Join host Dr. Lee Sharma and guest Dr. William Cooper as they discuss healthcare incivility, professionalism's impact on patient safety, and effective intervention strategies. Learn how a small percentage of clinicians drive major issues and how peer feedback can foster positive change.
How can addressing a small group of clinicians’ behaviors transform healthcare safety and culture?
In this episode of Scalpel and Sword, Dr. Lee Sharma sits down with Dr. William Cooper, to unpack 25-30 years of groundbreaking research on incivility in medicine. They explore how just 2-5% of physicians account for 50% of malpractice claims and unsolicited patient complaints, often linked to unprofessional conduct toward colleagues. Dr. Cooper shares how Vanderbilt’s peer-intervention model—using data-driven, non-punitive feedback—reduces complaints by up to 50%, improves patient outcomes, and mitigates risks like surgical complications and burnout. Dr. Sharma reflects on her own experience as a peer messenger in 2001, witnessing transformative change in a colleague’s demeanor.
The conversation dives into applying these strategies to safety protocols, like surgical bundles, to enhance adherence and reduce infections, emphasizing a culture of empathy and accountability to make medicine kinder and more reliable. Tune in for actionable insights on managing conflict, fostering professionalism, and preventing workplace tensions in high-stakes healthcare environments.
Three Actionable Takeaway:
About the Show:
Behind every procedure, every patient encounter, lies an untold story of conflict and negotiation. Scalpel and Sword, hosted by Dr. Lee Sharma—physician, mediator, and guide—invites listeners into the unseen battles and breakthroughs of modern medicine. With real conversations, human stories, and practical tools, this podcast empowers physicians to reclaim their voices, sharpen their skills, and wield their healing power with both precision and purpose.
About the Guest:
Dr. William Cooper, MD, MPH, is a pediatrician, Cornelius Vanderbilt Professor, and Associate Dean for Faculty Affairs at Vanderbilt University School of Medicine. As President of the Vanderbilt Center for Patient and Professional Advocacy, he has led 25+ years of research linking 2-5% of physicians to 50% of malpractice claims and incivility, impacting patient safety and burnout. His peer-intervention model uses non-punitive feedback to reduce complaints by 50% and improve outcomes like surgical infections. A prolific researcher with publications in JAMA and Pediatrics, he advises national bodies like the Joint Commission. Cooper promotes empathy and accountability, enhancing healthcare professionalism.
Connect via Vanderbilt’s CPPA website or
LinkedIn: linkedin.com/in/william-cooper-010061a9
Website: https://www.vumc.org/patient-professional-advocacy/vumc-cppa
About the Host:
Dr. Lee Sharma is a gynecologist based in Auburn, AL, with over 30 years of clinical experience. She holds a Master’s in Conflict Resolution and is passionate about helping colleagues navigate workplace challenges and thrive through open conversations and practical tools.
[00:00:00] Hello, my peaceful warriors. Welcome to the Scalpel and Sword Podcast. I am your host, Dr. Lee Sharma, physician and conflict analyst, and I am so excited to have on the podcast today Dr. William Cooper. Dr. Cooper is a graduate of the Vanderbilt School of Medicine. He did his residency and chief residency in pediatrics at Cincinnati Children's, and then he returned to Vanderbilt to do a general academic pediatrics fellowship.
After that, he got a Master's in public health and joined the Vanderbilt faculty in 1997, where he currently serves as Associate Dean for faculty affairs. He is also the president of the Vanderbilt Center for Patient and Professional Advocacy and. With all of this experience, we are going to delve deeply today into healthcare, incivility in the workplace, professionalism, how it affects our environment, how it affects our conflict, and how we manage it.
Dr. Cooper, welcome to the podcast. Oh, it's [00:01:00] great to be here. It's really exciting to, talk about the things that are interesting to you and, your listeners today. I'm so glad you're here. what was the impetus for you guys to start looking at managing incivility and some processes that could lead to addressing it?
Well, we've been doing this for about 25 to 30 years, and our early work was rooted in medical malpractice, recognizing that by specialty three to 5% of physicians account for. 50% of the malpractice claims we just sort of stumbled upon in having conversations with other leaders that those same physicians also accounted for 45 to 50% of unsolicited patient complaints where someone we fail to meet or exceed someone's expectations and they call our offices or our hospitals and, mention our clinicians specifically by name.
