CREATING A CULTURE THAT UNLEASHES YOUR PRACTICE’S POTENTIAL


cause patient death. People on the receiving end of rude behavior have their thoughts hijacked by the incident. The mind tends to dwell on the insult, not on the task at hand. This can have disastrous re- sults in medicine. In a study of 4500 medical doc- tors and nurses, 71% tied disruptive behavior (defined as “abusive personal conduct,” including condescending, insulting, or rude behavior) to med- ical errors they knew of and 27 percent tied disrup- tive behavior to the deaths of their patients. The results from the survey show that disruptive behav- iors lead to potentially preventable adverse events, errors, compromises in safety and quality, and pa- tient mortality. Strategies to address disruptive behaviors should1 prevent disruptive events from occurring,5 deal with events in real time to prevent staff or patient harm, and3 initiate post-event re- view, actions, and followup.6 A veterinary hospital must create a culture of


civility to create a work environment conducive to high-producing employees and outstanding care. Management, doctors, practice managers, and team leaders are all accountable for the level of civility in their work environment. Failure to set boundaries on workplace behaviors creates fertile ground in which incivility can grow. Part of maintaining civility in the workplace comes


from appropriate training. Employees should be trained on how to address doctors, managers, and coworkers. As mentioned earlier, boundaries should be set as to what behavior is and is not acceptable. How coworkers treat each other should be part of the mission statement or otherwise out- lined in the policy manual. Look to the mission statements of successful companies for ideas on how to verbalize civility. Southwest Airlines Mission statement contains the following: “Above all, em- ployees will be provided the same concern, respect and caring attitude within the organization that they are expected to share externally with every customer.” Dignity Health’s list of values includes respect for the inherent worth of each person, col- laboration, justice (including advocating for social change and act in ways that promote respect for all persons and demonstrate compassion for those who are powerless), and stewardship (cultivation of the resources entrusted to us to promote healing and wholeness). Starbucks company values include, “Creating a culture of warmth and belonging, where everyone is welcome” and “Being present, connect- ing with transparency, dignity and respect.”3 Another facet of maintaining civility in a veteri-


nary hospital is the disruptive client. Some clients are verbally abusive to staff, others are harassers. In either case, it is up to management to quell this behavior either by discussions with the client or by firing the client. In general, these scenarios are relatively rare, but they must be addressed for the staff to feel safe at work. Management must avoid the creation of a hostile work environment and that includes addressing sex-


ual harassment. A clear definition of sexual ha- rassment is necessary to understand what is and is not acceptable. Sexual harassment includes un- welcome sexual advances, requests for sexual fa- vors, and other verbal or physical conduct of a sexual nature. There are two types of sexual harassment recognized by federal law: quid pro quo and hostile work environment. Quid pro quo refers to situa- tions where employment decisions such as hiring, firing, or promotions are contingent upon the em- ployee providing sexual favors. Examples of quid pro quo sexual harassment are when a supervisor threatens to fire an employee who does not submit to sexual advances or where a supervisor promises to promote an employee in exchange for sexual favors. Hostile work environment sexual harassment re-


fers to situations where the employee’s work envi- ronment is made intimidating, hostile, or offensive due to the unwelcome sexual conduct and the con- duct unreasonably interferes with the employee’s work performance. This could take the form of un- wanted sexual advances by a fellow employee, but it need not involve sexual advances at all. Examples of hostile work environment sexual harassment in- clude making offensive sexual comments or jokes, discussions about sex, and the display of sexually oriented materials.7 Sexual harassment occurs in veterinary hospitals


as it does in any other workplace. It is perpetrated by doctors, clients and coworkers. Part of effective employee training is to educate the employee what to do and who to report to if harassment is occurring. It is then up to management to investigate and act appropriately. Failure to do so not only creates a work environment where employees feel unsafe, it leaves the practice open to legal action. To create a safe work environment, violence and the potential for violence in the workplace must be ad- dressed. Workplace violence occurs in the veterinary workplace as it does in any segment of business. According to the FBI, the perpetrators of workplace violence can be broken into four types (Table 1). The first strategy employed to combat workplace violence should be prevention. This falls under the heading of “know your employee.” When em- ployee behavior changes it should be reviewed to determine if it is a behavior of concern. Behaviors of concern can help workers recognize potential problems with fellow employees. If a co- worker begins acting differently, determining the frequency, duration, and intensity of the new, and possibly troubling, behavior can prove helpful. Specific behaviors of concern that should increase vigilance for coworkers and supervisors include sadness, depression, threats, menacing or erratic behavior, aggressive outbursts, references to weap- onry, verbal abuse, inability to handle criticism, hy- persensitivity to perceived slights, and offensive commentary or jokes referring to violence. These behaviors—when observed in clusters and coupled with diminished work performance (as manifested


AAEP PROCEEDINGS  Vol. 64  2018 149


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