Today I stumbled upon an intriguing, although somewhat troubling, blog post from last fall entitled, “Disrespect … is the Elephant in the Hospital.”  The post referred to two academic papers by Lucian Leape of the Harvard School of Public Health that closely examine how a hospital environment that tolerates disrespect — whether from doctors to nurses, staff to patients, administrators to clinicians or physicians to patients — leads to all kinds of bad outcomes, including very demonstrably increasing medical errors.

Tolerated disrespect isn’t just a hospital problem — it can happen in organizations of any sizes, including private practices.  And, the potential consequences aren’t just clinical.  If a manager or physician creates the sense that staff aren’t respected contributors to the team, it stifles staff contributions.  Team members who are in a position to observe operational problems will be discouraged from pointing them out — and so the practice misses out on an opportunity to improve. And, of course, the daily grind of disrespect will eventually cause your practice to lose its best employees.

Once a pattern of disrespect is well-established, it can be tough to break.  If a practice manager seems to treat staff dismissively or is demeaning to them, corrective action by the physician(s) he or she reports to is imperative.  If a physician seems unable to interact with staff without condescension or bullying, an intervention (perhaps with the help of an outside coach) is needed, and it may be necessary to carefully structure how he or she works with staff. Above all, the first step to repairing an office environment that has become hostile is to provide the means for staff to confidentially (anonymously) provide honest feedback, without fear of retaliation.  For a small practice, it may be helpful to work with a neutral outside party to gather employee opinions in a “safe” manner, and summarize them so that management can take corrective action.

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