We developed an intervention model to use peers to talk with colleagues and say, gosh, for some reason your practice [00:02:00] seems to have more of these, and we know that's associated with malpractice risk, which was our sort of early work. We then learned over time that it wasn't just patient complaints that were sort of had the same distribution, it was also unprofessional behavior towards colleagues, physicians to nurses and physicians to other physicians.
And so we learned that again, two to 3% of clinicians accounted for about 50% of those unprofessional conduct behaviors. Towards peers and colleagues. And we further began to recognize through studies that we published, that those actual same physicians, their patients are more likely to have surgical complications, wrong site surgeries.
They're more likely to have wellbeing concerns like burnout. And, cognitive impairment and other challenges. And so what we've really tried to do is to identify those individuals early and help them be the best version of themselves. So one of the things that we talked about off camera is with this research that Vanderbilt had done, that you actually started going [00:03:00] to community hospitals and other healthcare centers and training other physicians to intervene because we had this data and I was actually one of the physicians in this early program in 2001, and I actually remember because I think I was recently postpartum with my second, but I told my husband, it's like, okay, you gotta take care of the babies today 'cause I'm gonna go do this program.
And as we started hearing this data from Vanderbilt, that this is this very small percentage of physicians that was generating this very large percentage of complaints in malpractice. And what I loved about this intervention, and this was before I had done any kind of study in conflict resolution.
This was before I had done my master's, that we weren't going to these physicians and saying. You're bad, you're terrible, you need to do this. You're generating all of this. Literally the first intervention I did was with an ER physician and in accordance with the model, I had a list of all the complaints that he had, and all I did is I paged him and said, Hey, can I have 20 minutes of your time?
after a shift [00:04:00] and we went and sat down in the break room and I said, so what? I need to show you. Is a list of all of the complaints that you have had, all of the concerns patients have had, all of the concerns your colleagues have had. I'm going to just go and tell you by comparison, this is about 10 times what most of your colleagues have had, and all I wanna do is make you aware of it.
And that's all I did. And I said, is there anything else that you'd like to talk to me about right now? But otherwise I'm gonna leave you with this. And he said, no, I'm good. And I said, okay. And. Walking outta this, like, you know, oh my gosh, it was kind of scary to do that. With a colleague was really terrifying.
And like I said, I hadn't had any training and conflict resolution at that point, so I had nothing to fall back on, but got to circle back six months later. And this physician's complaint level had dropped on an order of 50%, five zero. And I still, work with this guy. I still see [00:05:00] him fairly regularly and it's so cool because he definitely had his demeanor changed the way he talked to people changed.
And so one of the things I love about the early work that Vanderbilt did, we weren't pointing fingers, we were raising awareness. And so that what a great place to sort of start in terms of. bringing this problem to light, but also developing a process to work with it. Where did the research go from there?
So the early things we did in malpractice really helped us understand, one of the things we know is that, for instance, your colleague, when you have a bunch of these patient complaints, you are at greater risk to be sued. I took over right in the center about 10 years ago, and we've added to that by linking all of these data to.
Surgical outcomes like with the National Surgical Quality Improvement Program data. To trauma outcomes with the National Trauma Data Bank, to wellbeing concerns to a study we did of cognitive impairment to understand that it's not just malpractice. It's patient [00:06:00] outcomes. And it's nurse turnover.
And having that peer-to-peer conversation is so powerful because if I can say, gosh, colleague, for some reason, and I don't know why this is happening, your practice seems to have more of these than your peers. This is you did. I also wanna make sure you know that this increases your risk for your patients to have worse.
And those things that what I've done, I've been a messenger even before I took over for probably 15 years. And when I have that conversation, there's often this light bulb that goes off. 'cause people have a natural defensiveness. But a light bulb goes off where you're like, okay, when I compare you, 'cause since those early days in 2001, we have trained people in 300 hospitals around the United States, 300 hospitals in Australia, New Zealand, and Singapore and other places in Ireland and UK and Canada.
And it works the same no matter where you are, whether you're in Opelika or Nashville or the Bronx, or in la. the ability to [00:07:00] give our colleagues feedback in a nonjudgmental, respectful way that appeals to their self-regulation and their commitment to their patients and to their peers.
It's such a powerful way to give this feedback and help them learn more about ways that they can improve their performance across this really critical skill. And I think that's so powerful because I think a lot of physicians don't realize if they have incivility on the daily or if they're having difficulty interaction with their colleagues or their other coworkers, they don't really realize that not only, it's not just about malpractice.
