I recently witnessed a dispute within my faith community.

One congregant was accused of violent and highly inappropriate activity.

The synagogue struggled to respond.

Things escalated. People took sides. Positions became entrenched. There was a mixture of genuine concern, mythology, innuendo, hyperbole, valid issues to be addressed and unsubstantiated issues that needed to be cleared up or dismissed.   It was divisive and extremely difficult for the community to manage.

The lack of process left the congregation and its leaders in limbo and confused, vulnerable and questioning their desire to continue in community.

Have you witnessed a bad situation where the organization’s response or lack of response made things worse?

As a lawyer who has worked in healthcare for 20 years, I have responded to hundreds of disputes between patients or caregivers and staff.

I deal with a lot of people behaving badly. Sometimes the person behaving badly is the patient or caregiver. Sometimes its the health care provider. Sometimes it is the organization. Sometimes its a combination of everyone.

Here are the key steps your organization should take to respond to bad behaviour and avoid making matters worse:

Step #1: Have a written policy.

It is vital for any healthcare organization to have a written document the leaders can turn to in times of turmoil and dispute.

If you have a small healthcare team, I can anticipate your response to this … “we’re too small”, “we love our informal leadership style”, “we’re ill equipped to develop something”, “we don’t have the resources to hire someone to write a policy”, “policy? What policy?”

Every healthcare organization of every size needs a policy.  It can be simple.  But you have to have something.  It helps you when there is a challenging situation if you can point to a process that demonstrates objectivity, due process and fairness.  It helps you keep your commitments to your mission, vision and values. Having a process in advance removes the risk of allegations of discrimination and bias which erode trust. Process fairness upholds the dignity of a community.

Step #2: Take decisive action in an emergency. 

You have the authority to address urgent security and values issues immediately.  Leaders must have the authority to remove someone from the premises in the moment to address an urgent need.  Once that happens, the complaints management policy needs to kick in. Early action does not have to be “perfect”. You can make mistakes. When in doubt, remember that safety trumps everything else.

Step #3: Be principled. 

Complaints management needs to reflect a few key principles: fairness and due process, safety, upholding the mission, vision and values of the organization, objectivity, transparency, consistency, timeliness, confidentiality and efficiency of operations.

Step #4:  When a problem arises – address it.

It’s not fair to an individual and the others they are affecting to ignore their low lying yet consistently inappropriate behaviour.

Such behaviour requires early intervention and careful documentation including and especially to the individual – who can misunderstand the severity of a situation when they are being casually told to stop.

Without tough conversations and escalating formality of documentation early on, seemingly benign situations have a way of escalating into situations where the only option is severance of relationship. That is deeply divisive and damaging in healthcare settings. It’s unfortunate when such situations could have been prevented by setting clear expectations, communicating standards and documenting those efforts.

Step #5: Informal minor complaints don’t need a lot of fanfare.

Informal complaints should be addressed informally and on an ad hoc basis.  Regular everyday queries about poor service and interpersonal slights may be addressed informally by the individuals themselves and as necessary with leaders without triggering the need for a formal process.

Frivolous or vexatious complaints should be dismissed. If a complainant’s allegations do not rise to a need to be addressed or have been raised without merit or with intent to derail operations or are blatantly false – you should say so. If the allegations even if proven to be true would not require action by the organization – then dismiss the complaint. There should be an off ramp option to close frivolous or vexatious complaints early. Do not over promise that there will always be an investigation for example because there doesn’t always need to be something.

Step #6: Be serious about serious allegations.

Certain types of complaints can never be addressed informally.  Serious allegations should be formalized. These types of allegations include sexual misconduct, harassment, criminal conduct, theft, violence, and abuse. If anyone raises such allegations  they must be followed up and addressed. Such allegations can never be dismissed out of hand or ignored or delayed in action.

Serious allegations must be recorded in writing.  In most situations it would be the individual who writes their allegations themselves.  Otherwise, they should be summarized back to the complainant in writing for confirmation.

