Respect for People: A Building Block for Engaged Staff, Satisfied Patients

Virginia Mason’s Respect for People initiative has been a decade-long program designed to sustain a culture of respect across the health system including training all employees in ways to respect one another in the workplace. The original foundation of this work, a Virginia Mason goal for both 2012 and 2013, was triggered in part by a visit from Dr. Lucian L. Leape, an international leader in health care safety.

As Dr. Leape observed, disrespect among workers is “a threat to patient safety because it inhibits collegiality and cooperation essential to teamwork, cuts off communication, undermines morale, and inhibits compliance with and implementation of new practices.’’

A team led by Lynne Chafetz, Virginia Mason’s senior vice president and general counsel, sought input throughout the organization asking staff members questions such as these:

• What does respect mean to you?
• What specific behaviors or actions show respect for you and other team members?
• What does respect feel like when you receive it?
• What kinds of things happen at work that make you feel disrespected?

The result of this work was a behavior guideline in the form of the “Top 10 Ways to Show Respect.” What has been the impact of this program throughout Virginia Mason? We spoke with several leaders in different parts of the organization to get a sense of the work and progress.

Susan Haufe, administrative director of patient relations and service, was in the thick of the work to develop a team across the organization to figure out precisely how to address the respect for people challenge. “We defined respect for people as how we treat each other as we work together to create a perfect patient experience,” she says. “We conducted surveys asking employees what respect looks like and received hundreds of responses in just a few days.”

The result was a large advisory team with representatives across the organization that helped define the top 10 foundational behaviors of respect. The training included a theatrical production where Virginia Mason hired actors to stage scenes that represented both respectful and disrespectful behaviors. The production proved quite effective in showing both positive and negative behaviors to staff members.

“Sometimes team members feel stifled and disrespected, and we created scenarios in the theater program to show this,” says Haufe. “For example, we showed two staff members at the end of the workday feeling discouraged about work. Then the actors went into the past to see what happened to create those emotions and showed the impact of those behaviors. It was very powerful.”

During the course of training for respectful behaviors, Virginia Mason team members were asked to select two of the top 10 behaviors to focus on, and Haufe says the top two chosen were “listen to understand” and “speak up.”

Denise Dubuque, RN, administrative director of surgical and procedural services, found during the Respect for People work that operating room staff members “were not feeling as recognized and supported as they wanted to be.” As Dubuque studied this it became clear these staff members were too often out of the loop on various issues and thus communication became extremely important.

“We’ve worked on different methods of communication, keeping them up on key initiatives and making sure we have adequate time at meetings for them to ask whatever questions might be on their minds,” Dubuque says. “We’ve been holding meetings where we express gratitude and thank people for hard work. Sharing information and listening to team members are really true examples of how you show respect for people.”

She says the training gets her back to the basics of civil behavior. “My most foundational belief as a leader is the old adage that you should treat people the way you would want to be treated. As leaders, we have a responsibility to treat our team members with the highest level of respect. This is so foundational, and we all have to remind ourselves of this every day we come to work.”

Chris Covey, director at Virginia Mason’s Lynnwood facility, focused intensively on professional boundaries and the way in which crossing such boundaries seriously violates Respect for People principles. Respecting professional boundaries means the entire team engages in behaviors that help us serve our patients in ways that are objective, respectful and consistent with what we are trained and hired to do. These behaviors are essential in our interactions with every patient, whether or not they also happen to be a staff member. “We’ve focused on making sure you are always appropriate when talking about a patient, as well as other staff members,” she says.

Covey said the theater piece was especially powerful for showing Virginia Mason staffers important behaviors. “That we respected staff members enough not to just send them an email or brochure, but to bring them to a presentation where the organization’s values are dramatized in that way. It really engaged the team. People enjoyed it. It was not just a lecture and they could relate to a lot of what was said.

“The actors did a great job coming up with realistic scenarios — stuff you see going on all the time where you’ve done it yourself or seen it happening to others,” she says.

All staff members completed the training, and more than 1,275 participants responded to an anonymous survey gathered four weeks post-training. Responses included:

• 83 percent of respondents agreed or strongly agreed with the statement “The training itself was engaging and informative.”
• 76 percent agreed or strongly agreed with the statement “I gained a greater sense of personal ownership for how I respect, support and appreciate coworkers.”
• 77 percent agreed or strongly agreed with the statement “I feel a greater sense of personal ownership for how I respect, support and appreciate coworkers.”
• 54 percent agreed or strongly agreed with the statement “I have noticed a positive change in my work environment.”

Our 10 foundational behaviors of respect:

Download the respect behaviors poster here.

1. Listen to understand.
   Good listening means giving the speaker your full attention. Nonverbal cues like eye contact and nodding let others know you are paying attention and are fully present for the conversation. Avoid interrupting or cutting others off when they are speaking.
2. Keep your promises.
   When you keep your word you show you are honest and you let others know you value them. Follow through on commitments and if you run into problems, let others know. Be reliable and expect reliability from others.
3. Be encouraging.
   Giving encouragement shows you care about others and their success. It is essential that everyone at Virginia Mason understand their contributions have value. Encourage your coworkers to share their ideas, opinions and perspectives.
4. Connect with others.
   Notice those around you and smile. This acknowledgement, combined with a few sincere words of greeting, creates a powerful connection. Practice courtesy and kindness in all interactions.
5. Express gratitude.
   A heartfelt “thank you” can often make a person’s day and shows you notice and appreciate their work. Use the Virginia Mason Applause system (an internal recognition program), give the colleague a handwritten note or verbal praise, or share a story of “going above and beyond” at your next team meeting.
6. Share information.
   When people know what is going on, they feel valued and included. Be sure everyone has the information they need to do their work and know about things that affect their work environment. Sharing information and communicating openly signals you trust and respect others.
7. Speak up.
   It is our responsibility to ensure a safe environment for everyone at Virginia Mason, not just physical safety but also mental and emotional safety. Create an environment where we all feel comfortable to speak up if we see something unsafe or feel unsafe.
8. Walk in their shoes.
   Empathize with others and understand their point of view and their contributions. Be considerate of their time, job responsibilities and workload. Ask before you assume your priorities are their priorities.
9. Grow and develop.
   Value your own potential by committing to continuous learning. Take advantage of opportunities to gain knowledge and learn new skills. Share your knowledge and expertise with others. Ask for and be open to feedback to grow both personally and professionally.
10. Be a team player.
    Great teams are great because team members support each other. Create a work environment where help is happily offered, asked for and received. Trust that teammates have good intentions. Anticipate other team members’ needs and clearly communicate priorities and expectations to be sure the workload is level-loaded.