It really is about patient care, but it's also about a, Personal wellbeing. There's so many things are being impacted by this and I think as you have the research to back it up. 'cause we are all, scientists , we're research driven. Show me the data and when you can present somebody with, I have solid evidence that shows if we can make positive changes in your professional behavior, it's not even just about you, it is really about your patient's outcome.
And Even if people are working through issues with [00:08:00] incivility, professionalism, we all want the same thing. We all want our patients to do well. It's why we're here. So as you start to have that data, it makes that interaction and that intervention so much more likely to be successful. You're appealing to other things that they care about.
Yeah, no, I'll tell you. And this was really driven home powerfully too, so since we trained you all those years ago, and I'm so delighted to hear the story about your emergency medicine colleague, it warms my heart. Yeah. But one of the interesting things is that early on in COVID, we also learned the power of engaging in respectful ways.
So, like many hospitals, our health system here at Vanderbilt, in the early days, we began to put in screening to make sure that people coming in didn't have fever or symptoms of COVID. We put, stickers on you for each day. And so there were station set up in front of all of our entrances and we had a a physician who entered our hospital three straight days, went past the tables without checking in, got on the elevator and went up.
Well, a unprofessional conduct report was entered because we [00:09:00] were wanting to make sure to protect everyone from COVID as far as we understood at that time. And when one of our peer messengers who had the courage just like you did those years ago, pulled 'em aside in a quiet way and just said, Hey, tell me a little bit what's going on here.
Wanted to check in with you and see how things are going. The individual, burst into tears and said, I'm a very private person and I've not told anybody. My spouse is up in the ICU here and is dying of COVID and was still trying to go about his workday and trying to get through. And in that moment, the messenger was able to pivot to say, oh my goodness, what do we need to do to surround you with the help you need right now?
Wow. And so we've modified our training even further based on those learnings just like that. And during COVID to really root what we do in empathy. So when I have one of these conversations, now I'm gonna say, tell me a little bit about how your call might went. Sounds like it was kind of busy.
Now tell me I know a nurse called you, [00:10:00] seems like about 10 o'clock, or so. Tell me how that went down. And they'll tell me. I'll say, gosh, I see how frustrating that must have been. 'cause they had called you three times with what seems like a normal blood pressure. Now the report we got said that you told 'em to quit calling you with stupid questions.
I get that you're frustrated. Is there any way that could go differently next time? 97% of the time, that's all it takes. They won't do it again. Yep. And so engaging in an empathetic way that says, I'm your peer and I understand what it's like. Can be so powerful. Absolutely. You also use this wonderful term, this is in your bio, but you just used it.
The idea of being a peer messenger. That we are not tattletales, we are not turning on our colleagues, that we are somebody who's carrying a message. We are carrying insight. And the other thing I love about your interaction that you. Talked about and it's so beautiful, is this idea of [00:11:00] you didn't go in there judgmentally.
You weren't like, you really can't do that again. Right. It wasn't that at all. It was, let me see what space you were coming from. you're seeking to understand, but you also. As a messenger, you are actively participating in the process of having this person perform better. You are actively trying to improve their professionalism, and sometimes that's such a powerful thing.
And the reason why I think your program does so well and why so many hospitals benefit from these kind of programs is. If we don't have a personal ownership or interest in engaging in a problem and we don't have the skills to do it, we're not likely to engage. And if you look at small hospitals like mine, if you look at most hospitals in general, everybody knows who's causing the incivility and professionalism problems.
We all know if you cornered one of my doctors up on saying, who are the three most disruptive doctors in the hospital, boom, boom, boom. You would have no problem getting a list. And I think most facilities are that way, but because [00:12:00] there's no training involved in actually having somebody engage and be that messenger and then being able to approach them, like you said, with empathy, people don't do it.
And so the problem just persists and unfortunately it can grow. In worst case scenario, the patients suffer from it. And so this training that you're giving people is so valuable, but I think the approach that you're giving them, the skillset is what's even bigger. What led you from going from this idea of having a messenger?
Because now we also have with an article that the center published in the British Medical Journal in 2024, using the concept of a huddle as a system to address these problems. You know, it's really interesting. we found that for the typical sort of rude behavior like I just described between a physician and a nurse or a physician where the ED calls and they refuse to come in to see the patient when they're on call or mm-hmm.
