How to eliminate disrespect in healthcare

R-E-S-P-E-C-T. While that's Aretha's line, it would seem to one Harvard professor that its opposite--disrespect--is the systemic cause of problems in hospitals. Anthony Cirillo

Lucian Leape, adjunct professor of health policy at the Harvard School of Public Health, was cited in a recent article saying disrespect is the reason why so many patients leave the emergency room, why staff is "demoralized" and why medical errors persist.

In the journal Academic Medicine, Leape and his co-authors outlined six categories of disrespect, the final one being systemic disrespect that's baked into the profession.

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Meanwhile, in other recent news, Press Ganey reported that hospitals that perform well on patient experience measures also have lower 30-day readmission rates and are least likely to receive a substantial readmission penalty. The conclusion there was that better communication at discharge, therefore a better patient experience and a better lasting impression, help people both rate the hospital better and follow discharge instructions.

Going back to Leape, isn't disrespect manifested most in how we communicate with one another? So perhaps at the end of the day, communication is the key issue and the solution to all of our healthcare issues.

But I am not talking about teaching people how to communicate or scripting them to speak a certain way. I think communication training sometimes covers over an inherent problem in healthcare, namely, lack of compassion.

As I wrote this I came across yet another article that offeredprescriptive solutions. It recounts how all the doctors at a 500+ physician group were going through patient experience training to learn about the true patient experience mission and to teach physicians the most effective communication techniques to achieve that mission's goals.

Sorry, I am not buying it. I agree with Leape that this stuff is baked in.

For example, at the Landmark Forum I recently attended, the discussion touched on the notion of "rackets," defined as an "unproductive way of being or acting that includes a complaint that something shouldn't be the way it is."

The problem is that rackets simultaneously present a payoff and a price. Whether our complaints are justified, we receive some benefit that bakes in the pattern of behavior. Yet thisway of being can lead to lower levels of vitality, affinity, self-expression, or fulfillment

We all show up at work with baggage. We all have reasons for why things are the way they are, and they affect all aspects of human relationships. So physicians think they are entitled. Staff thinks they are not empowered. Patients feel they are victims.

Perhaps at one time a patient experienced a situation in which they were treated poorly. But they translated it into being a victim. And perhaps it serves them well--they may get more care showered on them, but at the same time, in keeping with a victim's role, they sacrifice self-expression and empowerment in their care.

A physician, administrator or staff member can't simply go through communication training, customer service training or compassion training and come out a better person. A physician speaking to a patient more empathetically is inauthentic if at the same time that little voice in their head is saying things like: "This person brought the condition on themselves" or "They'll never stop their bad habits" or "Why should I treat them with respect when they don't treat themselves that way?" And on and on.

I have referenced this a few times in previous Hospital Impactblog posts, a comment from a physician reader:

"In the end, you reap what you sow, and it is not doctors' responsibility to heal society. There are a lot of other people with jobs to do, and I do not see they or you coming to my house to work for free to pay off their meager $100K hospital bill (to save their life) $1K of which I get, almost all of which goes to the bank."

Imagine that doctor undergoing empathy training when he looks at a patient and just sees a bill not being paid and his paycheck being affected.

Leape says a new expectation of respect must be built into hospital codes of conduct and performance reviews, as well into the very culture of medical education. In a society where people lack trust and think everyone is out to get them, no amount of training or "carrot and stick" mentality will work.

I say lose the baggage, get over it and live in the moment. That is all you have. Sure, easier said than done.

But if you approach every human encounter that way, you are open to any possibility and therefore true compassion and empathy. You may discover some things that may be challenging to and about yourself that also can be transforming at the same time.

Your communication will change dramatically and respect will be a natural outgrowth.

And I think that is where this conversation started.

Anthony Cirillo, FACHE, ABC, is president of Fast Forward Consulting, which specializes in experience management and strategic marketing for healthcare facilities. He also is theexpert guide in Assisted Living for About.com and Healthcare Channel Partner for CEO².

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