Step #7: Clarify roles.

It needs to be clear who has investigative powers and decision-making authority. Conflicts of interest need to be identified early and managed appropriately.  Only those tasked with responsibility should be involved and role delineation needs to be carefully maintained.

Step #8:  Keep confidences.

It needs to be clear to all participants and leaders what the rules of confidentiality are in the complaints process. You should discourage unsanctioned investigations and side conversations.

Step #9: Follow due process and fairness to people accused of things.

Accused individuals need protections too. In most situations they have a right to know the complaint against them. They have a right to respond and share their perspective. They may have a right to provide evidence and ask you to interview people they identify as supportive of their position.

Step #10:  Investigate.

The word “investigations” sounds intimidating – but they don’t have to be. However, there has to be some rigour to the collection of relevant information or evidence. All the relevant information needs to be collected. This may be simple or complex depending on the issue – it can take minutes or hours or days or weeks.

Step #11: Act proportionately.

Decisions need to be fair and consequences have to be consistently applied. You should avoid deciding one way when the same facts relate to a pleasant nice person and another way for a pain in the neck person. Consistency removes the risk of bias and discrimination.

Sometimes there is no response required because the allegations are unfounded.

If the serious allegations are found to be true there needs to be a response.  That response needs to be proportionate.

If the behaviour was not that serious – the result should not be serious.   Banning someone is a super humungous deal.  Sometimes that is the only reasonable result.  But there is a range of response that should be considered if the offending behaviour does not rise to the most serious.

As part of a proportionate response you may have to consider the length of time of the consequences. Most action warrants a temporary response with an opportunity for return. A permanent decision with no opportunity for restitution and return would be applied in only the most serious of situations of public safety.

Step #12: Sometimes, you have to ban someone.

If you ban someone you have to follow through.  You need resources to enforce your decision.  Failure to enforce your decision leaves the organization, staff, co-patients and the community at increased risk.   You cannot identify someone as a serious risk of harm sufficiently to warrant a permanent ban and then not enforce that decision. As necessary, involve security or the police. If you fail to enforce a ban, something terrible could happen. You also want to ensure your staff understand the rules so they can enforce them and have the means to do so.

Step #13: Communicate your decision.

Your decision must be communicated to the accused and in some cases the complainant.  At the very least the complainant deserves information that the complaint has been addressed and in some cases what you are going to do about it.

Clarity of response and action required by the offender must be communicated – almost always in writing. It should be clear whether the decision will be reviewed in the future and when.

Next Steps:

Being prepared for conflict is a requirement for all healthcare leaders.

If you would like some help preparing your team to manage conflict and de-escalate disputes between patients, caregivers and staff, contact me for more information on my team training.

Here are some of the testimonials from my recent training sessions:

Kate captivates the room within minutes. She knows the audience and is keen to support everyone in the room. She energizes the learning environment and she knows what is relevant and how to deliver a difficult point with professional wit! She is a great combination fun personality and a brilliant mind !

I highly recommend Kate’s “Managing Conflict” workshop – she is incredibly engaging and covered the topic very well! Laura Hornby RN

Kate is AWESOME! Such an excellent speaker. Very engaging, knowledgeable and personable. By far, my FAVOURITE facilitator in 30 years in the medical field. Rhonda Ruppert, Site Coordinator

This was one of the best training sessions I have been to. Kate was a great presenter . she kept my focus all day holding my attention all day is a great feat. Kathy McKee

The most important thing I learned was having some ‘go-to’ phrases, reviewing how to de-escalate situations, seeing different perspectives.

Being reminded to use my internal dialogue, “I can do this!” “remember to take a breath” was helpful.

I really liked finding our anger patterns (What can we do to head off problems?)

The notion of putting oneself in a variety of persons’ perspectives (not just another person’s shoes, but also their child, the other patients in the room, the doctor, etc.”) – that was the most important thing I learned.