A Short Workshop to Promote Professional Conduct - PowerPoint Presentation

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A Short Workshop to Promote Professional ConductSlide2

Your OrganizationMission: Vision: Values: 2 Slide3

ObjectivesRecognize professional conduct as a foundation for achieving organizational mission, vision, valuesDefine professional and unprofessional conductUse two approaches to unprofessional conduct: Enforcement & EngagementRespond to unprofessional conduct using connect and correct Recognize the high conflict personality and seek guidance from human resources when needed 3 Slide4

Interprofessional Professionalism“Consistent demonstration of core values evidenced by professionals working together, aspiring to and wisely applying principles of altruism, excellence, caring, ethics, respect, communication, and accountability to achieve optimal health and wellness in individuals and communities” (Interprofessional Professionalism Collaborative, 2010). 4 Interprofessional Professionalism Collaborative. Definition ofInterprofessional Professionalism. Retrieved Feb. 14, 2015 from http://interprofessionalprofessionalism.weebly.com/Slide5

The Science 5

Team

Leadership

Team

Orientation

Mutual

Performance

Monitoring

Back-up

Behavior

Adaptability

Shared Mental

Models

Mutual

Trust

Team

Effectiveness

Closed Loop

Communication

(Salas

, Sims,

Burke; 2005)

Big 5

Coord

.

MechanismSlide6

Professional Conduct and High-Performing TeamsProfessional conduct contributes to safe patient care and is a key component of high performing teams.Reinforcing professional conduct expectations within the team: Is a form of self-correctionProvides mutual supportReinforces trustProvides needed feedbackIs a key component of care coordination

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Defining Unprofessional ConductUnprofessional conduct includes disruptive and intimidating behaviors that interrupt teamwork and undermine safe care.

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O

vert behaviors:

Verbal abuse

Shaming in front of others

Scapegoating

Belittling

Physical threats/ throwing objects

Passive behaviors:

Refusing to answer questions or return calls

Backstabbing

Withholding information

Recruiting others to take

a side

Undermining

RetaliationSlide8

Impact of Unprofessional ConductAccording to Joint Commission Sentinel Event Alert #40 —Behaviors that Undermine Safe Patient Care: Intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators and managers to seek new positions in more professional environments.http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_40.htm

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Patterns of Unprofessional ConductA 2008 statement by the Center for American Nurses defines: Horizontal (lateral) violence as “the physical, verbal, or emotional abuse of a fellow employee” Bullying as “an offensive abusive, intimidating, malicious or insulting behavior, or abuse of power conducted by an individual or group against others, which makes the recipient feel upset, threatened, humiliated or vulnerable, which undermines their self-confidence and which may cause them to suffer stress.”

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Two Approaches: Enforcement & EngagementActions to promote professional conduct occur at both the individual and system levels.Two approaches for promoting professional conduct are:Enforcement (power based)Engagement (collaborative)

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Tiered Interventions

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Majority of professionals—no issues

Single unprofessional event

Apparent pattern

Pattern

persists

No

change

Informal conversation—

“cup of coffee”

Awareness intervention

Authority intervention/ PI plan

Disciplinary action / termination

Hickson, 2007Slide12

Tiered InterventionsVery often individuals are not aware of their behavior or the effect it is having on others. Receiving feedback from team members is a form of mutual support.Informal feedback from a trusted colleague is a good first step.

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Four Steps for Responding to Unprofessional ConductAddressing instances of unprofessional behavior in order to improve patient safety is the job of all team members.Four Steps for Responding to Unprofessional Conduct:AssessAdopt a stanceConnect & CorrectEvaluate

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Adopting a Stance: Examples Assertive, competitive: Imminent risk CUS—I’m concerned. I’m uncomfortable. This is a safety issue.Two-Challenge Rule—Assertively voicing a concern at least two times to ensure that it has been heard.

Assertive, collaborative: Resistance, non-imminent situation

Connect and correct

Connect with

PEARLA

Correct with

DESC

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Connect & CorrectUsing the two-stage collaborative process Connect & Correct:Improves the likelihood that the feedback will be received Does not compromise the work relationship Sets the stage for productive problem solving.

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NOTE:

See the Connect & Correct Tip Sheet

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Stage 1 Connect: PEARLAUnderstand first, explain later…To connect, use the following algorithm:PEARLAPresenceEmpathyAcknowledgementReflect/reframeListen openlyA

sk questions

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NOTE:

See the

PEARLA

Tip

SheetSlide17

Acknowledgment: Example 1Nurse 1: Are you kidding me? I can’t believe this is the assignment you gave me! How am I supposed to take care of this guy who is bleeding and get my other patient ready for OR? How might Nurse 2 respond?Nurse 2: It seems overwhelming. What would help you right now so you can feel more comfortable

caring for these two patients?