Any sort of type of interaction. Those are sort of, typical [00:13:00] unprofessional behaviors and, and those relate, there's a certain subset. That organizations are required by law or by regulation or by policy to be handled in a special way. Things like sexual boundary violation impairment by drugs or alcohol, violence towards a patient, or anything that sort of is that in that special space.
What we've learned over the years through our research is that these are often handled in variable ways, depending on who finds out about it first. So, if somebody observes it, they may not act and follow the exactly the pathway. So what we put in place here and now use in our other, organizations that partner with us is a process where if one of those reports hits a system here at Vanderbilt and any, all of our reporting systems talk to each other within four working hours.
We have a huddle put together with human resources. Legal risk management, physician leadership, if there's a physician involved. We have nursing [00:14:00] leadership. If there's a nurse involved, we're a teaching hospital, so graduate medical education, if there's a resident involved Only the people that need to be on the call and we have a seven minute huddle.
We don't try to decide whether we think it happened or not. We just say, gosh, based on the language in the report as we know it is Anybody here aware of anything else that's happened in this space for this event. And then who thinks this needs to be investigated, and if so, by what pathway?
Who's got point? Because when you look at the really, really challenging and vexing cases of sexual abuse and misconduct that have really been, and the headlines lately, mm-hmm. Across so many large organizations, one of the common elements was that an individual leader was made aware of the events, did their own review, and determined that there was nothing else further that needed to be done.
So the challenge with that is that you don't want a single person making that call. So this huddle has given us a chance to [00:15:00] engage in a thoughtful dialogue and to say, okay, who's gonna do it? And then making absolutely sure. We close the loop. The really cool thing about it though, it is, as a leader, it's also given me a chance to increase the trust and collaboration across all those key stakeholder groups that carries forward into other work that we do.
So it's been sort of transformational for how we think about things and as really been a really important effort on our part to ensure that these sort of tragic things don't happen to the best of our ability. this is so powerful. There is so much to unpack and talk about that's so positive with this process.
The first one is that there is a process. so often I think when these things kind of occur and inevitably they incur everywhere, that there's not a unified place people can report. you might report to your superior, but that's still only going to one individual. So the reporting itself is standardized, number one.
That's huge. [00:16:00] The second thing, as you say, often in places that don't have this kind of system, these things get siloed. They get stuck in one place, and so as they get siloed, they're going one direction. They get stuck with one person, and that one person now has the burden of deciding what the huddle really should be Deciding.
Not whether it happened or not. That's not what we're trying to decide. Just this is the event. These are the stakeholders, what needs to happen now. I think the other thing that's great about having a huddle as opposed to having it siloed with one individual is if there is retribution, if there is concern about headhunting finger pointing, you can't really say that.
If this is a group of people and you're much more likely to have an appropriate intervention or an appropriate solution, because you have a circle and not just one person. You also talked about the fact that this has carried over as a transformational act in institutions because all of a sudden people's trusted the [00:17:00] process.
And when You have a process in place that people trust, it creates safety. And when you create safety, you create an environment that people are more likely to come forward with conflict. Conflict is not bad. Conflict does not mean you're doing anything wrong, and I think that's one of the biggest things I see in my work is that institutions, because they don't have a way to work with it, they wanna brush it under the rug, they don't wanna deal with it, and they don't see that addressing conflict has power.
It actually has the ability to make the system healthcare the individual so much better. That's really one of the interesting things we learned after our first few huddles were. That we had to actually also, we added a section to our huddle, and that is to assess the wellbeing of everybody involved.
So if you've got somebody who gets really, really angry and throws something across the room, that may happen in some of the space where you, sit in the operative space in your careers, like mm-hmm. That is, there's something happening there is that person. Okay. And are they safe to [00:18:00] practice?
Do we want them operating on one of our loved ones in the next 20 minutes? So part of our huddle process is if we're not certain that they're doing okay, we go send someone to check on 'em. The second key player are the people that are in the environment that may be affected. Consider a setting where in a practice setting or an emergency department setting or something, someone shows up to work, unfortunately impaired by drugs or alcohol.
they are removed from the situation to follow the organization's policies. But everyone who's left behind is traumatized by that. That is so scary to see that happen. And many times they have inadvertently put workarounds around this person until their impairment rose to a level where they actually showed up to work impaired.
