing inappropriate behavior, consider these suggestions from your peers:
• Define disruptive and/or inappropriate behavior.
Vanderbilt University Medical Center in Nashville, TN, says that disruptive and/or inappropriate behavior may include behavior that prevents or interferes with individual or group work, or creates an environment that is unprofessional, unsafe, intimidating, hostile, or offensive. [A copy of the professional conduct policy is included.]
The Vanderbilt policy says disruptive and/or inappropriate behavior may include, but isn't limited to, behavior that prevents or interferes with an individual's or group's work or academic performance, or that creates an unprofessional, unsafe, intimidating, hostile, or offensive work or academic environment or that violates the medical center's policies. Examples include:
— verbal abuse, sexual or other harassment, or threatening or intimidating words or actions;
— yelling or inappropriate language;
— threats of harm or behavior reasonably interpreted as threatening.
Spell out expectations
Massachusetts General Hospital in Boston has a "credo" document that specifies, among other things, that staff will remain calm when confronted with or responding to pressure situations; treat colleagues with dignity, respect and compassion; promote interdepartmental cooperation; recognize and encourage positive behaviors; and provide private constructive feedback for inappropriate behaviors. (Mass General's Credo and Boundaries documents are included.)
• Outline disciplinary/corrective actions.
At Vanderbilt, corrective/disciplinary action or performance improvement counseling is initiated, depending on the facts and circumstances. Significant violations or a pattern of disruptive behavior can result in termination. The policy also says even a single instance of disruptive behavior might be sufficient for disciplinary or corrective action, including termination.
At North Shore Medical Center in Salem, MA, not following the Civility and Respect Policy can lead to corrective actions that may include formal apology; written warning; written reprimand; report to the professional societies and/or licensing agencies; restriction of privileges; and referrals for counseling, education, or other interventions.
• Provide details on who should receive reports of disruptive behavior.
Vanderbilt's policy explains that all staff are responsible for reporting disruptive, inappropriate, or unprofessional behavior. It spells out who should be given violation reports. It also says individuals who don't believe their complaints have been resolved should report the conduct up their chain of command. It also says any retaliation should be reported.
• Include zero tolerance.
The Joint Commission (TJC) recommends, but doesn't require, that the policy have a zero-tolerance approach.
"Zero tolerance is more about having the [facility] organized in a way that says it is acceptable to report intimidating or disruptive behavior, or says [such behavior] is not accepted within the code of conduct," says Peter Angood, MD, vice president and chief patient safety officer for TJC.
• Recognize a range of behaviors.
Not all incidents are serious, Angood emphasizes. The code of conduct should promote desirable behaviors and clearly delineate unacceptable behaviors, recognizing that a range of behaviors occur, he says. "The reactions from an organization to any reported incidences should also have a range of actions and reactions in place," Angood says. "It's not one-size-fits-all here."
All staff members have days when, for example, they might be having personal issues and will display grumpy attitudes, he says. "If one incident happens, and it's not a reoccurring problem for an individual, the organization should not overreact," Angood says.
• Encourage nonconfrontational interaction strategies to address intimidating and disruptive behaviors.
TJC recommends such nonconfrontational strategies, Angood says. For example, an individual might exhibit mild behavior problems and be perpetually unhappy, disrespectful, and/or passive aggressive. "That type of behavior should be recognized early," he advises. Peer interaction often is best, Angood says. He says there needs to be more intense counseling and a more specifically established time frame by which an organization can expect changes, he says.
There should be a "gradation of involvement based on gradations of behavior," he says. "It should be clearly stated, and there should be an end point in the whole process."
When developing an atmosphere of professional conduct, it's not a matter of simply taking a policy from another facility, putting your logo on it, and saying, "OK. We solved the problem. We're ready for The Joint Commission," warns Gregg Meyer, MD, MSC, senior vice president of quality and safety at Massachusetts General Physicians Organization in Boston and Massachusetts General Hospital. "Documents alone aren't the answer," Meyer says. "It's much more than that."
Your documents are only as good as the communication and culture around them, he says. "In and of themselves, they have relatively little impact," Meyer says. "When you couple development of these with engaging clinical leadership, and are mindful of the culture of the institution in terms of rolling these out and making then a part of what we do every day, that is more cohesive plan."
When developing a code of conduct and addressing inappropriate behavior, consider these suggestions from your peers:Subscribe Now for Access
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