Standards for RelationshipsLiving our Values

“Take care of yourself, take care of each other, take care of the place.”

~ Meg Wheatley

Staff Sessions

Rose has a habit of raising her voice very loudly when something upsets her, regardless of who is nearby. She makes comments such as, “What do YOU want?!” or “Why are you bothering me?!” to other staff when they notice.

Some staff members have tried to ‘step up’ & tell her they don’t like her yelling and sarcastic comments, but she shrugs and says, “This is just me; get over it. Everyone knows I get mad fast, but then it’s over.” or “ Don’t take it personally!”

Just now, you heard Rose talking loudly to Beth, the team assistant, saying, “I told you to send this yesterday and you didn’t do it. … do you ever do anything right?”

When Beth attempted to respond, Rose turned away and started doing something else at the desk. Beth tried to talk to Rose, but Rose said “Can’t you see I ‘m busy!”

Beth looked like she was about to cry and turned back to her computer.

What is the problem here?

Our values- based culture

• • RESPECTRESPECT • Excellence • Compassion

Our mission as a Catholic hospital

Conducting sound

business

practices

Strengthening effective

relationships

Honouring diversity &

access

Preventing Workplace

Violence

Why are we doing this?OUR AIM: We want…

– Positive, respectful and healthy work environment

– Clarity of expectations for behaviour

– Shared accountability for a ‘great place to work’

– Great reputation for our organization

Why this policy… Why now?

• What do you hear in the media or in our community about the topic of respectful relationships at work, or school, etc.?

• What do you know about what is occurring in health care, our community, our province… that is encouraging us to address issues of behaviour?

Background to our Policy• Staff want clear expectations about how we treat each other

• Staff want to know that inappropriate behaviour will be addressed consistently.

• 90% complaints are about colleagues disrespectful behaviour

• Growing awareness of the negative impacts of workplace ‘bullying’ and ‘violence’;

• Bill 168 and other relevant legislation; we need to understand and reduce risks in the workplace

• Nursing Council: concerned about inconsistency in managing unacceptable behaviour toward caregivers by patients & families;

• Aligned with CPSO’s Disruptive Physician Behaviour Initiative

• Aligned with LHSC Policy (Managing Abusive and Inappropriate Behaviours)

Other organizations’ experience of

Workplace Violence Dupont – Daniel and

Sears Chatham Coroner’s Inquests:

Legal duty and responsibilities of employers to:– Comply with legislation (OHSA, Criminal Code, Bill 168) – Create policies;– Train leaders and staff;– Ongoing monitoring and prevention.– Understand the Continuum of Violence

“Continuum of Violence”• acts of physical violence are clearly interpreted as violent

• acts of psychological violence may be confusing and inconsistently assessed as violent

A “continuum of violence” suggests that subtle and psychologically ‘violent’ behaviours (that we label as “innocuous”) may act as precursors to more physically destructive violent behaviours.

Sometimes these behaviours may seem relatively minor but cumulatively they can become very serious.

Joan Riggs,Catalyst Research and Communications

Definition of “Workplace Violence”

As defined in Bill 168 Workplace Violence means…

The exercise, attempt to exercise or statement or behaviour that it is reasonable for a worker to interpret as a threat to exercise, of physical force by a person against a worker, in a workplace that causes or could cause physical injury to the worker

Unacceptable Behaviours• Bullying (including cyberbullying), intimidating• Psychological abuse (avoiding, ignoring, gossiping about

others, withholding work related information . . .),• Verbal abuse: swearing, yelling, negative comments (e.g.

‘stupid’, ‘lazy’ ), name calling, derogatory comments• Stalking,• Uttering threats, • Assault, physical abuse• Damage to personal or hospital property,• Financial abuse• Retribution or retaliation for ‘good faith’ reporting of

behaviours• ? WHAT ELSE?

Unacceptable Behaviours• Gossip about colleagues, leaders, families, patients• Stereotyping

(“all nurses . . . “; “all respiratory therapists . . .”)• Undermining, sabotage• Intimidation by staring, glaring, silence etc• Ignoring or Discounting other’s thoughts, feelings & contributions• “Targeting” a colleague for mistreatment• Behaviour that splits teams or creates ‘factions’ in a team• Email messaging about a colleague or to a colleague / “cyber bullying”

(speaking badly of someone on Facebook, etc)

• Failure to intervene, assist or report when unacceptable behaviour is witnessed:– silence and / or inaction

Accumulation of Critical Events & Missed Opportunities Dupont Inquest

1 3 3 4 4 4

12

2228

3237

1 2 4 58 10

22

48

65

76

84

0

10

20

30

40

50

60

70

80

90

Critical Event

Opportunity

Margaret MacPherson, Ministry of Child & Youth Services, SW Region

Rights & Accountabilities

Everyone has rights and accountabilities….• Staff and affiliates (Physicians, Midwives,

Dentists)• Patients, families /visitors • Leaders, including physician leaders• Volunteers• Students• All people who work within our organization for

short term (eg Construction staff)

Consequences

All “consequences” are case specific

• Consequences of any breach of policy may lead to disciplinary action up to and including termination

Leaders’ Accountabilities• Model expected behaviours; coach others

• Clarify Expectations about behaviours• Risk assessment for inappropriate behaviours and potential for

violence;

