Happy, Healthy Docs and Health Professionals

Joint Commission Re-Names "DISRUPTIVE BEHAVIOR" - Will It Change How The Issue is Addressed?

As of 7-1-12, The Joint Commission has revised the term disruptive behaviors in Leadership Standard LD.03.01.01 (first out in 2009) regarding the culture of safety, to behaviors that undermine a culture of safety. Why? “Initially the Joint Commission decided to use the term disruptive behavior because it was commonly used in the literature and recognized by most individuals in the workplace. However, Joint Commission staff have since learned that the term disruptive behavior is not viewed favorably by some health care practitioners and is even considered ambiguous for some audiences. For example, some physicians have expressed that strong advocacy for improvements in patient care can be characterized as disruptive behavior. Also, the phrase disruptive behavior may be used in the context of a care environment that has become temporarily unsettled by the behavior of a patient, a resident, or an individual served. Using the language behaviors that undermine a culture of safety offers a better way to describe the problem addressed by the standard.”¹

Leadership Standard LD.03.01.01 says “Leaders create and maintain a culture of safety and quality throughout the [organization].” The above wording changes are as follows, in Elements of Performance: A 4 and A5 (old wording is in parentheses):

A 4. Leaders develop a code of conduct that defines acceptable (disruptive, and inappropriate behaviors) behavior and behaviors that undermine a culture of safety.
A 5. Leaders create and implement a process for managing (disruptive and inappropriate behaviors) behaviors that undermine a culture of safety.²

Will this change in phraseology affect the processes that health organizations now use to deal with intimidating and angry behavior? Might this softer approach allow such negative behaviors to be discussed more openly and be more frequently addressed? Or might it water down the issue and hamper facilities from addressing head on, what is essentially, call it what you will, disruptive behavior?

What's your opinion? Your comments are welcome and appreciated.

Our Disrupting Disruptive Behavior and Anger Management: Taming the Beast seminars can help your facility or company with these issues. We also offer individual Anger Management Coaching.

1, 2 - Joint Commission Perspectives®, January 2012, Volume 32, Issue 1 Copyright 2012 Joint Commission on Accreditation of Healthcare Organizations

Holiday Gifts for Relaxation, Stress Relief and Wellness

  Dear Readers,

 

I wish you all a happy holiday, and a healthy, peaceful and abundant new year!

 

And in these last few days of gift buying, here's some great ideas for promoting relaxation, wellness and fitness with holiday gifts, and even buy these for other gifts in 2012.  Purchase them with general gift cards from the company, or buy the specific items below. AND REMEMBER TO TAKE CARE OF AND PAMPER YOURSELF by asking for these or similar gifts for yourself, in addition to buying them for others.  Or just buy yourself one of these gifts now to make the holidays more relaxing!

  
For Relaxation: 
Massages (single ones or bundled packages)
Manicures / Pedicures / Hair salon appointments
A day at the spa
Meditation classes series
Meditation CD's
Yoga classes series 
New age or other relaxing music 
 
For Reading / Writing / Relaxing Hobbies:
Writing journals

Books
Health magazines subscriptions
Drawing pads

 

For Nutrition:
Lunch coolers for brown-bagging healthy meals
Herbal tea packages with mugs or hot drink cups

For Exercise:
Exercise classes series
Exercise videos
Yoga outfits
Exercise outfits
Exercise sneakers / shoes
Hats, gloves and scarves for walking in cold weather

If we at Visionary Health Solutions can be of help to you in 2012 with our Wellness and Emotional Health Seminars, Anger Management Coaching, Corporate Coaching for executives and staff, or Personal Coaching for private individuals, please contact us at (631) 269-7048 in New York.

Visionary Health Solutions - New Name & Services: Anger Management, Visionary Leadership Coaching & Team Building

Ex: SEE "REVERSING NEGATIVE BELIEFS 'BLUEPRINT' " VIDEO BELOW.

