Nick's Blog

Hospital Bullies take a Toll on Patient Safety

That was the title of an article written by JoNel Aleccia for MSNBC.com.  When I thought about writing this blog, a cold chill went down my spine. The last time I attempted to address this issue, I was attacked, not here, but from other places. My family was hassled, there were letters written to the paper, to my board, to the Medical Society and demands for apologies all around. This article, however, took a much tougher stand than I did, and made its point much better than I did as well. 

JoNel started by writing, "They're the bullies of the operating room, the brow beaters of bedside manner; doctors, nurses and other clinicians who make a habit of behaving badly."  Before you start sending me your hate E-mails and trying to get me fired, censured, and publicly whipped again, let me begin by saying that there are only about 4 to 6% of workers and staff nationwide who typically fall into this category, and, in our case, I can honestly and proudly say that at Windber Medical Center there are less than 1%, but that's not the point.  The point is that this type of behavior is still tolerated ANYWHERE. 

Ms. Aleccia goes on to say, "They yell, they cuss, they throw things. Or they engage in more subversive behaviors; ignoring questions, acting impatient, insulting colleagues or speaking to them in condescending tones."  Any of us in this industry who have not observed this behavior should please stand and be recognized.  Interestingly, the Joint Commission has recently taken a stand against bullying behavior with a first-ever alert, and the reason for their alert is patient safety.

Dr. Mark Chassin, President of the Joint Commission, says, "It's a problem that goes underreported, threatens patient safety and has become so ingrained in healthcare that it's rarely talked about."  (So, send your evil E-mails to Mark, and let me alone.)

Dianne Felblinger, an associate professor of nursing at the University of Cincinnati who studies medical intimidation goes on to state that "About 70% of nurses studied believe there's a link between disruptive behavior and adverse outcomes, and nearly 25 percent said there was a direct tie between the bad acts and patient mortality."

The great news is that Windber Medical Center's Administration, Medical Executive and Credentials Committees and Human Resources Department deal with these behaviors immediately. They do not and will not tolerate bullying.  Oh, and before we end this blog post, remember, this behavior is NOT limited to care givers; clearly, administrators, department heads, and others can be just as guilty.   

The advice given in the article is the same advice that we adhere to here at WMC as well.  When someone is disruptive we should simply say, "You know what...? That doesn't work here...And we're going to have to do this together as a team because that's what it's all about."

Amen!

I Fired a Fish This Week

The closest I’ve ever come to admitting my obsession with bullies came this week.  As I was walking toward the Men’s Room, my cell phone rang. Coincidentally, I was standing near a chair that was almost directly in front of one of our many fish tanks.  As the conversation went on, my eyes were drawn to the fish.  That’s when I noticed him; the biggest fish in the tank. He had little orange fins coming out of the bottom of its belly.  This dude was out of control.  He was chasing and biting every one of the fish in the tank, Alpha fish. 

This attacking went on during my entire conversation.  Chase, bite, chase bump, bite, chase; it was a flashback from my eighth grade year when some big, dumb junior used to grab my hat and throw it around the bus. Then, the coward would take my lunch and smash it into a baseball sized, brown wad of inedible nothingness.  He harassed me until I had one of my bigger friends threaten him one day. 

Now, this fish was really getting me riled up.  I was annoyed, then irritated, then exasperated, and finally infuriated.  What the heck?  This hospital is famous for treating its workforce, patients and physicians with dignity, compassion, and respect, and here was this bully fish chasing everyone around.  No matter where they went in the tank, he swam as fast as he could to scare and try to scar them.

 I went back to my office and ruminated for awhile about this aquatic creep, and my blood pressure kept going up until I could hear my heart thumping in my ears. No more. This fish had to go. I walked out to the tank and got the phone number of the fish tank maintenance people.  It was then that I realized that all of this was pretty silly. It is simply what nature is all about, survival of the fittest.  “Okay, alright, calm down, sleep on it,” I said to myself.  It’s just a big, mean, despicable fish. It’s not a person. It’s not disrupting the balance of life.  Just because it’s a wicked, shameful, loathsome, contemptible, wicked son of a #!%$ fish, there was no reason for me to continue to obsess over it.  