• Speak up about all behaviour that is inconsistent with our standards; hold people accountable to meet expectations

• Support staff who report concerns• Advise of resources available to staff

• Act on actual or threat of current violence; may include disclosure of relevant facts to appropriate parties

• Document & investigate all reports of concern in a timely manner & take corrective action

• Mandatory reporting as required

Staff & Affiliates AccountabilitiesSummarized from page 2 of policy

• Model respectful relationships with all people • Build skills for good working relationships; reflect

on your own behaviour• Take part in training• ‘Step up’ and speak up about disrespectful

behavior; report to leader as needed• Hold each other accountable to these standards

of relationships • Report breaches of these standards to leader or

other appropriate persons• Document using appropriate tools

Patient and Family/Visitor Accountabilities

• Treat staff, other patients/residents, and families/ visitors with respect

• Be an active partner in care

Key messages• St Joseph’s fosters a culture that reflects our values and

we are committed to a work environment that is healthy, safe and violence-free for staff and patients

• There is shared accountability of everyone to ensure a safe workplace, including people who witness unacceptable behaviour;

• We must recognize the impact each of us has on – Each other – Our experience of quality of work life and care– Our organization’s success and reputation

• Leaders (employer) have a key accountability to safeguard against workplace violence;

Key messages, cont’d

• Confidentiality will be upheld (within legal limits) to anyone who reports unacceptable behaviour;

• Individuals are encouraged and supported to resolve conflict with others as much as possible; leaders have a role to coach this resolution

• Violation of our standards is unacceptable and will have consequences no who is involved

• An appeal process is in place

Case Scenarios

Read the following scenarios…

• What is the problem?

• What can you do?

Scenarios• You notice a colleague saying loudly to a patient: “I

already explained this to you; why are you still asking questions?” Later, the same colleague opens the staff fridge and yells: “Who took my lunch?” and then glares at everyone in the vicinity.

• The person beside you whispers: “She had a fight with her husband this morning and is taking it out on everyone”.

– Why is this a problem?– What do you think you can do?

Staff Staff

A. Address Immediate IssueEnsure safety always; 55555 + Emergency procedures

• Report or document facts• Witnesses offer support for reporting

B. Injuries? obtain immediate assistance + inform leader immediately

C. Addressing and Reporting Complaint:• Give feedback first; talk to each other• If unable to resolve between two parties, discuss with your leader.

(If leader is the respondent, staff may report to a more senior leader)

• Leader asks questions and documents relevant details;

• Leader discusses issue or complaint with ‘respondent’;

Staff Staff, Cont’d

D. Investigation Process • Consult as required with appropriate stakeholders e.g. HR, Union,

Medical Affairs; document discussions• May speak with witnesses.• Leaders accountable to act on what they hear.

E. Determine outcomes of investigation; Consult and Inform all appropriate parties

• Determine remedies or consequence (consult as needed)• Inform respondent of right to appeal

F. Follow Up Actions• Implement changes resulting from findings of investigation• Ensure appropriate follow up

Case Scenario

LEADER TO INSERT APPROPRIATE TEAM BASED scenario relevant to THEIR team’s experience…

• What is the problem?

• What can you do?

Staff Patient/Family /VisitorA. Address Immediate Issue:

– Ensure safety of all parties– clearly state to the staff member the behaviour must stop

B. Injuries? : provide medical treatment; document facts in patient record

C. Response & Investigation• Report to Leader who starts immediate investigation, • Leader involves key individuals as appropriate e.g. witnesses, SDM• Documentation of facts in Health Record• Follows ‘Adverse Event Policy’ & reporting processes

• Communicates outcomes of Investigation: Revise plan of care as needed

D. Follow Up Actions:• Incidents reviewed /resolved in a collaborative and transparent manner.• Implement changes needed.

Case Scenario

• LEADER TO INSERT APPROPRIATE TEAM BASED scenario relevant to THEIR team’s experience…

• What is the problem?

• What can you do?

Patient / Family /Visitor StaffA. Address Immediate Issue : • Ensure safety, activate emergency response, inform leader, document facts

and if anyone witnessed event

B. Injuries? Call for assistance in house or in community

C. Response & Investigation:• Immediate reporting and documentation as appropriate• Leader support staff• Leader assesses risk, begins investigation & involves appropriate

stakeholders• Team assessment of patient behaviours, Review / revise care plan

D. Follow up :• Incidents reviewed /resolved in a collaborative and transparent manner.• Support to staff, and team (e.g. EAP, Debriefing)• Share outcomes of investigation appropriately; Implement Changes needed

Questions, Comments

• Questions can be directed to your leader or to HR, PPLs, or any of resources outlined in the policy

Evaluation for today is welcomed.

Other Scenarios for Discussion

• To be used by leaders with teams as required.

Scenario

“We have a colleague who is a bully. He makes unreasonable demands like “I won’t take any more patients today”. He’s good at his job, but is ornery and a bully. He doesn’t do his fair share. It ticks all of us off. We’ve lost a couple of good staff here because they were sick of putting up with him.”– What am I supposed to do?

Scenario

“Some people here are burnt out. They’ve lost the excitement or have some personal issue in their life . . . People have to cover for them-pick up their slack. People get mad at them, isolate them, don’t offer to help them, talk about them behind their backs, and yet they continue to do less than their share.”– What am I supposed to do?