In the year since my last post, a lot has changed - we have a new name, Visionary Health Solutions, and new services. In addition to Wellness, Stress Management and Personal Development Seminars for medical and other companies, our newest "Health Solutions" include Anger Management 1:1 coaching and classes; Team Building and Group Coaching sessions; and individual Leadership and Personal Coaching for executives and other leaders, and for other employees or private persons wanting to move forward or being mandated to get help in their personal or professional lives. Visit us at www.VisionaryHealthSolutions.com

Our new "Visionary" services incorporate cutting-edge techniques that can have profound effects. We help clients build and envision successful futures while helping them get "unstuck" and unearth blocks they have to getting there, and then move them toward their goals. Have you tried "The Secret" and visualized your future but are still stuck here? Then you need "The Secret" to "The Secret" - unlocking your subconscious negative beliefs that keep you trapped. And that's what we provide in our coaching sessions and seminars - processes that can flip around sometimes lifelong struggles that work more quickly and deeply than traditional methods. 

I explain more in this "Reverse Your Negative Beliefs 'Blueprint' "
6 minute video. Stay tuned for more on these subjects! 

  

Anger Mangement Video - A Holiday Gift

I'd like to wish you peaceful and joyous holidays, and most of all a relaxing break from work.  Make time for self-care, connecting with others, and for quiet introspection as you enter the new year.

My gift to you is a new video, "Anger Management Guided Introspection."  With the stress of the holidays, the economy, and patients - tempers can flare - often at the most inopportune time. And perhaps your anger gets the best of you more often than you'd like.  Or you know someone else like that.  This short video on Youtube, using a sample new coaching technique (see next paragraph), offers a simple way to better handle anger.  Find 10 quiet, private minutes and try this guided meditative process that helps you get to what's underneath your anger so you can better manage it and not let it control you. 

And by the way, thanks for your support this year by attending or scheduling my seminars, and/or reading my blog.  I have great new things in store for 2010 (including 2 newly healing ankles, thank God) - a website and new company name (referred to in the video), new seminars, and a new service, Visionary Leadership Coaching.  I look forward to seeing you and working together again soon, or meeting you for the first time, in 2010.  Have a happy and healthy new year!

Congress Gets Serious About Stress and Mindfulness

Listen to this inspiring YOUTUBE video I found regarding mindfulness. In a Congressional hearing, Rep. Tim Ryan (D-OH) asks Secretary of Health and Human Services Kathleen Sebelius about stress reduction via mindfulness, and how it can help our nation.  What's this about?

Stress management requires being mindful, or self aware in a given moment.  For example, if I'm feeling strong anger, rather than reacting and yelling, I might ask, "What am I feeling right now?  What's going on in my body?"  I might answer, "I'm really feeling hurt under the anger, and my heart is pounding."  So to slow the pounding and feel the hurt rather than yell, I breathe deeply for 10 minutes.  Being mindful helped me create a workable stress management strategy.  Now I'm calmer, I feel better physically, and I prevented an argument.   

Mindfulness meditation is an excellent tool to learn self-awareness - and to manage stress.  It helps with anger management, reducing violence, ameliorating pain, curbing compulsive/addictive behaviors, and more - areas now getting national attention.  So next time I'm upset and want to soothe myself with a donut, I might instead become aware that I'm really feeling disappointed and take a walk instead.

To do it:  Sit quietly.  Close your eyes.  Take deep breaths.  Become aware of your breath, your emotions, your body, by asking, "How am I experiencing myself?" For example, ask, "What emotion am I feeling right now?"  Or, "Where is there tension in my body?"  Then sit with that awareness.  Ask again:  "What emotion am I feeling now?"  A new one may rise up into your awareness.  Do this for 5-10 minutes. 

With practice you'll really get to know yourself well.  Becoming aware of your emotions is important, especially if this is difficult for you.  Why is it important?  Until you know how you truly feel about something, you won't change it.  Emotion is a much better motivator than denial. 

Disruptive Behavior - Owning Your Anger

 

"Disruptive Behavior" is the 2009 buzz word by The Joint Commission with their new Leadership Standard LD.03.01.01 mandating hospitals to address this issue head on.  A major hallmark of a disruptive individual is an angry outburst, often at the most inopportune times - in front of colleagues, patients, and their family members.  The "classic" profile of disruptive physicians are male surgeons who yell in the operating room, but they are by no means the only doctors who may engage in this behavior.  In fact nurses and other health professionals also project their anger outwardly.  Often such individuals have difficulty taking responsibility for their behavior.  Instead they blame their anger on others, such as laboratory personnel who produce late test results.  While it's true that poorly functioning departments or hospital systems can be very frustrating, screaming at those who work in them is not the answer. 

