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The Catalyst

Professionalism initiative handles conflict in the workplace

By Cindy Abole
Public Relations

In the changing world of health care, medical professionals are constantly striving to maintain a collaborative work environment. But the urgency to make life-or-death decisions in a high-stress environment can challenge the best physicians, nurses and health care specialists to react with bullying and disrespectful behaviors that can disrupt interprofessional relationships and negatively impact patient care.

Nurses and leaders commit to professionalism and sign a banner at the Aug. 29 LDI meeting.
Nurses and leaders commit to professionalism and sign a banner at the Aug. 29 LDI meeting. Photo by Cindy Abole

At MUSC, hospital leadership aims to maintain a healthy and safe workplace for their employees, patients and patient families.

In 2010, Annual Review of Nursing Research reported that interprofessional bullying, harassment and horizontal violence is a global issue and detrimental to a nurse’s well-being and the organization’s culture.

Examples of lateral aggression can range from aggressive facial expressions, passive-aggressive comments and use of technology in meetings (not giving attention to meeting and speakers). Vertical aggression examples include subordinates not respecting authority, team members directing downward aggression to trainees and not involving them in discussion and speaking. 

Beyond a nursing issue

MUSC recognizes that this is not just a nursing issue. Disrespect and unprofessional behavior among interprofessional teams is a problem, according to Marilyn Schaffner, Ph.D., R.N., clinical services administrator and MUSC chief nursing officer. Schaffner and hospital leaders know that hospital employees can commit to interprofessional work and practice professional behavior with proper training and tools.

Patrick Cawley, M.D., executive director and MUHA chief executive officer, agrees that disruptive and inappropriate behavior can hurt an organization.

“One way to destroy great teamwork is to allow individuals to be unprofessional with members of the team. You can’t have a good team when you have unprofessional behavior. We want to teach people in a very positive and professional way to turn back those being unprofessional,” Cawley said.

The Professionalism Initiative launched with medical center managers and leaders at the Aug.29 Leadership Development Institute #26 meeting where Cawley emphasized the importance of professionalism and the Just Culture program, an effort that focuses on behaviors, choices and personal accountability, as vital to the ongoing development of the medical center  as a high-performance team. The program was introduced by Schaffner and June Darby, R.N., Neuroscience Service Line administrator.

The journey to professionalism launched in 2005 when leadership conducted a survey of 663 nursing staff members on lateral violence. The survey revealed significant findings with 46 percent of respondents agreeing that lateral violence in the workplace is very or somewhat serious and 65 percent reported observing such behavior.

Radiology’s Maggie Carter and Nancy Monogan join Patient Access Services Cindy Williams and Radiation Oncology’s Sylvia Pratt in a discussion as they role play responses for Professionalism.
Radiology’s Maggie Carter and Nancy Monogan join Patient Access Services Cindy Williams and Radiation Oncology’s Sylvia Pratt in a discussion as they role play responses for Professionalism. Photo by Cindy Abole

In 2011, Schaffner accompanied a busload of MUSC nurses who traveled to Columbia to see national nurse speaker Kathleen Bartholomew, Ph.D., R.N., address the South Carolina Hospital Association about eliminating unprofessional behavior and its effects on interdisciplinary health care teams. Bartholomew was a featured speaker at the Feb. 2012 medical center LDI and shared strategies about improving health care environments to reduce bullying, bad behaviors and medical errors.  

In early 2012, Schaffner and several interdisciplinary colleagues conducted a Negative Behaviors in Health Care Survey with MUSC health care teams. The research team also included Lynne Nemeth, Ph.D., R.N. (PI), Martina Mueller, Ph.D., R.N., Karen Stanley, R.N., and Barton Sachs, M.D.

Of the 2,100 responses, more than half of the respondents strongly agreed or agreed that other contributing factors to negative behaviors that occur are related to the unwillingness of peers and leaders to intervene or to the targeted person’s unwillingness to stand up to the culprit. A total of 736 people said that they had shared in examples of lateral or vertical violence and stated that they had observed or experienced this type of behavior. Other qualitative data showed that 691 respondents shared a perception of causes and 651 shared suggestions for ways to eliminate lateral and vertical aggression.

