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High performing health care team members are a key characteristic of high reliability organizations (HROs). These team members are high-performers who are able to self-correct. A professional conduct toolkit and pocket guide are available through the DoD Patient Safety Program and designed to help military treatment facilities (MTFs) identify unprofessionalism and correct the situation.
"Conflict plays a role in communication errors. If you can't resolve conflict then communication errors will continue," said Col. (Dr.) Peter Napolitano, director of the Maternal-Fetal Medicine Fellowship program at Madigan Army Medical Center. "Communication errors are the number one reason for patient safety errors. It's important to address root causes of [communication errors] and manage conflict in an effective manner."
What is it?
Unprofessional conduct includes disruptive and intimidating behaviors, such as bullying and direct violence, that interrupt teamwork, undermine safe care and create unhealthy work environments. A majority of health professionals have witnessed or been subjected to disruptive and intimidating behaviors from colleagues.
What are the implications?
Unprofessional conduct can negatively impact patient care:
- Breakdown in information sharing
- Loss of trust among team members
- Keeping quiet when shortcuts or poor care are observed
- Hesitancy in asking questions or clarifying information
- Absenteeism and turnover resulting from stress in the work environment
- Fear of or delay in asking for help
- Loss of trust by patients and their families in the clinical care they are receiving
Professional Conduct Resources
Napolitano and his team supported the development of the DoD PSP Professional Conduct Toolkit. The toolkit consists of four modules to help MTFs eliminate bad behaviors and adopt professional conduct that is a hallmark of high-performing teams:
- Professional Conduct, Teamwork, and Patient Safety
- Responding to Behaviors that Undermine Safe Patient Care
- Supporting engagement: The Role of Leaders and System Responses
- High-Conflict Personalities, Mental Health Issues, and Safety Considerations
"It's one thing to create guidelines that people have to read and sign," Napolitano said of the hospital policies health care providers are required to complete, "but they do nothing to teach how to implement and manage it. The beauty of a toolkit is that it gives providers and people on the floors tools to manage unprofessionalism."
About three years ago at Madigan Army Medical Center, Napolitano and his team developed a program for their facility called Medical Unit Safety Simulation Team Training (MUSTT), a sustainment program designed to offer simulation training to manage those problems and practice implementation of professional conduct best practices.
MUSTT enforces TeamSTEPPS principles, Napolitano confirmed. "On a quarterly basis, we pick a problem from the operating room and then create a simulation scenario based on that problem," he said.
"There are different forms of conflict and varying degrees of it from a one-time event to chronic issue," Napolitano said. "If you treat all unprofessional behaviors the same, there won’t be any improvement."
The Professional Conduct Toolkit consists of presentations, handouts and digital files. Noticing a need for an additional professional conduct resource, Napolitano and his team recently collaborated again with the DoD PSP to develop a pocket guide that is available for ordering by MTFs within the Military Health System.
The Professional Conduct Pocket Guide was released in August 2016 and supplements the material provided in the Professional Conduct Toolkit. The pocket guide is meant to be kept handy:
- for quick reference and problem resolution
- to take advantage of teachable moments
- as a reminder to model desired behaviors
The Professional Conduct Toolkit and Pocket Guide are both available on the DoD PSP Web site and Patient Safety Learning Center.