Teaching respect at Maimonides Medical Center.

This edition of Frontiers has two thoughtful articles that take up the issue of disruptive behavior by physicians and other healthcare professionals, discussing tangible organizational approaches that address and remediate this unprofessional conduct. Disruptive behavior has become a hot topic in recent years, and so too, the close connection between bad behavior, harm to patients, and poor quality of care in hospitals. As Lucian Leape, a professor at the Harvard School of Public Health and a member of the Institute of Medicine committee that authored the seminal report on patient safety, To Err is Human, said, "the key success factors in a safety effort are teamwork and respect, two basic ideas that are too often lacking in medicine" (Grazier 2008). How can we overcome the formidable obstacles to achieving these two success factors? For me, it is leadership-and the recognition that leadership is not the exclusive province of management. People who work as clerks or housekeepers are also leaders in their own community, their churches, or schools. They are opinion shapers and often well regarded by their peers. As we broaden the traditional notions of what effective leadership is based on, it becomes easier to approach the issues of teamwork and respect. For as long as I've been a hospital CEO, I've been taken with the importance of teamwork (or the 5,000-person team, as I envision it). Teamwork happens when all or at least most of the hospital staff-from admission clerks, housekeepers, nurses, and nurse managers, to residents and clinical department chairs-understand that they have a common purpose: to take care of patients. Teamwork is effective when staff members also understand the important role that each can play in making the hospital a better place, and when they have been trained and supported in how best to contribute their expertise and experience to this shared purpose. Teamwork is simply not possible with- out mutual respect. A dietary aide can't offer her insights about the hospitalized patient if she believes that she won't be lis- tened to because of her low status. The resident is afraid to warn the attending surgeon about operating on the wrong side of the patient after being yelled at and worrying that this, or something even worse, might happen again. As one observer recently wrote in the Los Angeles Times: "Slurs? Throwing things? Was this a hospital or a reform school? I asked one physidan, a department chief. He shrugged and told me that such behavior was far more common than I might imagine....'I've worked in lots of hospitals where surgeons have thrown instruments; they get scissors that don't cut, they fling it across the room'" (Salamon 2008). Indeed, the ways in which physicians, nurses, and other hospital staff interact with each other fundamentally shapes the institutional culture in which patients and their families are treated. The article by William H. Swiggart and colleagues at Vanderbilt makes the important point that disruptive behavior can result in more workplace stress, contribute to poor workplace environments, and create dysfunctional teams, thereby reducing the quality of care for patients and their families. It also describes an effective model for engaging people at all levels within a healthcare system who exhibit disruptive and other unprofessional behavior. The Vanderbilt experience described in this article is cogent and offers hope that disruptive behavior can be identified and treated. Diane Felblinger's article persuasively argues that civility starts with a commitment and that, when an organization becomes a civil place to work, patient needs are met and everyone benefits. She notes that good, sustainable programs perpetuate themselves and demonstrate that civility is a way of life that can be taught, internalized, and rewarded. Both of these articles reveal that decent human values have actually become cutting edge concepts in medicine and business, along with diversity, integrity, and transparency. …