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Acknowledgment: Example 2Nurse 1: I can’t believe you went ahead and left the clinic early yesterday! You really left us in a bind trying to get all of the patients prepared before the provider saw them.How might Nurse 2 respond?

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Nurse 2

:

I can see that my absence caused some

difficulty.Slide19

Reflect and Reframe: ExamplePerson 1: It figures that the new person was involved in this medication error. It seems like every time something bad happens, he’s had something to do with it.How might Person 2 respond?Person 2: Rarely is one person to blame for everything that goes wrong. What do you think contributed to this particular situation? OR—

So you’re saying you’re concerned about medication safety on this unit. What concerns you most? OR—It’s hard to say what happened since he’s not here. Have you spoken to him directly about your concerns?

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Sample Clarifying QuestionsTell me—what would help you right now?Where would be a better place to have this conversation?What does respect look like to you?What is going on that has you so upset?What do you think is the impact of your behavior?What do you hope to accomplish by talking this way?How is this helping you get what you need?

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Acknowledgement and Clarifying: Example 2Nurse 1: I can’t believe you went ahead and left the clinic early yesterday! You really left us in a bind trying to get all of the patients prepared before the provider saw them.How might Nurse 2 respond?

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Nurse 2

:

I can see that my absence caused some difficulty

(acknowledgement

).

We had discussed that I needed to leave early.

How could we better prepare for a staff absence the next time (clarifying question)?Slide22

Stage 2: CorrectUsing the TeamSTEPPS® DESC script is one way to seek correction of unprofessional behaviors.DESC: Describe the specific behavior Express how it makes you feel and what your concerns are Suggest alternatives and seek agreementClarify the consequences in terms

of the impact on goals of the team 

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Stage 2: DESC Script SampleDescribe: When you don’t answer pages or return phone calls …Explain: I am worried that I won’t be able to give safe care to the patient.Seek alternatives and agreement: I need for you to respond or have someone call for you if you are busy. Is that something you could try?Clarify Consequences: If not, it is going to have an impact on patient care and how much I can trust you.

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Practice Exercise: Using Connect & CorrectYou will be assigned one of the video scenarios to work with Using the Connect (PEARLA) and Correct (DESC) techniques, develop a response to one of the individuals who is behaving unprofessionallyIn pairs, practice your response with a partnerhttp://www.youtube.com/watch?v=mBCRBaLHR1k&feature=PlayList&p=2643A7B123CC8F01&index=2

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Exercise DebriefWhich of the two stages, Connect or Correct, feels easier? What makes it easier for you? Which of the skills would you like to be better at? What steps could you take to improve your skills?What could help you feel more comfortable using these in your daily work? 25 Slide26

Practice Exercise: Using Connect & CorrectThink of a conflict scenario you have recently or commonly face at work, or one you need to address. In pairs, practice your response with a partner:Connect first using PEARLADebrief with group Correct using DESCDebrief with groupGoal: develop a response to one of the individuals who is behaving unprofessionally 26 Slide27

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High-conflict people are those individuals who have a life-long pattern of high-conflict behavior and who typically exhibit long-term traits of those with personality disorders and who engage in ongoing high-conflict thinking.

Eddy, W.

It’s All Your Fault: 12 Tips for Managing People Who Blame Others for Everything.

(2008). Janis Publications.

High-Conflict PersonalitiesSlide28

Destructive Conflict BehaviorsFor high-conflict people, the ability to self-reflect and self-correct is limited or nonexistent. They default to destructive conflict behaviors and they seem unable to make different choices.

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Tips for Managing High-Conflict PeopleUse empathy and create connection repeatedly.Acknowledge their fears and emotions as real to them without agreeing with their conclusions or beliefs.Listen openly to their concerns without being taken in by misinformation or inaccurate conclusions.Consistently set clear limits on behavior and create structures to contain their impact on others.

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Tips for Managing High-Conflict PeopleDon’t fall for the drama and don’t adopt high-conflict behavior yourselfRecognize that a single intervention will not be sufficient—they will require continued interventions and limit settingDo not take their attacks personally or feel you are to blame for the situation

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SummaryProfessional conduct is consistent with your organization’s mission, vision, valuesKnow when to enforce and when to engage using connect and correctManage the high conflict personality; DON’T let them manage you 31