By Ted A James, MD
July 31, 2018
The Foundation of Respect
Respect is an essential component of a high-performance organization. It helps to create a healthy environment in which patients feel cared for as individuals, and members of health care teams are engaged, collaborative, and committed to service. Within a culture of respect, people perform better, are more innovative, and display greater resilience. On the contrary, a lack of respect stifles teamwork and undermines individual performance. It can also lead to poor interactions with patients. Cultivating a culture of respect can truly transform an organization and leaders set the stage for how respect is manifested.
Respect for Colleagues
Research from Kristie Rogers, associate professor of management at Marquette University, demonstrates that people value two distinct types of respect: ‘Owed’ and ‘Earned’. Owed respect meets the universal need to feel valued and included. It rests on the concept that all individuals have inherent value and the right to be treated with dignity. When owed respect is lacking, it manifests as over-monitoring (i.e., micromanagement), distrust, misconduct, and indifference (i.e., making people feel like they are easily replaceable). Disrespect can lead to a toxic atmosphere that diminishes joy and fulfillment, leading to dissatisfaction and burnout. Earned respect recognizes individuals who have gone above and beyond expectations. It meets the need to feel valued for accomplishments and a job well-done. Neglecting to provide earned respect can reduce motivation and accountability.
Respect is also established by supporting other members of the health care team. Speaking poorly of another service or health care professional undermines patients’ confidence in the entire health care team and lowers their impression of the system. Interactions with colleagues can be improved by always assuming best intentions and giving other people the benefit of the doubt. Before reaching a negative conclusion, ask questions to clarify and assume that best intentions were in mind.
In 2012, Virginia Mason launched a ‘Respect for People’ initiative that engaged all of their employees in approaches to respecting one another in the workplace. The program involved training, simulation, and defining what respect meant. The outcome was a greater sense of personal ownership for how employees respect, support, and appreciate their coworkers. The following is their “Top 10” list of ways to show respect:
- Listen to understand
- Keep your promises
- Be encouraging
- Connect with others
- Express gratitude
- Share information
- Speak up
- Walk in their shoes
- Grow and develop
- Be a team player
A culture of respect also recognizes that everyone in the organization plays a meaningful role in the ability to care for patients. All members of the team are valued and have important contributions to make. Respect is given to everyone, regardless of their position on the organizational chart. For example, when a physician holds the door for a hospital cleaner, this simple act boosts self-worth and appreciation. The same effect is seen with a thank-you letter from a peer or supervisor for a job well done.
Respect for patients
Equally, if not more important, is respect for our patients. All patients deserve to be treated with dignity and an acknowledgment of their value as individuals. One of the most widely cited elements of disrespect mentioned by patients is simply failing to pay attention to their needs, by leaving them unattended or ignored. Think of how this translates to the way patients are greeted by your front staff, treated in the emergency department, or when they appear lost in the halls. As Don Berwick stated, “We are guests in our patients’ lives.” As such, we must act accordingly. This is demonstrated by listening to our patients, asking for their opinion, and recognizing the importance of incorporating their personal values and priorities into treatment decisions. We convey respect by being considerate of patients’ time (e.g., striving to provide timely service and apologizing when we fail to do so). The physical environment that we create for patients is a direct reflection of our respect for them. Our ability to ensure privacy, cleanliness and quiet surroundings speaks volumes. When we request permission to enter a patient’s room, ask a patient how they would like to be addressed, and explain to patients who we are and what we plan to do, this all communicates respect for them as individuals. Respect is also showing gratitude to our patients who entrust us with their care. A simple thank you can mean so much.
At Beth Israel Deaconess Medical Center in Boston, the approach to respecting patients was operationalized. In 2015, the organization extended their existing quality and safety reporting systems to include complaints and grievances from patients and families that seemed to describe a disrespectful experience. A mechanism for staff to report episodes of disrespect was also created. As a result, awareness of the principle of respect for patients and families was increased, and respect and dignity became a metric tracked by senior leaders and institutional governance.
Creating a culture of respect requires action on many fronts. Leaders set the tone by modeling respectful conduct in their words, by their actions, and in the way they interact with each member of the team. The manner in which leaders treat people will have an impact on the way they treat each other and patients. This applies to all levels of leadership. Treat your clinical staff with the same respect you want them to treat patients. Here is how leaders can impart respect in every day behavior:
- Active listening
- Valuing diverse backgrounds and ideas
- Entrusting others with important tasks
- Remaining open to input
- Providing autonomy
- Affirming value to the organization
- Taking an interest in non-work lives
- Supporting individuals in critical situations
Clear expectations should also be set for everyone in the organization (e.g., clinicians, administrators, support staff, etc.). Ideal acts of respect should be rewarded openly. Acknowledgment or praise from a leader is a powerful catalyst for feeling valued. However, when disrespectful behavior occurs, it must be addressed consistently and effectively regardless of whom it stems from. Constant offenders must be made accountable for correcting their disruptive behavior or leaving the organization. Finally, as a leader you also show respect through humility; acknowledging that you do not have the monopoly on truth and that others bring value and can make meaningful contributions.
We are all responsible for making our health care settings ones that demonstrate the highest level of respect, collegiality, and professionalism at all levels. This requires having zero tolerance for inappropriate behavior, and being accountable to one another. Treating people the way we would want to be treated is a strong competitive advantage and the right thing to do.
- Do Your Employees Feel Respected? Kristie Rogers. Harvard Business Review, Aug 2018
- The Practice of Respect. Lauge Sokol-Hessner, Patricia Folcarelli, Kenneth E. Sands. NEJM Catalyst, June 23, 2016
- Understanding respect: learning from patients. N W Dickert and N E Kass. J Med Ethics 2009
- Respect for People: A Building Block for Engaged Staff, Satisfied Patients: Virginia Mason Institute, 2013.
- Perspective: a culture of respect, part 2: creating a culture of respect. Leape LL, Shore MF, Dienstag JL, Mayer RJ, Edgman-Levitan S, Meyer GS, Healy GB. Acad Med. 2012
Dr. Ted James is a medical director and vice chair at BIDMC/Harvard Medical School. He is an alumnus of the Harvard Health Care Management program and is involved internationally in leadership development and health care transformation. Follow Dr. James: LinkedIn / Twitter
Dr. James blogs about health care transformation. To see more of his posts, click on his name in the tags below.
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