That night, I kept waking up, thinking about that fish and all of the nice little fish who were being attacked, threatened, and terrorized because of this storm trooper.  When I got to work, I walked into the office of the closest fish attendant, a wonderful employee who feeds them and makes sure the lights get turned on and off each day, and I said, “Get rid of the fish with the orange fins.”   She smiled and replied, “Really?”   “Yep, I want him fired,” I replied.  “Send him to some other fish tank full of fish that are bigger than he is.”  Just get him out of here!”   She laughed quietly, and said something like, “No one is safe when you’re in one of these moods.”

That day, the fish tank attendant came for a visit, placed our aquatic terrorist in a big plastic bag, and said, “Don’t you worry, I’ll take him to a safe place.”  Heck, safe was the last thing I wanted for this guy.  Later that afternoon, I was standing in front of the other fish tank at our research center and what I saw was nothing short of a war.  They made our orange finned guy look like Nemo.  “What’s this all about,” I asked our receptionist.  She smiled and said, “These are bad, bad fish. They are Cichlids, and all they do is chase each other all day, eat their young, and make life miserable."  No leadership there.  Fish tanks can be just like work.  Guess it depends on who you have for a boss.HTML

Random Thoughts. . . Learn From Your Mistakes

Make sure you know the question before you give the answer.

My kids taught me a lot about this job. At age seven, my son said, "Dad, where did I come from?" I knew that question was coming, but I had not expected it that soon. "Son," I said, "Let me explain about life" As I began my meticulously rehearsed tale of the birds and the bees, I slowly explained the nuances of life, love and more bees.

I was perspiring profusely as I stumbled over these sensitive descriptions. After about ten minutes of squirming, stuttering and stammering I said, "Do you understand, son?" To which he turned to me and said, "Heck, Dad, I knew all that stuff. I just wanted to know what hospital I came from, Mercy or Windber?"

Learn to share.

Hospitals deal every day in life and death issues. They are extremely complex and multifarious places. Emotions can run very high as well as we deal with the challenges and mysteries of life. Helping people to share has been a very large part of my life. Helping them to share resources, time, space and all aspects of life is a very important contributor to our success as both care givers and human beings. When I was eight, my Aunt Mildred gave me three pieces of bubble gum. As I was walking home with all three pieces stuffed into my jaw, a group of kids jumped me, pinned me down, took my gum right out of my mouth and divided it up between them. It would have been a lot easier on me if I had just kept a few pieces out to share.

Finally, don’t repeat it if you don’t understand it.

In any organization there always seems to be someone who takes great pleasure in telling the story when they aren't really sure of its meaning. After standing near Jack, a 15 year old sixth grader at school one day, my vocabulary expanded exponentially. He talked about mysterious things that made no sense to me, but he was big and I was small. In my world, that meant that Jack knew all. That night when my mom told me, the little third grader, to get ready for bed, I looked up at her standing beside my grandmother, aunt and dad and said, "I don’t have to go to bed, you @$#%&*$@!"

My limp cleared up right before I had to walk across the stage to pick up my college diploma thirteen years later.

Learn from your mistakes.

So You Want to Be A CEO: Part Eleven

This is the eleventh year since I first came through one of the six front doors at Windber Medical Center. There were several things that I vowed to do when I arrived. The first physical change that I wanted was to actually create a way to get to one of those sets of front doors. It hasn't happened. It's ten years later and still no steps.

My second plan was to put in electric doors. No electric doors.

Oh yeah, and I wanted to move the cafeteria to an area where people in wheel chairs could actually go to eat. I know, novel idea for a hospital. That hasn't happened either.

Due to budget and resource allocation considerations, these projects have been cut at least ten times. Disappointment becomes part of life, but you can't focus on what hasn't been done because it will make you crazy.

On the other hand, we have built over $20 M worth of buildings all around the campus.

Throughout the past decade, every one of these improvements have come at a cost to someone. Sometimes, very tough politics.

Through all of this, however, our board has remained extremely supportive at all times. They have remained squarely behind us.

We have grown from 250 or so employees to nearly 550, and, although our accomplishments as a medical center and research institute have been regularly recognized, life does continue to be challenging. The steps are still not done. Our grants, due last July, have still not been released, and that makes every day an adventure, but we will push forward.

One of my teachers once told me that the Great Barrier Reef, the largest collection of living organisms in the world, is a unique phenomena.  On the bay side where things are calm, everything is dead, but on the ocean side where the waves smash against it, life prevails, positive stress seems to be the answer to survival.

Good will prevail. We will survive. We will succeed. We will get those steps in, create a handicapped accessible cafeteria and install electric doors, and that's just the beginning. Just you wait and see.

Let the good times roll.