BWH Launches Center for Professionalism and Peer Support
Shapiro Named Director
In recent years, independent efforts at BWH have sprung up around staff professionalism, peer support and disclosure and apology, each focusing on improving the culture among clinicians to improve patient care. This fall, BWH formally combined these existing efforts under one umbrella, the newly created Center for Professionalism and Peer Support.
“Our ability to sustain the constant drive for excellence at BWH in today’s challenging financial landscape with increasing regulatory and consumer scrutiny depends on our ability to maintain a culture of respect, civility and professionalism,” said Andy Whittemore, MD, BWH’s chief medical officer. “Our new Center for Professionalism and Peer Support will formalize a hospital-wide network of support for all our clinical colleagues.”
Otolaryngology Chief Jo Shapiro, MD, FACS, who was involved with early efforts to develop the peer support team in the OR, was named the center’s director. Shapiro is nationally known for her efforts to reform medical education, and she has lectured throughout the country on disclosure and apology efforts. The center also includes BWH’s new defendants program. See related story on page 11.
“The underlying principle is that we want Brigham and Women’s Hospital to deliver the most compassionate care to our patients,” Shapiro said. “If we don’t create and maintain a culture in which we support one another and feel supported by one another and the institution, eventually it will trickle down to our patients.”
The center will encompass and build on existing efforts already underway at BWH, including the Peer Support Program which is designed to bring the health care team together to discuss any type of serious, unanticipated adverse event. At the heart of the program is an effort to build a network of trained clinicians who would reach out to colleagues in such cases and host group discussions with members of the involved care team with EAP-trained peer facilitators. In 2006 and 2007, there were 18 group discussions generated from the OR with 332 clinicians involved. Of those 18, eight were co-led by peer supporters and EAP staff.
The Peer Support Program evolved from an informal initiative that started in 2004, and then launched as a pilot program by the departments of Surgery, Anesthesiology and Perioperative Nursing in partnership with the Partners Employee Assistance Program. With assistance from Henri Menco and Allison Lilly of EAP, anesthesiologist Rick Van Pelt, MD, joined forces with Janet Barnes, RN, JD, executive director of Clinical Compliance and Risk Management, to build a peer support program modeled on support networks used by first responders, including the Boston police and fire departments and EMS.
“Physicians typically do not access support services,” said Shapiro, who also is one of the program’s initial leaders. “We have a culture supporting the myth of invulnerability with a back-in-the-saddle mentality,” she said.
For this reason, in addition to the established group peer support efforts, the peer support team wants to further develop one-on-one support programs for physicians. This one-on-one peer support outreach will be private and confidential.
Shapiro hopes the new center can build on the existing successes of the Peer Support Program, bring together the trained peer supporters to see what has worked well and what has not. Top priorities include increasing the number of trained peer supporters and spreading the word that these clinicians are available to help out a colleague.
For nearly two years, BWH’s professionalism program has trained medical staff on the elements that make up mutual respect, teamwork and professionalism. In addition, hospital and department leaders designated approximately 30 professionalism officers to receive and respond to complaints of unprofessional behavior.
Shapiro intends to seek wide-ranging input to develop a set of specific expectations around what it means to be professional. In order to be successful, these expectations have to come from a consensus of hospital staff. With BWH’s diverse culture and many perspectives, it won’t be easy.
“For example, ‘Can you yell at someone?’” she asks. Answers to such questions are not always black and white, she said.
Also, Shapiro anticipates modifying the professionalism training program to better meet the needs of physicians and expand this program beyond physicians. In addition, she hopes to increase the number of trained professionalism officers across the hospital and develop a mechanism so each professionalism officer can learn from one another how to address issues and how to prevent such issues from happening in the future.
“We need to uncover repeat issues, potentially remediate people and highlight the so many positives that exist,” she said.
Disclosure and Apology
BWH’s Department of Risk Management and CRICO/RMF, the patient safety and medical malpractice company owned by and serving the Harvard medical community, have teamed up to improve on the apology and disclosure program in the hospital. Disclosure of unanticipated outcomes has been a Joint Commission standard since 2001 and a BWH policy since 2002, and BWH and CRICO/RMF have worked to develop a team of coaches to help clinicians with such disclosures to patients and families.
“We have a commitment from hospital leadership and the standard in place from the Joint Commission, and we know we must tell our patients what happened,” Shapiro said. “We need to teach our physicians and health care professionals the subtleties of doing this right and in a way that supports our patients, their families and each other.”
There are many barriers to disclosing to patients what may have precipitated an unanticipated outcome. Each member of the care team has his or her own emotional reaction and, often times, there is a lack of clarity on exactly what happened at the moment. In addition, there are natural fears of punishment, anger from patients and/or peers and even disagreement and significant variability on what should be disclosed.
CRICO’s program has trained dozens of BWH clinicians and staff on a disclosure coaching model, and these coaches will be available for clinicians throughout the hospital. These coaches “help frame the dilemma and clarify the grays of disclosure,” Shapiro said.
“Each situation calls for a specific response based on needs of that patient and the family, and we’ve trained people who are available to sit down with the care team to discuss how to disclose what happened,” she said.
With each effort that grew organically, BWH is one of very few institutions with such programs in place. With its newly created Center for Professionalism and Peer Support, the hospital is in the vanguard with its commitment to creating and sustaining such a culture.
“Ultimately, we want to ensure we have a culture of trust,” Shapiro said.