If you are quick to respond with anger in frustrating situations, especially if it happens more than you - or others - would like, the problem may also lie within you.  When I first saw the above cartoon, I  thought Lucy's response to "Why are you always yelling at me?" might be, "Because you're an idiot!"  To my surprise, she took responsibility for her yelling.  That is the start of the healing process for those who can't control their anger.  Chronically angry people may blame others for everything and see themselves as right.  They can't see how their outbursts exacerbate their problems.  They don't do this on purpose.  They really believe they're not at fault. 

This topic can take up many blog posts.  As a first step, ask yourself:  "How well do I handle my anger?  Does it handle me?  Do I feel powerless to control it?  Does it get in my way at work?  Is it affecting my relationships?"  If you answer yes, consider that you could possibly use some help.  The first step is owning the fact that this area of your life isn't working and is causing you pain.  Give it some thought, and stay tuned for more on this.  

Learn to Reverse Negative Behaviors in a NO-COST STRESS MANAGEMENT Phone Seminar 2/17/09

 Are you stressed out because you have not very useful behaviors you'd like to change but can't?  Do you get easily angered and yell?  Are you disorganized?  Do you procrastinate, overeat, smoke, etc.?  Everyone has something.  So why don't we change?  One reason is we believe we can't.  You might find yourself thinking, "It's too hard, too much work, takes too much time, I'm not capable of changing that, I don't know how, I've tried and it didn't work, etc."  Most of us unconsciously think these thoughts all the time.  What we don't realize is that they drive our behaviors and keep us stuck in the negative ones.

A trick to changing behaviors is to bring to conscious awareness the UNDERLYING BELIEFS we have about not being able to change them, and to replace them with beliefs that work.  To help you see this in action, I'm offering a FREE TELEPHONE SEMINAR tonight from 8-8:45 pm EST.  I'll do a GUIDED RELAXATION EXERCISE to help you work on your particular problem.  You call in from the comfort of your home or office.  CLICK HERE TO REGISTER.  This session will also provide a sample of what we'll do in the Meditation and Relaxation Training Phone Seminars (DESCRIPTION) on 2/19, 2/26 and 3/5/09 from 7-8am or 8-9 pm.  Read more about that in the post below, which also tells you how to enroll in the 3 session series. 

New Tough NY Physician Discipline Laws

  On 11/3/08, new legislation became effective in New York making the disciplinary system more strict for physicians reported to the Office of Professional Medical Conduct (OPMC) for misconduct, and makes such information more accessible to consumers. 

These law changes make it even more imperative for clinicians with addictive and psychological problems to seek immediate treatment to regain their health and avoid discipline.  A report to OPMC can result in quick publicizing of charges, and possible losses of license, job, career, income, self-esteem, and thousands in legal fees.  Colleagues in leadership positions should ensure such individuals get help ASAP.  Such individuals can also self-refer or be referred to the Committee for Physician Health at 1-800-338-1833 or 518-436-4723. 

A synopsis of the law changes include:

1.  OPMC now makes charges against a physician public much sooner: after they are served vs. after an order is issued, and before appeals.  

2.  OPMC can more easily obtain a physician's personal medical records if they believe s/he may be impaired by addictive and psychiatric disorders.    

3.  Physicians must update their profiles every 6 months, a condition for license re-registration.  

Other law changes involve mandating clinical competency exams, reviewing malpractice histories to see if doctors should be investigated, and more.  Courts must also notify OPMC of physician misdemeanor and felony convictions, such as DWI's.

Go to www.abramslaw.com for an article fully describing the new law, "The Office of Professional Medical Conduct:  How Changes In Public Health Law Section 230 May Affect You" by Lawrence F. Kobak, DPM, JD and Michael S. Kelton, Esq.  

   

Perfectionism and Medical Errors: What's the Connection?

