Amid the COVID-19 pandemic, front-line hospital staff have been dealing with the brunt of patients and visitors frustrated with new policies, such as wearing masks and new visitation policies. Cleveland Clinic's chief experience officer, Adrienne Boissy, MD and Washington, D.C.-based Georgetown University professor of management Christine Porath, PhD, shares three ways to minimize disruptive patient behavior in a May 14 report published in Harvard Business Review.
In some cases, frustration has turned violent and can lead to medical errors. For example, shortly after visitation was restricted in April 2020 for safety reasons, Cleveland Clinic saw the frequency of threatening and violent behavior increase, and the complaint rate doubled from 1.19 to 2.63 complaints per 1,000 patients.
Here are three ways to minimize disruptive behavior:
- Implement safety training.
Healthcare workers are several times more likely to experience workplace violence than those in other industries. To minimize violent interactions with patients, Cleveland Clinic launched online reporting on incidents, put up signs indicating violence will not be tolerated and made programs like Non-Abusive Psychological and Physical Intervention training available to caregivers. NAPPI training focuses on de-escalation, self-protection and restraint training. -
Nudge patients and caregivers.
Nudging patients and caregivers can be useful in encouraging positive behavior. At Indianapolis-based Indiana University Health, visitors are greeted by a sign that reads, "Please take responsibility for the energy you bring into this space … your behaviors matter. Our patients and caregivers matter. … Take a slow, deep breath and make sure your energy is in check before entering."
After repeated attempts to manage a patient's behavior through conversation, Cleveland Clinic will draft a formal agreement about expected language and behavior, which outlines the associated consequences. This increases clarity for the patient and safety for the hospital staff. At the Cleveland Clinic, there were nine behavioral contracts in 2017. In 2020, that number skyrocketed to 183. -
Reinforce expectations with training.
Just as healthcare workers need training on how to restrain a patient, they need training on how to respond respectfully and hold people accountable. The pandemic showcased health disparities, systemic racism and unconscious bias in how COVID-19 affected communities of color. Some hospital staff noted an increase in racial slurs directed at themselves or colleagues, and many employees didn't know the proper way to respond. Cleveland Clinic implemented additional training to address this issue.
To read the full list of recommendations, click here.