And so that is a view. So we send people over just to check on the team and make sure that they're doing okay and that the patient cares. But we also think about patients. So let's say you've got a cardiologist who becomes really, really, really angry because the green drapes are on the patient instead of the blue [00:19:00] drapes and they want blue drapes.
Dang it, right? Yep. And so, yep. I know you've run across this kind of stuff in your career. Every once in a while it's like, They do it wrong. And you've seen colleagues who have this, well, the cardiologist throws the drapes on the floor, walks out past the holding room where the patient's family is sitting and says, these idiots, we'll cancel this case and get going later on today.
Well, we also need to think about what are the needs of the patient there? And so we've learned through this huddle is that we need to address those regulatory things, but we also have to think how can we provide the best care for everybody who's sitting and affected by this, including. All of those key stakeholders.
There's so much power in seeing this as a systemic issue. We have to address the system. Yes, the prompt may have been an individual's incivility or unprofessional behavior, but the system is gonna suffer. And so we have to address the system as well. And the fact that you've added that to the huddle, how great is that, that you're actually making sure that everybody involved?
Because that is a traumatic thing for people to witness, to see if [00:20:00] an impaired physician that has to leave, You were actually able to do that. And I have no situations where I know in my institution, and this was years ago, where there were impaired physicians that were let out by security because they were, making a ruckus in areas at the hospital.
But nobody went back to see, how were the people who were there, who witnessed it, how are they doing? That didn't happen. And now we have more wisdom about the systemic nature, the fact that. We are part of that system, and I think that's one of those things that doctors sometimes are not good at. We see ourselves like the system is in service to us, right?
We don't really see ourselves as part of the system. And so that's a really big mind shift for us to actually, no, no, no, no, no. We are part and parcel of this symbiotic relationship that we have with our working environment, and we have to approach it that way. Our behavior does affect what goes on in that environment and.
Being able to raise someone's awareness to that, but also to have a process in place is so powerful. [00:21:00] One of the things that when you looked at your study that was in the BMJ last year was the percentage of the different areas of complaint for incivility and difficulty with professionalism. One of the things I found the most interesting was the most common level of complaint was discrimination.
that shocked me. 'cause I wasn't expecting that. we have seen that and fortunately the behaviors that exist. And, sort of sexual boundary violation being impaired by drugs are extraordinarily rare, like extraordinarily rare. Mm-hmm. But other types of behaviors where there are sort of, discriminatory behavior perceived or received by an individual really requires us to make sure that we are following all of the relevant sort of, laws and policies regarding that and this study that was in BMJ was from across places from New York to. Nashville , Tennessee to the Dakotas, to California. And so it's really mm-hmm. [00:22:00] Across a wide range of the country. And, one of the things that has been important as, we've used the huddles to evaluate those types of things, sometimes it is a perception.
Of the behavior, but we have to may pay attention to both the person who's reporting and reported. One of our early huddles in this space was a clinician was walking one of their patients out to the front desk to reschedule a follow-up visit. And just sort of said, with a sweeping arm gesture, these people will, schedule your follow-up appointment.
Well, these people, the two persons sitting behind the desk were women of color. And the person, who was doing that was of the majority population. And, in that they felt that this was sort of an unfair characterization and sort of sweeping generalization. Mm-hmm. So as a part of our review process, talked with them and said, tell us a little bit about what was going on here.
And they said, well, this person, the physician who had this is an amazing person. So kind and so fair and inclusive. But this was [00:23:00] something that we wanted them to be aware of how we perceived this. So we were able to help them and say, is there anything else that we can do to support you? And then when we gave feedback, the person was obviously very bothered by the fact that they had, been perceived this way, but it gave them a chance to reflect.
So that action did that so many times. Those sort of reports of these kind of behaviors allow us to help and support everybody who's involved so that we can ensure that we create a place where everybody wants to come to work and be, a part of something that is creating the best workplace for our colleagues, but also for our patients, of course, to deliver great patient care.
And you yourself, as part of what you do, you are also a faculty messenger. You also have that role at Vanderbilt, and 85 to 90% of the physicians that you've intervened with have had positive change. And I think that's a testament to the fact that the vast majority of people who are in healthcare practice, if they have [00:24:00] incivility or difficulty with professionalism, most of them may be unaware.
