Making 2019 The Year of Civility in Healthcare: Documentation of Bullying and Chronically Uncivil Behavior

 

Multiethnic Group of People with Feedback Concept
Multiethnic Group of People with Feedback Concept

 

At some point in our nursing career, we were all trained in the cycle of abusive behavior. Whether the topic was domestic violence, elder or child abuse, the cycle was the same. There would be an event followed by a period of expressed remorse and promises of reform. The abuser’s behavior would be repentant and overly kind. Over time, the abuse would become irritable and the potential target would start to become anxious in anticipation that another event was imminent. Then, something would trigger the abuse and another event would take place.

This is exactly the same pattern of behavior exhibited by a bully. Their inability to have sufficient self-awareness and empathy for others overwhelms their ability to self-manage and sustain any claims to have turned over a new leaf. The bully will make the same claims that they were provoked and that the reason for the event lies with someone else. The bottom line is that the bully’s behavior is predictable and that they are unable to sustain any guarantee of reform.

Clear, objective documentation of offense after an offense is vital to memorialize the investment of time and effort into working with this individual. It can take fifteen to eighteen months of ongoing, consistent documentation to demonstrate that, regardless of the attempts and approaches to convince the bully that this behavior can no longer continue, the individual is not capable of sustained improvement and cannot continue in their position. Documentation of this magnitude requires documentation tools that are standardized, easy to follow and efficient to complete.

I suggest capitalizing on some of the tools that are already accepted in the industry. There are a variety of acronyms such as D.E.S.C. and S.F.E.D that make easy to use templates for quick documentation. D.E.S.C. (from TeamStepps) stands for:

  • Describe: Summarize the specific situation from your perspective
  • Express: Offer your concerns
  • Suggest: Offer options and alternatives to be used in the future
  • Consequences: Clearly state the next step to be taken should the situation not improve in a non-threatening manner.

Or follow the acronym S.F. E.D. (the professional feedback model)

  • Self-Assessment: Ask the individual their opinion on their performance or response to a situation
  • Feedback: Offer your objective, factual feedback
  • Encourage: Offer encouragement in a clear but humanistic manner
  • Direct: Offer coaching or counseling in how the situation can be better handled in the future. Try to obtain learner buy-in to this coaching if possible.

Each of these four bulleted areas can make a nice and easy template to capture the essence of any coaching or counseling conversation that needed to take place in the moment. The template should be kept in an easy accessible place on your computer so that you can simply print it out and complete it readily.

It may also be helpful to create a spreadsheet. The following suggested template allows you to capture incidents and events over time. It also allows you to demonstrate that the behavior is not just directed to one person or population but it indiscriminately targets everyone:

Target: Date: Provider Leadership Colleague Support Staff Other
           
           
           
           
           
           

 

If you are trying to create a simple, clear tool for documenting a witness’s accounting of an abusive episode consider a template using five simple headings known as the 5 Ws:

  • W = Who
  • W = What
  • W = When
  • W = Where
  • W = Witness, was there someone else that was present?

These user-friendly approaches make the arduous task of documenting aberrant behavior over a prolonged period of time more simple and hopefully less challenging for the individual(s) who are already laboring under an all too stress situation. In my next posting, I will discuss the formulation of a Performance Improvement Plan.

Contact Information:

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.