Relationship-based Civil Leadership as a Health Care Business Strategy

Individuals may choose how they want to behave outside the work world, but businesses cannot afford to allow them this same choice in the workplace. The risks of taking a passive stance toward bad behavior are too high.

^— Giovinella Gonthier and Kevin Morrissey [In Gonthier, G and Morrissey K: Rude Awakenings: Overcoming the Civility Crisis in the Workplace. New York: Kaplan Trade Publishing, 2002, P 23]

 The Costs of Incivility (Bad Behavior)

All of the behaviors one associates with civility are critical to establishing effective working relationships with colleagues, patients, and health care staff.  Civil leadership—that is behavior—has a direct effect on health care outcome (compliance and safety), satisfaction and malpractice liability. (And keep in mind civility = kindness.) Behavior of individuals in leadership positions, whether a formal or informal position of leadership (power), has profound effects on employee satisfaction and retention, each of which can impact the organization’s bottom line. Consider these points, cutting across all groups of health care providers:

• Thirty percent of individuals in a survey of nurses, pharmacists and physicians knew of a nurse who left an organization because of disruptive physician behaviors.2
• Hostile treatment of graduate nurses by more senior nurses results in high staff turnover and the resultant poor communication results in poorer patient care.3
• Sixty percent of graduate nurses leave their first job within six months due to nurse-on-nurse violence… primarily verbal abuse from the individual’s preceptor. Twenty percent of new nurses leave the profession of nursing within three years to escape the hostility.3
• Disruptive behaviors of both nurses and physicians have a documented, significant negative effect on patient outcomes.4
• High-stress areas in medicine, like the operating room, are bastions of dysfunction that dramatically inhibit optimal team function and reduce the likelihood of an optimal outcome. “Disruptive behaviors increased levels of stress and frustration, which impaired concentration, impeded communication flow, and adversely affected staff relationships and team collaboration. These events were perceived to increase the likelihood of medical errors and adverse events and to compromise patient safety and quality of care.”5^{(p. 96)}

Companies of all flavors spend millions of dollars annually on leadership and communications training for their employees. This isn’t done out of the goodness of their hearts —they do it because such training has time and again demonstrated huge returns on investment for the company. Improvements realized from focused enhancement of leadership skills have a beneficial effect on the organization for years beyond the initial training, with sustained improvements in customer and employee loyalty and organizational profitability. Providers, their practices and health care organizations, can realize the same benefits of leadership and communications training, yet few health care organizations see the value proposition. Such expense is viewed as promoting “fluffy, touchy-feely” stuff, not the critical business proposition it really is. As Stephen Covey would say, they’re too busy driving to stop and get gas.

Relationship-based civil leadership, along with the attendant improved communication and interpersonal skills will increase health care revenue in five distinct, often under-appreciated areas:

One—Increased patient satisfaction and retention. Few physicians or health care organizations realize that attracting new patients costs six times as much as it does to keep the ones they have by ensuring they are satisfied. Further, a 5 % increase in customer retention translates into a 25 —125% increase in revenue!6

Two—Increased health care employee satisfaction and reduced turnover. I have consulted with health care organizations that have 18 —27% annual turnover of their health care staff, including nurses, resulting in millions of dollars of lost revenue annually. Providers do not appreciate that replacement and retraining costs for an employee is estimated to be between 70 —200% of the departing employee’s annual income.7 If a health care organization (or provider) decreases employee turnover, it enables them to keep more of what they collect.

Three—Reduced provider malpractice premiums. As a result of enhanced patient and employee satisfaction, and increased physician personal effectiveness, communication and interpersonal skills, malpractice liability will decrease. It wouldn’t be unreasonable for groups of physicians to ask for premium discounts if they demonstrate an overall improvement in civil leadership skills through a documented, standardized approach.

Behavior and liability are intimately linked.

Four—Reduced health care organizational liability. The same advice might be worth considering for health care organizations. A significant degree of stress within health care cultures is driven by provider behavior. In a study of 12,000 health care workers examining how job stress affected medical malpractice risks, organizations where workers had the greatest number of complaints concerning on-the-job stress had the highest rates of medical malpractice claims. Providers who create stress due to their behavior contribute to stress within an institution the organization, resulting in an unnecessary increase in organizational liability. 8,9,10,11

Five—Enhanced quality outcome and patient safety. Better communication and patient rapport translate into better treatment compliance with fewer complications and better health outcome.12, 13 In this day of pay-for-performance, quality equals dollars. In capitated environments, enhanced compliance results in fewer dollars being spent from the kitty—for the right reasons. You keep simply keep more of what you are paid.

Up next in the Communication Series: The Bottom Line Cost of Losing Employees

All content from Civil Leadership, by Michael S. Woods. © 2007. All rights reserved.

 

REFERENCES

1. Gonthier, G and Morrissey K: Rude Awakenings: Overcoming the Civility Crisis in the Workplace. New York: Kaplan Trade Publishing, 2002, P 23.
2. Rosenstein A., O’Daniel M. Disruptive behavior and clinical outcomes: perceptions of nurses and physicians. Am J Nurs 2005;105:54–64.
3. World, H.: The violence that ends careers. http://news.nurse.com/apps/pbcs.dll/article?AID=200661222029&template=printart (accessed Jun. 27, 2009).
4. Rosenstein A., O’Daniel M.: Disruptive behavior and clinical outcomes: perceptions of nurses and physicians. Am J Nurs 2005;105:54–64.
5. Rosenstein A.H., O’Daniel M.: Impact and implications of disruptive behavior in the perioperative arena. J Am Coll Surg. 2006;203:96-105.
6. Sheth, J. Sisodia R.: Marketing productivity: issues and analysis J Bus Res, Volume 55, Issue 5, May 2002, pp. 349-362.
7. Kaye, B., Jordan-Evans, S.: Retention: Tag, you’re it! Training & Development, Apr. 1, 2000 p. 29.
8. Jones, J.W. et al: Stress and medical malpractice: Organizational risk assessment and intervention, Journal of Applied Psychology 73, 1988.
9. Caterinicchio R.P.: Testing plausible path models of interpersonal trust in
   patient-physician treatment relationships. Soc Sci Med. 1979;13A:81–99.
10. Thom D.H., et al.: Further validation and reliability testing of the Trust in Physician Scale. The Stanford Trust Study Physicians. Med Care. 1999 May;37(5):510–517.
11. Hall M.A., et al.: Measuring patients’ trust in their primary care providers. Med Care Res Rev. 2002 Sep;59(3):293–318.
12. Safran G.D.,et al.: Linking primary care performance to outcomes of care. Journal of Family Practice 1998;47:213–20.
13. Leach, M. J.: Rapport: A key to treatment success. Complementary Therapies in Clinical Practice, Vol. 11, No. 4. (2005), pp. 262-265.