These are things that are happening, and I think that's huge. The idea that you are giving somebody a space to self-reflect in a very kind way, and then you're seeing positive change from that. I think that also goes back to successful process, meaning the huddles and the way that you're intervening
But I also wonder, and I think your data really bears this out, that a vast majority of physicians who have uncivil or difficulty professionalism are unaware. They may be modeling behavior that they saw from other people. You know, I saw somebody in residency who got mad and threw an instrument across the room, and therefore I must think that's okay.
Right? I heard somebody else use this term, and therefore I think it's okay to use. This term, and I don't think it's derogatory because so and so did it. I was very blessed. my dad was a general surgeon and one of the things he said to me, he trained in the sixties, you know, when you were a gentleman in the operating room and he used to tell me, I may be dead, but if I ever hear that you threw [00:25:00] something or yelled in an operating room at somebody.
I will come find you and I will haunt you. And that was my model of what professionalism looked like. I looked at my parents who were both physicians and both just phenomenal doctors, but phenomenal humans. everybody who worked for them said the same thing. They were so good to work with.
but I feel like I was very blessed that I had a model of what that behavior looked like. But if you are in a situation where that was not modeled to you. You think it's okay and you act that way, you're gonna keep acting that way, making everybody else around you miserable until somebody kindly sits down to you and looks you in the eyes and says, how are you?
What's going on? Let's talk about what happened at 10 o'clock when you said, stop calling me with the stupid phone calls. And then all of a sudden, the light bulb goes off and that person has an opportunity to actually have that self-reflection and then be better. And then. In addition to being better, their patients get better [00:26:00] care, they're less likely to get sued.
This ripple effect goes on, and then you add to that the fact that you're in an academic medical center, you're helping the faculty act better. There's no question the medical students, residents that are going to be training with those people are going to benefit from that behavior as well. As you have been able to introduce these, you've also said that, of course the process exists for residents and medical students.
Have you been able to see any of this change the level of occurrence with graduate medical education? Absolutely. One of the really fun things about my job is that across all these, sites here in the state, we have all of their patient complaints in these unprofessional conduct reports. So we have five or 6 million reports that we can review.
Wow. I can show you how you compare to other ob gyn docs or to other general surgeons or to other. Pulmonary docs across country so that when we can provide that comparison We have a similar database for our residents and fellows and trainees. And so if we [00:27:00] identify an individual in the first year of their residency, and that's the most common time they're identified and we intervene with them, there's an 87% chance they're gonna graduate from residency and not have another report.
Wow. And you talk about the ripple effects so during that time of that residency, they're taking care of patients. But when they graduate, the typical physician is gonna provide care for 20 to 30,000 patients during the course of their career. And so you think about that early course correction, what a powerful impact that has on the rest of their career.
'cause just like your ED colleague, if you get this feedback and you improve, we have shown over 20 years of data, you stay good. people don't typically come back and have a reversion of these behaviors because it is a self-regulation, just as you described, that sort of seems to stick with people.
Do you ever find that there are physicians who don't respond favorably to this kind of intervention? Yeah. And so we identify two to 3% of physicians in our patient complaint [00:28:00] work, and a different two to 3% of physicians in our coworker work. They're different populations, right? So, both of those operate in parallel .
If 87% of those respond. To those interventions, once they develop that pattern At leaves about 0.5%. In that case, what we do is we escalate the intervention by having their supervisor. So if they're a member of an organized medical staff, like at your hospital They will go if your bylaws allow focus, professional practice evaluation, we might use a peer review process or an employment process to put a corrective action plan, and that's still about 70 to 80% effective.
And so as I think about our work in the coworker side, we've tracked 160,000 docs, 18. Finally, out of the whole 160,000, were not able to improve and had to undergo form formal disciplinary action. Mm-hmm. so what that means is 90% never had any unprofessional events ever, ever, ever. [00:29:00] 8% get an occasional stub, their toe day.
2% get that pattern. And so it's a increasingly smaller numbers, but we ratchet up the intensity of the intervention as the needs arise. And we keep it as informal as possible as we can down sort of at the lower levels of intervention. I think that also, keeping it more of the personal informal interaction, I think does invites people into that process more easily.
I think that sometimes people are more comfortable with informal conflict resolution processes, and I think escalating only when you have to. Is a really, really sound way to approach it because I think most people respond very well to informal processes. A lot of times formal conflict resolution doesn't feel good to people.