U turning bad behaviors

Employees can now use a DESC framework as a tool to respond to unprofessional behavior  –  Describe (situation and facts), Express (your feelings), Specify (behavior or outcome preferred) and Consequences (positive and negative). Planners also adopted the “U turn” as a verbal signal and gesture to reverse unprofessional behavior and practice guidelines prepared in the Professionalism Pathway to Resolution.

At step one when bad behavior is encountered, staff and physician-faculty are encouraged to use the code word, U turn, followed by open conversations to resolve issues. At step two, if bad behavior persists, a manager or department director will be invited to discuss and coach the behavior. In step three, if issues are unresolved between employees, they will meet with a MUHA Human Resources representative or conduct a Peer Review to  evaluate the situation and make recommendations that may involve consequences. 

“There’s a tendency to avoid conflict or heighten conversations. If someone is unprofessional to you, most people’s first reaction would be to avoid heightening conversation and conflict. This is the wrong thing to do. There’s a way to turn people around using simple tools and in a nice, respectful way stop people from being unprofessional. This is the most effective way for dealing with unprofessional behavior,” Cawley said.

What was needed, according to Schaffner, was for leadership to recognize the problem, create awareness and guide staff with tools and training to embrace professional behavior. Since gathering results from both surveys, Schaffner has presented them to various hospitalwide groups including the chief residents, Graduate Medical Education program directors, medical ethics committee and all physician leaders. The organization’s goal was to adopt a prevention program like professionalism combined with Just Culture training, to establish a safe, quality work environment.

“It’s about having conversations and U turning unprofessional behaviors in real-time. We want to create a zero tolerance for unprofessionalism and establish a place where staff wants to work and patients want to come to receive quality care,” Schaffner said.

In fall 2012, hospital leaders met with 100 interdisciplinary staff and management to devise a strategy toward professionalism dividing the work to three subcommittees – process, accountability and communications. Their first task was to define professionalism, which is a behavior toward another person that makes that person feel valued and contributes to mutual respect, effective communication and team collaboration.

“Professionalism is really about a culture change. What we desire is a culture of behavior toward one another that make staff feel valued, contributes to mutual respect, and provides effective communications, collaboration and safety. It’s about celebrating examples of professionalism and connecting it to safety,” Schaffner said.

The subcommittees worked to devise communication and implementation plans, create learning tools, core content and policies, write and produce videos and establish a model of accountability and professionalism timeline.

Professionalism training will extend to all MUHA employees, residents and physicians in September. Managers will receive a Professionalism Tool Kit, which includes links to U turn Professionalism video vignettes (LDI website), a manager’s instructional PowerPoint’s with key messages, ID badge U turn cards; Standards of Professional Behavior brochure and poster; commitment statement for new employees, and a list of updated policies relating to the Professionalism.

For information, visit

Professionalism U-turn Video Training Vignettes

YouTube link:

Features stories and examples from employees who’ve experienced lateral and vertical aggression (backstabbing, bullying, gossiping and broken confidences) and best practice examples that U-turn bad behavior

YouTube link:

Employees discuss more examples of lateral violence and share examples and best practices demonstrating the U-turn to improve behavior.

YouTube link:

Best practice examples for U-turning bad behavior dealing with scapegoating and broken confidences.

Professionalism Subcommittees

Communications – Terry Wilson, chairman; Sandra Belton, Allan Coulter, Sabrina Jamison, Cindy Little, Sarah Palmatier, Barrie Tyler, Kari Walker, Kathleen White, Jennifer Wright, Lynn Barber, Heather Woolwine, Hailey James, Cameron Mitchum Evers, Victoria Boucher, Stacey Laws, Sandy Ogden and Sallie Campbell

Process – Dr. Barton Sachs, chairman; June Darby, Barton Short, Dr. Ashlyn Savage, Dr. Angela Dempsey, Coco Dumont, Rob Finch, Carole Russell, PharmD., Joan Herbert, Weatherly Brice, Hailey James, Terry Wilson, Lynne Barber, Debbie Browning, Sally Potts, Leah Ramos, Nicole Bernier, Kelly Cave, Andrea Coyle, Beverly Horne and Melissa Osowiecki

Accountability – Debbie Browning, chairman; Eric Frisch, Maureen Ducharme, Adam Kornegay, Kelly Crawley, Tamika Anderson, Deborah O’Donnell, Cindy Wyatt and Julie Heckman

September 4, 2013

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