Bad Behavior = Bad Business

An Ask the Expert feature with Stephen Paskoff, ELI

Healthcare has gotten the message and is setting a standard that other industries will follow. Bad behavior, as opposed to illegal behavior, causes horrific patient risks.

“Bad behavior devastates patients' lives and erodes the ethics of healthcare institutions”
-Stephen Paskoff, ELI

From medication errors to botched surgical procedures to fatalities, bad behavior devastates patients' lives and erodes the ethics of healthcare institutions. This is a serious business issue in every workplace, though the harm may be less obvious in non-healthcare settings. Threats, demeaning behavior, a failure to tolerate dissent or welcome questions are too often viewed through the narrow lens of workplace illegality. When unprofessional conduct does not qualify as illegal, we sigh over its regrettable nature, throw up our hands in helplessness, and wish we could eliminate the problem, but seldom do we give it high priority, much less make it an organizational imperative. Healthcare, however, is taking a radically different, new and exciting approach.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) recently issued an alert. Effective January 2009, healthcare institutions must have a series of standards and processes to identify and remediate unprofessional conduct, as distinguished from the narrower ring of illegal workplace conduct, such as sexual and racial harassment. JCAHO’s initiative explicitly recognizes that bad behavior creates dangerous patient risk, thus significantly raising the bar for acceptable behavior. Furthermore, tying conduct to accreditation creates powerful leverage to change the way organizations typically work – losing accreditation for bad conduct poses a larger strategic risk than losing a single claim of discrimination.

Up until now, high-profile doctors have operated by an unwritten rule: they can berate nurses and others because that’s how they get results. At long last, that myopic view is changing. The following is a checklist to consider when implementing behavior standards. While these relate to healthcare, change a few words, and the message adapts to any employer.

• JCAHO’s requirements demand a comprehensive cultural initiative, not a checklist of action steps. Unprofessional conduct stems from flawed thinking. Changing the way a healthcare community thinks involves the re-programming of attitudes in every level of the community, and this re-programming must be reinforced time and again if the initiative is to succeed.
• Talking about respect, civility, and professionalism will not change a thing. Instead, the initiatives should describe these values and their equivalents in terms of behavioral standards, which must be concrete and few in number; otherwise, they represent platitudes, not cultural change.
• Medical and executive leaders themselves must act in line with the standards, or this initiative will fail. Altering entrenched patterns of conduct that are often unconsciously accepted will require a commitment at the very top.
• Workday behaviors and leadership skills must be measured with the same rigor as clinical outcomes. In the constant quest to ensure patient safety, the healthcare industry measures clinical results with numerical precision. If the new professionalism initiatives also increase patient safety, they, too, require strict measurement standards to prove and reinforce their effectiveness.
• Consistency and accountability will determine the initiative’s success, but they will be painful to implement. The challenge lies in handling the high-profile cases. In healthcare, for example, it’s often prominent physicians, those whose practices generate the biggest revenue, who are the worst offenders. If healthcare organizations ignore their conduct or require only token counseling, JCAHO’s initiative will become a pointless exercise.

Of course, while JCAHO’s behavior initiative requires the formulation of standards and processes, only individual healthcare organizations can determine whether the initiative actually transforms the way their work community thinks and operates. Accommodating the initiative on paper is a far cry from accommodating the initiative in practice. JCAHO is providing a window of opportunity for healthcare professionals and leaders to take a decidedly proactive approach. By setting standards for behavior and aggressively remediating bad behavior, healthcare organizations can divert the catastrophic results that often accompany outrageous behavior in the workplace. An ounce of prevention is supposed to be worth a pound of cure.

Stephen Paskoff is President of ELI, a training firm that helps clients translate values into behaviors, increase employee contribution, build respectful and inclusive cultures, and reduce risk. Prior to establishing ELI in 1986, Paskoff was a trial attorney for the Equal Employment Opportunity Commission and partner in a management law firm.