Work to dismantle racism and advance health equity often occurs without addressing an important gap — an institutional culture in health care that has caused employees to feel pressured to accept discriminatory, disrespectful or abusive behavior from patients and visitors.
That must change because maintaining a safe, inclusive and caring environment for all means valuing the employee and patient experiences as equally important, Brigham leaders emphasized during the Diversity, Equity and Inclusion Town Hall on Jan. 10.
“We want to ensure every member of our team — our workforce — and every patient and family member who walks through the doors of the Brigham and Mass General Brigham is treated equitably, with compassion and respect,” said Robert S.D. Higgins, MD, MSHA, president of the Brigham and executive vice president at Mass General Brigham.
Last October, Mass General Brigham announced a systemwide Patient/Family/Visitor/Research Participant Code of Conduct policy, which defines appropriate conduct for patients, families, visitors and research participants and provides a model for workforce members to respond to disrespectful, discriminatory, hostile or harassing behaviors.
The policy, developed as a systemwide effort through Mass General Brigham’s United Against Racism strategy, represents “a new paradigm” in health care that affirms the intersection of employee and patient experiences, explained Normella Walker, MA, CDP, executive director of Employee Experience in Diversity, Equity and Inclusion and the Office of Mediation, Coaching, Ombuds and Support Services.
The policy does not circumvent our institutional commitment or our legal obligation to provide high-quality care to patients, but rather provide an avenue to ensure our workforce is supported.
“There’s this idea that you just have to ‘put up with disrespect for the sake of the patient, but what we’ve been doing is tacitly condoning bad behavior,” Walker said. “If we’re going to create a culture that feels good for everybody, that culture also has to include a positive experience for our employees.”
Kevin Slattery, director of Police, Security and Commuter Services, shared how staff can use the S.A.F.E. Response framework to address inappropriate or abusive behavior. S.A.F.E. is an acronym, with each letter representing a step in the process: Spot a threat, assess the risk, formulate a response and evaluate the outcome.
The Brigham’s S.A.F.E. Response framework provides a consistent approach for responding to challenging interactions with patients or families in inpatient and ambulatory settings. When a S.A.F.E. Response is initiated, a multidisciplinary team comes together within 15 minutes, including representatives from the care team, Police and Security, Quality and Safety, Patient and Family Relations and others as needed.
“The employee should not feel like they are left alone to address this by themselves. We want to make sure they have all the support they need,” Slattery said.
The S.A.F.E. Response framework is not intended for a rapidly escalating situation where there is an imminent threat of violence, Slattery emphasized. In those situations, staff should call Police and Security at 617-732-6565.
‘Equity Is the Only Acceptable Goal’
Additionally, several clinical leaders shared updates during the forum on how the Brigham is advancing health equity in patient care. Speakers highlighted examples of how the Brigham is committed to ensuring every one of our patients and their families have the best experience — one defined by high-quality care and compassion.
Regan Marsh, MD, MPH, medical director of Quality, Safety and Equity, discussed how domain teams of health equity leaders work in collaboration with unit-based teams to systematically advance racial justice and equitable care delivery.
Charlene Hollins, DNP(c), MSN, APRN, FNP-C, nurse administrator at the Brigham and a nurse practitioner for Mass General Brigham Urgent Care, highlighted several initiatives the Emergency Department has undertaken to deliver equitable care, including the department’s Anti-Racism and Trauma-Informed De-escalation Training Program.
Nadia Raymond, PhD, MSN/MHA, RN, regional nursing director for Southern Jamaica Plain Health Center, reflected on the joy and fulfillment that comes from working together to reshape health care systems so that they are equitable for all.
“Although we are keenly aware that much work is ahead of us, as a community we choose to see that as opportunities,” Raymond said. “Ultimately, this is creating a greater depth, meaning and humanity to our work in health care. Collectively, we are stating what my dear friend, the late Dr. Paul Farmer, once said: Equity is the only acceptable goal.”
The Patient Code of Conduct seeks to maintain a safe, inclusive and caring environment for all. The following resources are available for staff who experience or witness inappropriate, discriminatory or abusive behaviors by patients, families or visitors.
- Tip sheet for responding to discriminatory remarks
- SAFER model algorithm
- Ordering and printing Code of Conduct posters and handouts
- Policy: Patient/Family/Visitor/Research Participant Code of Conduct: Responding to Disrespectful, Discriminatory, Hostile, or Harassing Behaviors
- Mass General Brigham Patient Code of Conduct