Disrespectful and unsafe behavior by physicians and advanced practice medical professionals can undermine health care teams, but research shows that often a simple conversation to make an individual aware of their action can promote self-reflection and change.
A Vanderbilt University Medical Center study published in the April issue of The Joint Commission Journal on Quality and Patient Safety examines data from the Co-worker Observation Reporting System (CORS), a system of peer reporting of perceived disrespectful and unsafe conduct that was established at VUMC in 2011.
The Medical Center adopted the program after first creating and implementing the Patient Advocacy Reporting System (PARS), which uses feedback from patients and families to promote positive changes in physician behavior. Building on PARS’ success, leaders from the Center for Patient and Professional Advocacy and Quality, Safety and Risk Prevention worked to create CORS, which captures co-workers’ concerns.
Since CORS’ inception, 71 percent of those individuals who received a report of some behavioral concern were not named in any subsequent reports during a one-year follow-up period after the behavior was brought to their attention, and 3 percent of the medical staff were associated with a pattern of CORS reports, meaning they received three or more CORS reports within a rolling three-year period.
“These results are reaffirming that the environment here at VUMC is based upon mutual respect for everyone — our patients, their families and our co-workers,” said Lynn Webb, Ph.D., assistant dean for Faculty Development and the study’s lead author. “We treat others as we wish to be treated. That’s direct from our Vanderbilt Credo, which is a set of guiding principles all our employees seek to follow, and we tend to reflect on and respond positively to the feedback.”
A key factor in CORS’ success is how rapidly a report is shared with an individual, said Roger Dmochowski, M.D., associate director of Quality and Safety and executive director of Risk Prevention for Vanderbilt Health System. A trained messenger — a department chair or a designee of the chair — shares the information with the individual within five working days of the report during a private “cup of coffee” conversation. This makes the individual aware of their behavior and gives them the opportunity to make any needed changes on their own. Based on the data, the process works.
“The majority of individuals respond positively and can address the concerns of others,” said Dmochowski. “This is certainly a nice reflection on humanity. Most people understand that when these kinds of things are brought to their attention, it is not only to improve the patients’ experience, but also to benefit the people who are assisting them in team-based care delivery.”
Vanderbilt department chairs have been extremely supportive of the program, and resources are already in place on campus to address behavioral issues, if needed, including courses offered through the Center for Patient and Professional Advocacy (CPPA) as well as the Faculty and Physician Wellness Program, Dmochowski added.
“Medicine is inherently stressful, and all of us, on occasion, will behave in ways that may not be consistent with who we want to be,” said Gerald Hickson, M.D., senior vice president for Quality, Safety and Risk Prevention. “The goal of this program is to engage colleagues early so they can be self-reflective. That’s the key to being a professional.”
The aim of CORS is not perfection, said Hickson, but rather avoiding the development of behavioral patterns that can create problems for team members and the patients we serve.
According to William Cooper, M.D., MPH, director of the CPPA, CPPA partners nationally with 40 major medical organizations and health care systems to implement PARS (impacting 28,000 physicians), and 10 of these organizations are adopting the CORS model this year.
