When Jo Shapiro, MD, was a medical school student, she was taught that a clinician’s individual actions and decision making were the determining factor in a patient’s outcome.
“I was told that nothing else mattered and not to trust anybody else,” Shapiro told an audience of more than 40 BWHers in January. “But my lived experience did not match that training.”
Instead, Shapiro found support and respect from nurses and other team members, and came to realize that the culture of the organization had a deep impact on her and her colleagues, and in turn, on the experiences of their patients.
Shapiro is the chief of the Division of Otolaryngology and is also the director of the Center for Professionalism and Peer Support. On Jan. 14, she described the work of the center in building a respectful, trusting culture at BWHC, and the impact that such a culture can have on patient safety, staff morale and other measurable outcomes. Her seminar, titled “The Impact of Just Culture, Peer Support & Professionalism at BWHC,” was a pilot collaboration sponsored by the BWHC Collaborations Workgroup and organized by BWH’s Center for Faculty Development & Diversity.
In her talk Shapiro cited a study of 300 surgical cases in which patients whose surgical teams exhibited less productive teamwork behaviors were at higher risk for death and complications. She then shared a slide showing a direct correlation between “relational coordination” – a measure of shared goals and knowledge, frequent and timely communication and more – and an index measuring the quality and efficiency of surgical performance.
“Culture matters when it comes to patient outcomes,” said Shapiro.
Shapiro pointed out that not all acts that result in medical error are the same; some result from human error, others from “at-risk” behavior and a smaller fraction from reckless behavior. “At risk” behavior refers to when someone doesn’t recognize the increased risk of a certain choice, or mistakenly believes that choice to be justified. Coaching those who engage in at-risk behavior and consoling those who have made a human error may be more helpful in preventing future errors than issuing a standard punishment or penalty, says Shapiro.
“How we respond when things don’t go well is a measure of who we are as an institution,” Shapiro said. “We need to foster an environment where we help each other, where people feel supported and valued.”
The Center for Professionalism and Peer Support has been instrumental in developing several programs to meet different needs within the organization, including a group peer support program, designed to support a clinical team following a difficult event or outcome, such as a young patient dying. “We want to give people the space and opportunity to reflect and share,” said Shapiro.
Shapiro and her colleagues found that while group peer support is helpful for many team members, physicians are often reluctant to share their emotional experience in front of the team. The team surveyed physicians, and, in a study published in the JAMA Surgery, reported that 88 percent of physicians preferred to receive individual support from a physician colleague. Based on the data, the center developed a 1:1 peer support program in which trained clinician peer supporters reach out and offer support to their colleagues who may be facing stress. The center continues to offer both group and 1:1peer support programs as well as defendant support, disclosure coaching, support around teamwork communication and a professionalism initiative which handles physician professionalism concerns.
These programs are all geared toward fulfilling the center’s mission: to encourage a culture that values and promotes mutual respect, trust and teamwork.
“Just culture is our best selves: it’s a culture where there’s justice and a hunger to learn,” said Shapiro.
To learn more about the Center for Professionalism and Peer Support and its offerings, visit PikeNotes.
To learn more about the hospital’s Just Culture efforts, visit PikeNotes.