  After my last post on “Perfectionism:  An Unacknowledged Source of Stress” (below), I was asked to conduct Grand Rounds on this topic.  (Having only been a blog post, the stress of creating a perfect seminar on perfectionism was great.)  At its end, a participant told me it was a great talk, as it was a topic never discussed anywhere in medicine – an arena in which everyone is expected to be perfect.  This expectation attracts perfectionists into medicine, which in turn creates perfectionistic medical leaders who train new doctors to be perfect.  
    The low self-esteem (and fear of making errors) that underlies perfectionism can ironically be transformed into arrogance – the flip side of the same coin – when compounded by the rigors of medical training and sometimes accompanying demanding, highly critical clinical trainers.  Initially fearful residents who drive themselves very hard into becoming highly skilled practitioners, may eventually find themselves saying, “Me?  Make a mistake?  I DON’T MAKE MISTAKES!  I’M PERFECT!”  This creates a closing off to constructive criticism and feedback from others.
    My seminar discussion went onto that track.  An attending shared he had mistakenly mixed up medication orders for two patients.  A resident realized it, and kindly said:  “Dr. Smith (name changed), in looking at these two patient records I think there may be a mistake in your medication orders you might want to look at.”  Dr. Smith was very grateful to this resident.  She averted a possible disaster.  He was humbled by this and saw that despite his high skill level he was still capable of making medical errors.  He was aware of his humanism and imperfection.  
    He further shared stories of famous doctors, experts in their fields, who write the teaching manuals, create the training videos – and who still make mistakes and get sued for malpractice.  He said, “Wouldn’t it be great, if when a nurse says to such a doctor, ‘Doctor, please take a second look at the paperwork, as I believe you may be about to remove the wrong organ,’ that physician could respond with, ‘Thank God you noticed!’ vs. ‘Don’t question my authority!’?”   
    Dr. Smith's point was that BECAUSE no one is perfect, it’s vital for medical team members to stay humble and open to receiving constructive feedback from each other no matter what their status – AND to feel safe in giving it.  My point is the cure for perfectionism is to work on raising your self-esteem.   These two things work together.  True self-respect – vs. arrogance – creates a comfort level with one’s own imperfections and an openness to admit mistakes.  It also creates respect for others – a vital need for a functioning medical team that ultimately results in fewer errors and optimizes patient care.

The Minimization of Drunk Driving and DWI

With July 4th and the holiday increase in drunk driving, I've been thinking about a comment an instructor of mine made years ago when I was in training to become a Credentialed Alcoholism and Substance Abuse Counselor.  He said, "People convicted of 1 or 2 DWI's/DUI's in reality probably have hundreds of "DWI's" for which they were never pulled over."  The enormity of that statement struck me.  In other words many people routinely drink and drive but only rarely get caught.  Such people, and society in general, greatly minimize the significance of this.  They see this behavior as being a "problem," or see themselves as "having a drinking problem," only if they get caught and convicted, regardless of how often in reality they drink and drive.    

An editorial by Michelle Chen in the July 1, 2008 issue of Newsday, a Long Island, NY newspaper, further reminded me of whether people look at their own drinking and driving behavior.  In Nassau County, NY, the County Executive recently put on its website a "Wall of Shame," a frequently visited site of photos of people charged with driving while intoxicated.  While questioning whether shame and mass humiliation work, Ms. Chen makes an interesting point:  "When shame devolves into spectacle, we enter a moral theater where the audience's reaction, not the nature of the offense, is the key player.  The Wall's awkward faces probably elicit more snarky chuckles than grave reflections on the dangers of reckless driving.  It's validating to know you're not "them."  And there's the titillation of knowing that your own transgressions remain secret because of your smarts or good fortune." 

Unfortunately cars can be huge weapons of destruction on the road.  And coming out of denial about personal behavior requires a willingness to be self-honest.  Do you drink and drive?  How often?  Are there passengers and kids in the back seat?  As health professionals there's an even greater social responsibility to get honest.  I used to smoke.  I'm a Health Educator.  I couldn't bring myself to teach smoking cessation classes until I quit.  It's hard to be a role model, and it's even harder to look inward at ourselves.  But driving under the influence and thinking it's no big deal is even worse.  As Ms. Chen says  in conclusion, "It's unclear whether the Wall [of Shame] will make roads any safer, but it could at least force us to turn the lens on ourselves..."