The Mitchell Organization has created a special training program:  Medicine and Manners

Created in response to Joint Commission Recommendations

The Issue:

Medical etiquette has been increasingly on the minds of physicians and hospital administrators.  In July 2008, The Joint Commission for Accreditation of Hospitals put forth several recommendations in reference to modifying physician behavior.  Among them were to:

1. Educate all team members – both physicians and non-physician staff – on appropriate professional behavior, defined by the organization’s code of conduct.  The code and education should emphasize respect.  Include training in basic business etiquette (particularly phone skills) and people skills.
2. Provide skills-based training and coaching for all leaders and managers in relationship-building and collaborative practice, including skills for giving feedback on unprofessional behavior, and conflict resolution.

At TMO, we believe that these recommendations can be fulfilled with training courses and coaching in etiquette-based medicine.  And we are not the only ones.  The New England Journal of Medicine published an article by Michael Kahn, M.D., entitled “Etiquette-Based Medicine.”  In this article Dr. Kahn argues convincingly that simple etiquette rules could be implemented with dramatic effects-- much the same way that a simple checklist introduced by Peter Pronovost and associates helped sharply reduce central line infections.¹

In a similar fashion, simple etiquette checklists for physician to physician/patient/administrator interactions could be implemented, hopefully with similar positive results.  After all, etiquette is simply a set of rules that can be readily taught, whereas teaching a physician to be more empathetic, patient, or caring is more complex.  Fortunately, with etiquette training, individuals can learn to interact in a more respectful manner, regardless of any differing and formerly potentially disrupting viewpoints they may hold.   Such is the power of etiquette, and great is the need of medicine to adopt a mannerly foundation.

By comparison, if proper training is not proffered, physicians and administrators will experience continued difficulty interacting with each other, and disputes will often turn uncivil, thereby becoming that much harder to resolve.  By the nature of their work, administrators and physicians must discuss, disagree, and argue, but such discourse is never facilitated by rude behavior.  Unfortunately, some physicians have adopted a very “prickly” attitude in as a means of intimidating others in order to get what they want.  Not only is this juvenile, but the Joint Commission warns that, if allowed to continue, “intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators, and managers to seek new positions in more professional environments.”²

And that is just the beginning.  Patients and employees who are mistreated are much more likely to seek litigation.  The bottom line is that etiquette training will help hospitals, clinics, and doctors' offices run more efficiently, be more pleasant, and ultimately cost less money.

Delivery method:

Based on information gathered from your hospital, The Mitchell Organization will develop an entertaining, informative, pragmatic, and interactive program.  Case scenarios will be used to illustrate key concepts.  Ideally, a measurement instrument could be implemented, comparing current complaint numbers with numbers after training.  We always conduct in-depth informational interviews to determine the most effective course of action for all involved. The approach we take will depend upon the needs of the organization or individuals involved and may include:

1. An in-house train-the-trainer program
2. Proactive workshops
3. Remedial seminars
4. Personalized, targeted one-on-one attention
5. A series of short programs

Participants will learn:

1. Standards of behavior/using etiquette as a tool to get things done.

• The emphasis will be on how to interpret the hospital’s stated standard of  behavior – what it means and what it does not mean.

2. The process of effective communications – how we communicate.

• Participants will learn that effective communication is less about the message we send than about the message the other person receives.
• In order to deal with challenging individuals, it’s important to understand the process of communications - how speaking out loud does not mean we’ve really communicated.
• Participants will absorb active listening skills.

3. Barriers to communication, with patients, colleagues, and hospital staff.

• Why we get into trouble when we expect people to respond to situations the way we do.
• How our age, education, gender, ethnic background, and other factors can be barriers to effective communications without our ever knowing it.

4. Personality styles – why we communicate the way we do.

• Why some people are motivated by getting it right; getting it done; getting along; or getting noticed.
• By learning the different ways in which different people receive information, participants will be able to quickly spot the signals that will help to decide how to reach them.

5. Handling difficult people and emotional situations.

• How to defuse difficult people in emotional situations, such as adverse outcomes, near disasters, and more.

6. How to give negative feedback in a positive way.  How to respond to feedback.

• We will be looking at quality of care issues, incident reports, & peer review data.
• Practical language suggestions for different situations will be given.

7. Conflict/disagreement.

• Participants will learn the tactics to manage conflict, criticism, sarcasm, and being yelled at.

8. Communicating life-threatening diagnoses.

• How to deliver life-threatening diagnoses in compassionate and effective ways.

9. How to utilize etiquette skills to get things done effectively and to avoid the biggest business behavior blunders.

• How to avoid bad attitudes, electronic blunders, and disregard for traditions.
• How to make communications compassionate and personal, yet efficient.

10. Meetings and greetings.

• How to make a positive first impression, introduce yourself to patients respectfully, minimize their apprehension, and engage them in conversation.

References:

1. Kahn, MW:  Etiquette-based medicine. New England Journal of Medicine, May 8, 2008, 358; 19:1988-1989.

2. The Joint Commission: Behaviors that undermine a culture of safety. Published Online, July 9, 2008. http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_40.htm

Article on Medical Etiquette:

• Physicians' Newsletter