You know, they don't like how that feels. And so you'd have to be really, really, really, unresponsive, I think to something more informal. If hospitals or a medical institution was trying to start the huddle process, how do you recommend that they kind of go about initiating that? So one of the [00:30:00] things is to understand, first, recognize that you've gotta have the right leadership buy into this, like the leadership of your organization, and the leaders of all those stakeholder groups have to say, yeah, this is something that's we're gonna do because that has to do.
Mm-hmm. You gotta make sure you've got the right policies and procedures. So are you following the bylaws? Policy or your bylaw policy or whatever it is. And then you need data. So you have to understand where are all these things coming in? Is it a compliance hotline call? Is it a integrity hotline call?
Is it a patient complaint, is a report to a supervisor, and it doesn't matter where it comes in, you just have to make sure on the back end that you're getting those, all those data sources aligned. And then once you've got buy-in of those groups and you've got data, you've got a policy, then having a systematic way to have a key person identified.
I remember I told you that we do these within four hours of a report hitting. The only way that works is that each of those representatives of those teams makes it a priority. And they know, 'cause we run the huddles, we're not [00:31:00] gonna let it go longer than seven minutes. 10 would be tops. Mm-hmm. So they know they're gonna get in, get out, it's gonna be efficient, we're gonna follow through.
So those key things are essential to make sure that you follow that. And then tracking and recording to make sure that you've documented, we had a huddle, here's where we went, and then handing it off to the appropriate regulatory or investigatory process. There's so much that in terms of not only making it where people can put in the complaint, and I think that's an anonymous process, right?
When people are putting those in, so oftentimes they, when they put in that complaint, and then after that, they're not waiting months and months, they don't feel like it's been swept under the rug. They don't feel like they've been forgotten about. 'cause I do think when you set up these kind of process for people to report, one of the biggest thing that happens, and I think this kind of goes back to the siloed model.
It's not a priority for that individual. If it's an OR manager, they've got 80 billion things going on that day. If a surgeon threw something and someone, Hey, so-and-so threw an instrument [00:32:00] at me in the operating room, oh, okay, well, I'll look into it. Well, that may not happen for another month, and all of a sudden the employee feels very frustrated.
They might be scared. Like we said, we haven't even addressed the problem, much less the system. So the fact this is happening within four hours is huge. That means that person feels like they're heard. That means that voice actually resonated. And then you have a multidisciplinary team that's looking at this.
You've made it where this is not a huge imposition on their time. On a busy clinical day, I'm talking about seven minutes of your day. I can do this in seven minutes. They have that assurance that you are not interrupting on their time. Not that this is not important. But they need that. this is logistics of what we do.
And then also at that point, we're not trying to decide what we're trying to decide, where does this need to go forward and all of these things, this process that you have designed. It's fluid, it's efficient, it allows people to be heard and it doesn't let the problem fester. I think one of the things, biggest things that happens in complex [00:33:00] situations when hospitals don't have systems in place is these problems basically grow and grow and grow and grow, and all of a sudden so and so heard that this happened and they're gonna put their 2 cents in and how dare you do this to my friend?
And all of a sudden this. It has taken on a life of its own and it's really hard. It's really hard to manage conflict when it gets to that point. 'cause that's typically when you're calling in somebody to help you with it. And at that point, literally it has taken on a life of its own. And it's very difficult to get, not even just a resolution, just to get a handle on the stakeholders in the problem because the stakeholders have also grown.
When that happens. So we're actually establishing a very clear delineation for how to manage this, and I think that's one of the many reasons why your huddles are so successful is because of the way the system looks. It's very, very efficient and the way that you have it set up and have it implemented, I think it's something that.
As you say, when you get people to buy into the process, and I think your data definitely makes it easier for people [00:34:00] to buy in. You have the data to prove it, and how successful this is. I think this is going to help so much for so many institutions. Where do you see this process evolving? As you know, you're getting more data.
There's many places that are using the huddles. How do you see this process evolving? Especially as you note that since the pandemic, our incivility and professionalism unfortunately has increased. So one of the interesting things is that we started with physicians. We then added nurse practitioners, our trainees.
We now do this work with staff nurses. Okay. And so we recognize the same distributions occur. We use peer nurses to talk to peer nurses and peer nurse practitioners. So one of the things that we are interested in is continuing to see the impact on sort of culture and safety and outcomes across. Having these interventions across the entire workforce.
