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May 19, 2021

6 proven ways to handle disruptive patient behavior, according to HBR

Daily Briefing
    Editor's note: This popular story from the Daily Briefing's archives was republished on Nov. 10, 2021.

    Writing for Harvard Business Review, Christine Porath, professor of management at Georgetown University, and Adrienne Boissy, neurologist and chief experience officer at the Cleveland Clinic, share six ways to curb disruptive behavior among frustrated, stressed patients—and ensure providers can provide the best possible level of care.

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    Amid the Covid-19 pandemic, frontline staff in the health care industry are "bearing the brunt of a much angrier, more frustrated, and weary" patient population—and this disruptive behavior can negatively affect providers' ability to provide quality care.

    For instance, according to the authors, research indicates that "exposure to rudeness … negatively impact[s] medical teams' diagnoses and procedural performance." In fact, according to one study of more than 4,500 physicians and nurses, "71% saw a link between disruptive behavior (defined as 'abusive personal conduct,' including condescending, insulting, or rude behavior) and medical errors, and 27% connect such behavior to actual deaths among their patients," Porath and Boissy write.

    "To protect both patients and frontline workers," the authors share six research-backed steps aimed at reducing "incivility and bad behavior."

    1. Implement safety training

    Noting that health care workers are "several times more likely to experience workplace violence than those in other sectors," the authors recommend health care leaders take steps to implement routine safety training, such as the Non-Abusive Psychological and Physical Intervention (NAPPI) training program. According to the authors, NAPPI "focuses on de-escalation, self-protection, and restraint training"—and caregivers who have participated in the program have "reported feeling more empowered and confident in their own abilities" to spot and manage upset patients and family members.

    For its part, Cleveland Clinic has partnered with local police to mitigate potential violence; posted signage "indicating that violence will not be tolerated"; established a workplace violence committee; routinely runs active shooter drills and alarm testing; and flags patients who have threatened violence against themselves or caregivers in EHRs, along with "suggested safety mechanisms."

    2. 'Nudge' patients and providers

    "Nudges—short, personalized recommendations with a clear call-to-action—have been useful in a variety of settings, including health care," the authors write, with research indicating that, across industries, "people who receive nudges are 53% more likely to take action."

    Accordingly, several hospitals and health systems have recently adopted nudges as part of their safety protocols, such as signs at Indiana University Health that remind visitors to "take responsibility for the energy [they] bring into this space." On a slightly different track, Cleveland Clinic has implemented "behavioral contracts," which are formal agreements drafted between the system's ombudsman and disruptive patients who haven't responded to conversation-based interventions to clarify "expected language and behavior and … the associated consequences."

    3. Bolster expectations with training

    According to the authors, training and reinforcement of clearly stated expectations help providers know "what they need to do in volatile situations, how to respond respectfully, and how to hold people accountable."

    At Cleveland Clinic, for instance, the system tweaked its inclusion training program to include "listening tours on racism and bias, training … on how to create inclusive environments, and sharing skillsets for how to address racism directly"—including how to address racism from patients. More broadly, Cleveland Clinic in 2011 began offering formal training in empathy- and relationship-focused communication skills—the Communicate with H.E.A.R.T. and REDE to Communicate programs—which together serve "as the foundation of all other communication guidance," including guidance on how to discuss mask-wearing with patients.

    4. Meet people where they are

    According to the authors, organizations can aid providers' "growth and healing in part by simply recognizing that the pandemic has created trauma—not just medical trauma, but also devastating psychological trauma, physical injury, and emotional harm."

    The authors recommend that organizations engage in trauma-informed care, along with supplemental tactics and commitments, such as ensuring people have the basic necessities, such as water and housing; avoiding furloughs; establishing peer-support groups; honoring those who have been lost; and developing policies, language, and training for how to address incivility of any kind.

    5. Create recovery moments

    Acknowledging that those organizational tactics won't "stop incivility altogether," the authors note that "it's also important that you and your people take care of yourselves in the face of uncivil behavior." For instance, the authors recommend encouraging providers to "take breaks when they can," such as by taking deep breaths, repeating meaningful mantras, or creating small, mindful routines in their workday.

    6. 'Find your tribe'

    According to the authors, research underscores the importance of "positive relationships inside and outside of work," so it's incumbent on leaders to encourage providers to "identify and call on their energizers, the people in their lives who lift their spirits." That community-building approach "increases both theirs and others' success," the authors write—"just like caring for patients."

    The authors explain that our "brains are wired to mirror the body language and emotion of others," which—while making incivility more dangerous—also "offers a way forward."

    They write, "Because happiness, peace, and empathy are also infectious, we can actually change ourselves, our teams, and the world—one gesture at a time" (Porath/Boissy, Harvard Business Review, 5/14).

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    The Covid-19 pandemic is rapidly increasing the need for behavioral health services. But there are significant gaps and barriers that stand in the way of people getting the help they need. Download our take to learn how health systems can prioritize addressing the immediate needs of both staff and patients, especially those with preexisting behavioral health needs or comorbid conditions.

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