Now that things have settled down, I want to emphasize that there is no favorable outcome in taking sides or disparaging a segment of healthcare workers.
According to studies, patients whose healthcare providers had an exceptionally high number of complaints from coworkers were at a higher risk of surgical and medical complications. I believe the results aren’t entirely surprising.
I tried to address some of the utterances made by the NSS director (former) and not justify the unwarranted microaggression and confrontation between the house officer and a nurse. We agree that the man’s actions and descriptive utterances could have been more measured, as are the nurse’s comments/behavior.
The purposeful propagation of misleading information concerning erroneous “Diazepam” prescription reveals the toxic atmosphere in our healthcare industry, which is inimical to the overall progress of the sector. The unjustifiable reaction that followed obviously demonstrates a lack of communication etiquette and courteousness in the workplace.
My goal in this write-up is to provide an unbiased assessment of the NSS director’s conduct and offer solutions that foster teamwork and cooperation, ultimately delivering value to our patients. In addition to the baseline stressors we encounter at our workplace, we cannot afford to add any more sources of negative stress, especially from coworkers.
Several statements, including some from the Ghanaian Diaspora Nursing Alliance, expressed support for the GRNMA. The fact that opinions differ noticeably depending on the source calls for epistemic humility among healthcare practitioners. As members of a professional organization, we are accountable for correctly presenting events as they are and communicating with objectivism despite our affiliation.
My outlook has always been to value everyone equally, irrespective of their societal echelon. Having a lifetime perspective of the power asymmetries in our relationships with people helps us to become better health professionals. We cannot successfully lead teams if we do not enhance our people skills.
The Manhyia Incident
The Manhyia episode is emblematic of the systemic failure and blatant lack of mutual respect plaguing our healthcare system. A well-designed system would figure out how to handle a “change in Normal Saline prescription” without requiring the involvement of a doctor who has concluded her shift. The Manhyia instance is only one of many occurrences with the potential to jeopardize healthcare delivery.
There is no denying the pervasiveness of bullying in our training institutions and work environments. The NSS director’s actions/reactions amplify an existing false impression of superiority. There is already a false narrative of competition between the different cadres, with some believing that doctors are holding them back from moving up the career ladder, which seems absurd. However, our body language and what we say actively discourage the degree of engagement with other disciplines necessary to improve healthcare. There can be no progress toward a solution unless we accept that we contribute to the issue.
The fundamental problem is the lack of a “mutual respect and safety culture.”
Mutual respect is essential in developing a culture of safety in healthcare. Medical technology and healthcare delivery changes will further heighten the necessity for teamwork. It has also been shown that improved patient care and happier healthcare staff may be achieved by breaking down barriers like professional stereotypes and the culture of hierarchy.
A hostile work environment is fueled by rudeness, lack of politeness, and general contempt for others. We have all seen the many forms of disrespect in our healthcare system. Disruptive behavior (e.g., yelling), humiliating, degrading treatment of students, residents, and other entry-level healthcare professionals, passive-aggressive behavior (e.g., delaying tasks or completing them in a way to annoy others), and passive disrespect (e.g., Delayed response to colleagues, etc.) are all forms of disrespect prevalent in our working environment.
Disrespectful encounters are correlated with high levels of stress. We must acknowledge that when folks with distinct professional hierarchies come together under conditions of low mutual identification and understanding, communal feelings of disrespect emerge.
Disrespect for a healthcare provider, whether a doctor, nurse, dentist, or even a facility cleaner, may have severe consequences for our patient’s health outcomes.
I am glad that the GRNMA have seen reason to immediately call off their strike to save, preserve, promote, and manage health.
Unfortunately, a reputable organization need not declare a strike because of an escalation of workplace conflict. I have seen statements justifying the strike action referencing a similar declaration by the GMA. However, the recent strike action fails to meet any criteria that would generally be considered to make that determination.
Strikes should only be used as a deadlock-breaking mechanism, especially when an employer fails to come through with their promise or when the long-term outcome eventually improves patient care.
Conflict resolution should be based on dialogue and compromise instead of domination.
Patient care is not an unintended consequence of our profession as healthcare workers. Our fiduciary commitment to patients trumps an unjustifiable reason for a strike, according to the tenets of our work. The duty and responsibility to protect life are among the first in the hierarchy of values for healthcare professionals.
Interdisciplinary teams are essential to healthcare delivery, and a culture of mutual respect among staff members has been shown to improve patient outcomes and decrease staff burnout. Mutual respect is a learned trait, and people must be taught to work in teams.
Mutual respect stimulates exchanges that demonstrate the importance of professionalism. We must develop policies that promote mutual respect through fairness across various cadres, consistency of actions, graded responses, and surveillance mechanisms that provide workers with access to a reporting system. A strategy like this guards against any form of reprisal.
Collaborative training is crucial because healthcare is a team sport. We cannot improve patient outcomes unless we emphasize communication and teamwork skills among healthcare personnel. The more we deceive ourselves that we can work in isolation, the worse the problem becomes.
Proper system design and redress procedures prevent confrontation. We need to implement effective processes to reduce specific events like the occurrence in Manhyia.
Finally, a just culture understands the need to forgive for events attributed to human imperfection, condemning only the irresponsible.
Elsewhere, before you are inducted into a multidisciplinary team, you must undergo training in Professionalism, Workplace bullying, Sexual exploitation, abuse, etc., all to engender mutual respect. Perhaps we need to consider these concepts in our training.
By Banda Khalifa (MD, MPH, MBA) Ph.D. Student @ Johns Hopkins University, Vaccine Regulatory and Policy Analyst at International Vaccine Access Center (IVAC)
Maimonides Medical Center. Code of Mutual Respect. Accessed June 14, 2022. https://maimo.org/wp-content/uploads/2021/10/Code-of-Mutual-Respect.pdf
Kaplan K, Mestel P, Feldman DL. Creating a culture of mutual respect. AORN J. 2010;91(4):495-510. doi:10.1016/j.aorn.2009.09.031
Rosen MA, DiazGranados D, Dietz AS, et al. teamwork in healthcare: key discoveries enabling safer, high-quality care. Am Psychol.2018;73(4):433-450. doi:10.1037/amp000029