The other thing that we're really exploring, which I'm fascinated by is how do we use a same sort of tiered, really gentle feedback, respectful approach when people don't [00:35:00] follow our safety and quality processes. So whenever time, whenever you, do a procedure and you have a procedural timeout, my guess is that just in the brief time we've talked, you make sure that the room follows the timeout procedure, quiet.
Nobody's on their phones. You're following that. Not everybody does that. Or when there are, c-section bundles or colorectal surgical bundles, or a ventilator management bundles, or in MySpace vaccine guidelines. 90% of people follow that every single time. 7%. Occasionally may miss a timeout or miss a vaccine or something, but 2% of people account for the misses.
And so what we're looking into is can we use our same peer-driven, data-driven leadership supported processes to say, gosh, when we looked at your operative, reports for the last week, it looks like that, following the bundle for your practice occurred about 60% of the time. Your peers at this place are doing it 98% of the time.
we piloted [00:36:00] in colorectal surgery and drove our adherence to the bundle to the high nineties, and guess what happened to our surgical site? Infections dropped Precipitously , and so we are exploring, we have national round table, so we're holding one later this fall about how do you think through other things that get in the way of what we're trying to accomplish, to have the best things happen to our patients when they show up at our doors?
That's huge and it's so true. I think about like robotics at our hospital. So I do robotic surgery. So one of the things that happened at a robotics meeting is they actually started looking at the costs of each surgeon. Yes. For each case. So for the other people in your peer group that are doing X case, this person is charging X number of dollars per case, but this person is charging X number of cost.
Let's look at what X person is doing. Are they doing something that's really clinically required? Is what they're doing getting a better outcome? No, it's not. Can we standardize this process and actually get great patient care, but also work on maintaining cost as well? [00:37:00] And all you have to do, like you said, you don't have to point a finger, you don't have to be putative.
All you have to say is you, this person's here, this person's here, and that's it. Yeah. Because the majority of people, once that's up on a screen, will go, oh. Well, I'm not gonna be the outlier anymore. And then you come back to the next meeting three months later and all of a sudden everybody's doing the same thing and that's getting great care, but it's also doing good things economically.
It's also easier for the hospital in terms of logistics. I mean, there's so many positive things that come from that, but I have definitely seen that in real time. And I do think as you. talk about processes and how processes are effective for managing conflict, they're also positive for preventing it as well, right?
And the whole goal of programs like yours, and to me, what's made them so successful is not only have you found a way to successfully manage conflict as it occurs in very [00:38:00] real time in a very, very, very short window, but you've also made it less likely it will occur. With this process in place and conflict is illuminating.
It can be inevitable, but it does not mean it always has to be. And I think, your research shows that really beautifully. Thank you. It's really for fun and important to do. We come to work to make medicine kinder, safer, more reliable, and anytime we can do that, it is been a good day for me.
No doubt, Dr. Cooper, if people wanna find you or find out more about the center, how would they most easily do that? So, we're easily found on LinkedIn. You can find me or our Center for Patient and Professional Advocacy. We also have a website here that can be the Vanderbilt CPPA is our, our sort of our acronym, or abbreviation.
And they can find us that way. always glad to talk to anybody that has interest in learning more about what we do. All right. Thank you so much for your time. I love the work that you're doing. Honestly, it was really [00:39:00] exciting when I started reading and I found your research and I found the center and I realized, wait a second.
I know these people. I remember this. That was both people. Yeah, I remember this. I'm so proud of you for doing it so effectively that, it had a lasting effect. Way to go. Thank you. Well, and that's kudos to you and the work that you guys have done and I don't know for sure, but. I don't know if that was part of what made me go into conflict resolution, because I think it really had such a profound effect on me seeing what I was able to do for my colleague that it's like, is there a way that I can learn more about this?
And so I ended up doing a master's while I was practicing, and so I've been working in this space since then. Yeah. so I will definitely take my hat off to you and everybody at Vanderbilt for giving me that experience, because I wouldn't have had it without you. So thank you very much. Thank you and thanks for the work you do in conflict.
That's really important. So, I loved the invitation. It's a great conversation and I appreciate your, talk with me. Hey, thanks for being here, for all of our peaceful warriors, thank you for joining us today on the [00:40:00] Scalpel and Sword. Please join the conversation and until next time, be at Peace.