By Brian Ward
Preventing harassment before it begins and taking action when it does
Sexual harassment always has been an issue in healthcare, and it’s not hard to find examples: a California surgeon who slapped a nurse’s rear every morning while saying “I’m horny”; a Denver nurse sent to prison for groping patients while they were sedated; a patient who pinned a nurse to a bed and ripped her clothes off.
Ideally, everyone could go to work without having to worry about harassment and reprisal. But since this isn’t an ideal world, healthcare organizations must act. Kate Fenner, PhD, RN, is managing director of Compass Clinical Consulting, specializes in organizational optimization, performance improvement, and regulatory compliance. She spoke about how harassment allegations should be handled, preventive measures, and the need to take both seriously.
Q: Should facilities expect more surveyor focus on sexual harassment?
Fenner: The very public attention currently being paid makes it even more imperative that executives lead their organizations on this pressing issue. Prevention, detection, and remediation are the key components of a successful approach. Thoughtful leaders use all three to ensure a safe and productive care environment.
Regulators and surveyors (e.g., CMS and The Joint Commission) pay careful attention to the news and trends in public interest. Allegations of improper conduct such as that recently lodged against a physician then practicing at Cleveland Clinic pique regulator interest and focus attention.
The Joint Commission requires that its accredited facilities meet all applicable laws (Civil Rights Act of 1964, Title IX, for example, the recognition of sexual harassment as an infringement on civil rights for employees), and CMS is stringent about protecting patient rights (CMS Tag A-0145), including the right to receive care without harassment. Attention to a harassment-free environment is good business, good public relations, good regulatory management, and just plain the right thing to do.
Q: How can hospitals demonstrate to staff/patients that they are taking sexual harassment claims seriously?
Fenner: With patients, it’s pretty straightforward. [You need to have a] patients’ rights statement that everyone is required to have and should be prominently promulgated, and of course it includes the right to be cared for in a respectful manner.
The other piece of that is hospitals promulgating how patients can complain. Usually there are either patient representatives or an ombudsman system allows patients access to give their concerns and complaints.
For staff members, it’s imperative that the hospital has clear, solid policies and even more importantly, procedures and communication of those procedures for reporting any problems around the hospital, including potential harassment. And the procedures for reporting need to be such that staff know things will be managed in confidence and there will be no retribution.
Q: What preventive steps can hospitals take to harassment?
Fenner: Several things. One is widespread education and communication of what is harassment and what isn’t tolerated, what we do when we find and can prove incidences of harassment. Very straightforward, informative education, across the system, across the environments. And this includes starting with a discussion of policy around harassment at the board level.
Making sure medical staff, as part of their orientation, understand the hospital’s philosophy [on harassment]. And being very quick and very firm about any responses to any incident of harassment.
Q: Walk me through the response and remediation of a sexual harassment claim. For example, one staff member accuses another of harassment. What happens next?
Fenner: The accusation (which I hope is kept confidential) needs to be followed by intense investigation by people who are trained in how to do the investigation in an objective, unbiased way. So, how do we go about finding out the real truth of what happened? [Determining if] we have the pattern of harassment or abuse or is this a one-time event is probably the most important piece. Harassers rarely commit only one act of harassment: Either they repeat the behavior with multiple people, or they focus on one particular person and persist in harassing behavior.
The investigation normally goes through the HR area so it can be kept confidential. If it’s validated, if it’s seen as a legitimate complaint, then an action appropriate to the level of concern needs to be taken.
Q: What about remediation and punishment?
Fenner: Each organization should have different levels of response depending on the severity of the incident. The punishment needs to fit the crime. If it’s something really outrageous, regardless of the level of the staff member, pretty strong action needs to occur: suspension, termination, revocation of privileges. The actions need to be connected and appropriate to the validated complaint.
For example, if a staff member alleges another used inappropriate language. If it’s verified that occurred, there needs to be some sort of proactive corrective step. That might be counseling, performance improvement plan, put the person on warning.
The reaction to the behavior needs to be uniform in terms of level of justice, regardless of the position of the individual. [There was a case] where a patient transport staff member engaged in behavior that was perceived as harassing and creating a hostile work environment. He was terminated, and he came back to the hospital with evidence that that behavior had been exhibited by a physician. And that physician wasn’t dealt with.
Q: What’s the process if the harasser is a patient?
Fenner: There’s a court case on this where a staff member had been harassed by a patient in an outpatient setting. She complained about it to her supervisor, and they didn’t take corrective action. It was a repetitive problem, and the patient wasn’t dealt with. The staff member sued [the facility] and won.
We have an obligation to make certain patients know that staff members aren’t to be harassed and that patients understand the rights and privileges of the staff member to work in a dignified and safe environment. And it starts with a supervisor’s attention that if there’s a concern about the patient, then that supervisor needs to take appropriate action. Meet with the patient and family and discuss appropriate behavior. Change out staff members; sometimes it’s one particular person, and if you put in a different person for that care, the behavior won’t occur again.
Q: Is there ever a case where a patient’s behavior is so outrageous they have to be removed from the facility or transferred? Is that ever a possibility?
Fenner: I’ve not encountered that. Most people, if you can’t get a reaction from the patient, generally you can get a reaction from the family member.
The most typical cases, unfortunately, are with geriatric patients who might have Alzheimer’s or some other form of dementia and just don’t have the same control over behaviors. Then you can enlist family members: “Hey, can you talk with Dad/Mom about what they’re doing?”
I’m not aware of an institution discharging a patient [because of sexual harassment], but I am aware of the fact that institutions need to make proactive, firm efforts to manage patient behavior.
[Also,] the more typical incidents for harassment or hostile work environments come from within the institution itself. Employees to physicians, physicians to employees, supervisors [to staff]: that’s way more typical.
Q: How can you tell when your anti-harassment program is working?
Fenner: There’s several factors. One is the level of activity around respect and interpersonal behavior and the discussion about it is robust, but not necessarily trivializing.
Two, reported cases of harassment become few and far between. People are comfortable making complaints and know that their complaints are going to be kept confidential. That there’s going to be a prompt investigation to see if they merit attention. And if they merit attention, then the appropriate consequences occur.
But I think you keep the complaints few and far between, you have a robust program for onboarding staff in a way that acquaints them to your policies and procedures and your zero-tolerance expectations. We really need to say, “We don’t do this, period. We don’t tolerate this, period. It’s part of our values; a safe and respectful work environment is as important to us as safe and respectful patient care.”
It all goes hand in hand; it’s all part of the organization’s ethics. It becomes woven into the fabric of how members of the organization treat each other and expect to be treated.
Q: Is there anything else you wanted to add?
Fenner: I suspect we’re going to see much more attention to this in healthcare, because it’s in the headlines. We know that we have some healthcare incidents that have gotten national attention. We know that CMS takes this seriously, Joint Commission takes this seriously. So healthcare organizations need to review their vows about how they provide a safe working environment for employees. I think it’s the right thing to do and the smart thing to do, because it’s going to come up.