|by Evan M. Benjamin, MD | March 27, 2013
Last week I had the privilege to participate in the first meeting of Baystate Medical Center’s (BMC) newest committee, the Behavioral Event Review Committee (BERC). BERC was established last fall by the leadership of the medical staff to examine and address the behaviors of medical and associate professional staff members that have the potential to affect our hospital’s standing as a beacon of patient safety. We sat as peers coming from different specialties, yet we were all united in a common goal to better understand how individual behaviors, good and bad, can affect the entire culture of an organization. The conversation was not easy, but in the end we had a consensus not only on how to improve the culture of safety impacted by certain behaviors, but how to address future issues as well. While the proceedings of the BERC are protected, the issues discussed and their resolutions can have a profound impact on the culture of safety at our hospital.
Can you tell how strong our culture of safety is by observing professional interactions? What does it mean to have a culture of safety? The study of this field of quality improvement informs us that there is a clear relationship between respectfulness, teamwork and patient outcomes. Organizations with programs to monitor and improve team-based care actually have a better culture of safety and fewer harm events. Baystate has a long history of promoting this culture with our “TEAM Stepps” training, as well as adapting James Reason's medical error algorithm to create a just culture of blame in our peer review process.
Inappropriate behavior can be subtle. Clear examples of disrespectful or otherwise inappropriate actions are easy to identify, and these would trigger referrals to the BERC. Yet a physician who ignores or disregards a nurse who questions a plan of care is also an example of inappropriate behavior. "Tell me where you attended medical school?" is a question that intimidates our colleagues. Subtle intimidation shuts down cooperative teamwork that actually could save lives and reduce complications. Disrespect is a barrier to healthcare organizations becoming collaborative, supportive centers of patient-centered care.
Medicine is a very precarious field. Our individual best efforts are inadequate to produce reliable care time after time. Our success is truly dependent on the entire healthcare delivery team, and teamwork allows our eyes and ears to be extended to include the many individuals working with us. We must continue to challenge each other and actually thank our colleagues who respectfully question us. The first words out of our mouths after a colleague questions a care plan or a medication order should be "thank you", followed by a moment of thoughtfulness and reflection as to why the question was asked.
Our behavior speaks volumes about our culture. Thanks are extended to the leadership of our medical and associate professional staff for creating a mechanism at Baystate to promote teamwork and to work with our colleagues to improve behavior that jeopardizes our goal of remaining one of the safest hospitals in the country. I welcome your comments and suggestions at firstname.lastname@example.org. We’ve joined the conversation on Twitter, find this newsletter and other great content @Baystate_Health.