1 Developing an Environment of Civility and Respect in Healthcare Organizations: Resources to Empower Healthcare Leaders to Identify, Intervene, and Prevent Workplace Bullying, Incivility and Disrespect Doral Jacobson, MBA, FACMPE - speaker Ernest Grant, PhD, RN, FAAN - speaker Jami DelliFraine, PhD, MHA - moderator

2 We all know this kid. Some of us ARE this kid, and others of us might be the kid getting pushed down. Hopefully we are neither, but we definitely all know jerks like this. Some of those jerks might have grown up to work in your organization. Today our goals are to have a conversation with you about 1. why you should care about incivility and disrespect in your organization (because some of you might think that there’s always going to be a few jerks in any organization, and most people are pretty nice, so why do I need to do anything about the ONE person causing problems?), 2. how to identify incivility, and 3. strategies you can use to intervene and address incivility.

3 How do I know if someone is a bully?Do you/target feel oppressed, humiliated, de-energized, or belittled by the person? Does the target feel worse about him\her self? Does the person consistently aim their venom at people who are less powerful? Is this behavior consistent? Sutton, R.I. (2007). The No Asshole Rule: Building a Civilized Workplace and Surviving One that Isn't. Business Plus Hachette Book Group, New York, NY.

4 The Dirty Dozen Personal insults Invading one’s personal territoryUninvited physical contact Threats and intimidation, both verbal and non-verbal “Sarcastic jokes” and “teasing” used as insult delivery systems Inflammatory s Status slaps intended to humiliate Public shaming or ‘status degradation’ rituals Rude interruptions Two-faced attacks Dirty looks Treating people as if they are invisible If these behaviors sound familiar, it’s because they are very common. In other industries, 25-40% of workers report experiencing these behaviors (this is even consistent in other industrialized countries). However, 90% + of nurses report having been the victim of verbal abuse (in several studies). This suggests the problem of incivility is much more pervasive in healthcare settings. This is something you all probably know at least anecdotally. How many of you experienced or witnessed these behaviors? How many of you witness it on a daily basis? A lot. Why is healthcare different? Why do we need to address it? Sutton, R.I. (2007). The No Asshole Rule: Building a Civilized Workplace and Surviving One that Isn't. Business Plus Hachette Book Group, New York, NY.

5 What’s the damage? Reduced productivity Turnover Theft Lost resourcesContagion Poor employee health Human costs and financial costs Reduced productivity – a bad attitude can be contagious, and negative people can suck the energy out of the team or individuals on the team; this results in reduced productivity for everyone Turnover – research suggests that those who experience bullying or incivility in the workplace are more likely to leave the organization Theft – those who experience incivility, especially from those in power, are more likely to steal from the organization to ‘even the score’ Lost resources – cost of replacing employees, loss of revenue from reduced productivity, costs of theft, but also cost of dealing with the incivility (lawsuits, disciplinary actions, grievances and intervening in disputes) Contagion – if the bad behavior is allowed, it can easily spread and create a toxic environment Negative health consequences – toxic and stressful environment can lead to poorer employee health, including heart disease, mental illness, and poor lifestyle choices

6 Example – time costs for 1 incidentTime spent by direct manager Time spent by upper management Time spent by HR Time spent by legal counsel Time spent recruiting and training a new person 6-8 hours 1-2 hours 40+ hours

7 $$ Costs (conservative) for one incident$ costs of 8 hours of direct manager time $ costs of 2 hours of upper management time $ costs of 2 hours of HR time $ costs of 2 hours of legal counsel time Total for one incident $330 $580 $70 $250 $1,230 Manager – assumes salary of 85k Upper management – assumes 2 execs at 300k each HR – assumes an HR specialist at 70K Legal – assumes a lawyer making 250K

8 $$ Costs (conservative) annually3 incidents per year $ cost of recruiting and training a new employee (entry level) $ cost of recruiting and training a new employee (mid-high level) $3690 $20,000 $100,000 Entry level – assumes 40k, costs 30-50% of annual salary to replace Mid-level – assumes 100k, costs 100% of annual salary to replace You can see how quickly these costs can escalate if you have to deal with a lot of incidents, if there is a lot of turnover due to one person’s bad behavior, if there is a lawsuit (something we didn’t even estimate in this scenario).

9 Jerks at work What is the impact on patient care and outcomes?

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11 Doral Jacobson, MBA, FACMPE, CEO Prosper Beyond, IncDoral Davis-Jacobsen, MBA, FACMPE is CEO of Prosper Beyond, Inc., a specialized healthcare consulting firm nestled in beautiful Asheville, North Carolina. Doral is a seasoned healthcare consultant with over 20 years of experience serving healthcare providers ranging from solo practitioners to large academic medical centers. She is a popular speaker and author, always looking around the corner to help her clients prepare for ‘what’s next’. Doral is known for assisting practices with next generation managed care contract negotiations, revenue cycle and payment reform. She is a Fellow in the American College of Medical Practice Executives. Doral graduated from Florida Atlantic University with a bachelor’s in health services and obtained her master’s in business administration from Webster University in Denver, Colorado. Doral has authored numerous articles on medical practice revenue cycle, managed care contracting and payment reform is a frequent speaker at national, regional and local healthcare forums.

12 Ernest Grant, PhD, RN, FAAN Vice President, American Nurses AssociationDr. Grant is an internationally recognized burn-care and fire-safety expert and serves as the burn outreach coordinator for the North Carolina Jaycee Burn Center at University of North Carolina (UNC) Hospitals in Chapel Hill. In this role, he oversees burn education for physicians, nurses and other allied health care personnel and runs the center’s nationally acclaimed Burn Prevention Program, which promotes safety and works to reduce burn-related injuries through public education and the legislative process. Dr. Grant also serves as adjunct faculty for the UNC-Chapel Hill School of Nursing, where he works with undergraduate and graduate nursing students in the classroom and clinical settings. Dr. Grant holds a BSN degree from North Carolina Central University and MSN and PhD degrees from the University of North Carolina at Greensboro. He is the first male elected to the office of vice president of the American Nurses Association.