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Respect: The foundation for quality care

June 10th, 2013

by Gary S. Kaplan

At Virginia Mason Medical Center, we understand respect must be shown every day, at all levels of our organization, for us to provide the best care and a perfect patient experience. If our physicians, nurses and other team members don't feel valued and respected, this will affect their ability to put the patient first in everything we do.

Lucian L. Leape, M.D., a founder of the National Patient Safety Foundation, has observed that disrespect among hospital employees 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."

We launched Virginia Mason's Respect for People initiative in 2012, recognizing it is applicable to our strategic priorities (people, quality, service and innovation). Because respect for people is essential to our success as a health system, we also have established it as an organizational goal.


To kick things off, we asked our 5,500 team members to help us better understand what respect looks like. We assembled an advisory group with representatives across our organization that defined the top 10 foundational behaviors of respect.

We developed a training program to ensure everyone has a shared understanding of why respect is so important and how it can be consistently demonstrated in the workplace. The training included a theatrical production in which we engaged actors to stage scenes that represent real-life respectful and disrespectful behaviors. Within a few months, all our team members, including leaders and providers, had gone through mandatory training and learned about the respectful behaviors we strive to practice at Virginia Mason.

They include:

1. Listen to understand. Good listening means giving the speaker your full attention. Non-verbal 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 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 understand their contributions have value. Encourage your co-workers 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 genuine "thank you" often makes a person's day and shows you notice and appreciate their work.

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.

7. Speak up. It is our responsibility to ensure a safe environment in the hospital; not only physical safety but also mental and emotional safety. Create an environment where everyone feels comfortable to speak up when they see something unsafe or feel unsafe.

8. Walk in their shoes. Empathize with others; understand their point of view and their contributions. 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 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 your teammates have good intentions. Anticipate other team members' needs. Clearly communicate priorities and expectations to be sure the work load is level.

The feedback from this training has been positive and our team members across the organization are very engaged in eliminating the subtle disrespect so prevalent in healthcare today. While we still have much to accomplish, we are making great progress and our staff and patients are the ultimate beneficiaries.

Gary S. Kaplan, M.D., FACP, FACMPE, FACPE, is chairman and CEO of Virginia Mason Health System in Seattle. He also is a practicing internal medicine physician at Virginia Mason and current board chair of the Institute for Healthcare Improvement.


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