JCAHO To Require Healthcare Organizations to Stop Workplace Bullying

On July 9, 2008, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) issued a Sentinel Event Alert amending its Leadership Standards and requiring accredited healthcare organizations beginning on January 1, 2009 to (1) create codes of conduct which define acceptable and disruptive and inappropriate workplace behaviors and (2) create and implement a process for managing disruptive and inappropriate behaviors. The JCAHO also amended the Medical Staff standards to incorporate six core competencies to be addressed in “the credentialing process including interpersonal skills and professionalism.”

The JCAHO explained that it was taking this action because “intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse consequences, increase the cost of care and cause qualified clinicians, administrators and mangers to seek new positions in more professional environments. Safety and quality of patient care is dependent on teamwork, communication, and a collaborative work environment.”

While recognizing that workplace bullies have contributed much to this endemic problem, not all “such behaviors [are] confined to the small number of individuals who habitually exhibit them . . . It is important that organizations recognize that it is the behaviors that threaten patient safety, irrespective of who engages in them.”

“Organizations that fail to address unprofessional behavior through formal systems are indirectly promoting” a culture “of tolerance and indifference to intimidating and disruptive behaviors in health care.” Granted, the recurrence of dealing with highly emotional and stressful situations “can contribute to occasional intimidating or disruptive behavior, particularly in the presence of factors, such as fatigue. Individual care providers who exhibit characteristics such as self-centeredness, immaturity or defensiveness can be more prone to unprofessional behavior” and lack interpersonal, coping or conflict management skills.

In addition to the mandatory standards for addressing this problem, the JCAHO recommends that organizations take an additional thirteen steps, including:

* Educate all staff on appropriate professional behavior defined by the organization’s code of conduct with an emphasis on mutual respect. The training should include basic business etiquette, telephone skills, customer service and other basic people skills.
* Hold all staff accountable for modeling desirable behaviors and enforce the code consistently and fairly among all staff, regardless of seniority or clinical discipline. This should include both positive and negative reinforcement where appropriate.
* Develop and implement policies and procedures which address zero tolerance for egregious instances of disruptive behavior (such as assault, threats and other criminal acts). These standards should be incorporated into bylaws and employment agreements as well. Physicians and staff should be held to the complementary standards. Staff should be encouraged to report and cooperate in investigations of disruptive behavior by including non-retaliation statements into all policy statements.
* “Provide skills-based training and coaching for all leaders and managers in relationship-building and collaborative practice, including skills for giving feedback on unprofessional behavior and conflict resolution. Cultural assessment tools can also be used to measure whether or not attitudes change over time.”
* “Develop and implement a reporting/surveillance system (possibly anonymous) for detecting unprofessional behavior. Include ombuds services and patient advocates.”
* “Support surveillance with tiered, non-confrontational interventional strategies, starting with informal “cup of coffee” conversations directly addressing the problem and moving toward detailed action plans and progressive discipline, if patterns persist. These interventions should initially be non-adversarial in nature, with the focus on building trust, placing accountability on and rehabilitating the offending individual, and protecting patient safety. Make use of mediators, and conflict coaches when professional dispute resolution skills are needed.”

Insomniacs can read the Alert in full at http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_40.htm. The Alert does not address what will happen to Dr. Greg House when these standards become effective.:)

NOTICE: This summary is designed merely to inform and alert you of recent legal developments. It does not constitute legal advice and does not apply to any particular situation because different facts could lead to different results. Information here can change or be amended without notice. Readers should not act upon this information without legal advice. If you have any questions about anything you have read, you should consult with or retain an employment attorney.

Employee Who Quit Because Boss Frequently Yelled at Him and Others Is Awarded Unemployment Compensation

In late January, a divided Ohio Court of Appeals from Summit County affirmed the award of unemployment compensation to an employee who quit twelve days after being hired because his actual duties did not match his job description and because the boss frequently yelled at him and others over his protests. Ro-Mai Industries, Inc. v. Weinberg, 2008-Ohio-301 (1/30/08).

The employee accepted a position with the employer after interviewing with the owner. The employee, “who had extensive experience in sales,” testified that he was told that his position with the employer would involve sales work and would require him to be at the office only from approximately 8:00 a.m. to 5:00 p.m. The owner testified: "When I hired [the employee], I told him I'm probably the worst employer to ever work for[.] I'm difficult. I expect a lot. And I warned him in advance that I'm very difficult. *** [W]hen it comes to the business, I . . . I can yell. I did yell."

The employee began work on October 24, 2005. After a few days of work, however, he says that it became clear that “his actual duties differed from the job description that he received. He was not given any sales work and he often worked well over the nine hour shift that he was promised.” In addition, he discovered that the owner had a habit of yelling at the employees. Although the employee told the owner that he did not appreciate being treated in such a manner, the owner continued to yell.

On November 3, 2005, the employee informed the head of human resources that he intended to quit and was told: "[O]h, it[] gets worse. That's the way he is." However, before the employee left the office the owner sought him out, promised to stop yelling at him, and convinced him to stay. The employee returned to work the next day, but the owner resumed his habit of yelling at him. Accordingly, the employee quit the following day.

In opposing the unemployment claim, the employer argued that the employee voluntarily quit without just cause because he did not want to work more than eight hours a day, as a salaried employee sometimes must do, and he did not enjoy the type of work that the employer assigned him. It also argued that the employee was overly sensitive to the owner’s yelling, in that such yelling had never caused any other employee to quit. The dissent was persuaded by this argument and expressed concern that an employee could obtain unemployment compensation anytime he or she quit after being yelled at by a manager or supervisor. “No other . . . employee quit because of the yelling. This, therefore, obviates the hearing officer's determination that a reasonable person would quit in such a situation. While it may be uncomfortable for an employee to have an employer yell at him or her, if we were to take the reasoning of the hearing officer to its ultimate conclusion, there would be reasonable ground for quitting just because one employee simply raised his voice at another. I would find being yelled at, as a matter of law, is not just cause to qualify for unemployment benefits.”

The hearing officer determined that a reasonable person in the employee’s position would have quit his employment. Noting that the employer had misrepresented the employee’s job duties and the number of hours that he would be expected to work as a salaried employee, the hearing officer and the majority of the Court were also influenced because the “yelling was not a single, isolated incident.” Had it been a single, isolated incident, the employee would not have had just cause to resign. Rather, it “was a repetitive problem that [the employee] unsuccessfully tried to address with [the employer’s] human resources department prior to quitting. [The employee] even agreed to resume work the first time that he intended to quit because [the owner] asked him to stay and promised to stop yelling. He did not abandon his employment without warning, or leave with utter disregard for the good of the business.”

Insomniacs may read the full decision at http://www.sconet.state.oh.us/rod/docs/pdf/9/2008/2008-ohio-301.pdf.

NOTICE: This summary is designed merely to inform and alert you of recent legal developments. It does not constitute legal advice and does not apply to any particular situation because different facts could lead to different results. Information here can change or be amended without notice. Readers should not act upon this information without legal advice. If you have any questions about anything you have read, you should consult with or retain an employment attorney.