Author: Gary S. Kaplan, MD, and Katerie Chapman

A pharmacist in the Oncology Infusion Center noticed something odd about a chemotherapy order. This was for an established patient, but the drug combination was different than usual. The pharmacist checked for an indicator of a new regimen; there was none. She called the oncology nurse, who quickly notified the charge nurse. The charge nurse contacted the nurse working with the treating oncologist, who walked the order to the treating physician and confirmed that, indeed, the chemotherapy order was incorrect.   

The team member did not hesitate to question the medication order, quickly communicating with colleagues who acted with equal urgency. The genesis of this behavior is a culture of respect – a working environment characterized by teamwork, trust, communication, continuous learning, and a shared focus on patient safety. No organization can simply hope for a culture of respect. Creating one means gathering input – from the front lines to top leadership – and then developing the core attributes of respect and the guiding behavioral expectations. 

In 2011, mandatory service training for all team members at Virginia Mason Medical Center in Seattle yielded groundbreaking feedback: team members wanted to work on improving behavior with each other. A leadership team began surveying team members, asking questions such as: What specific actions show respect? What does respect feel like when you experience it? What makes you feel disrespected at work? Hundreds of responses poured in. An analysis of the responses identified four behavior-centered themes: communication, appreciation, consideration, and teamwork.

An advisory group comprised of team members from across the organization produced 10 Foundational Behaviors that demonstrate respect and build trust: Be a team player; Listen to understand; Share information; Keep your promises; Speak up; Connect with others; Walk in their shoes; Be encouraging; Express gratitude; Grow and develop by committing to personal development and seeking feedback to enhance self-awareness and your abilities.

We added a live theater production with a local improv acting troupe, portraying respectful and disrespectful workplace scenarios, to our Respect for People (RFP) training. More than 5,000 team members – from physicians to board members – completed the training in just four weeks.

As RFP took root in our organization’s cultural rituals – from staff onboarding and CEO messages to team huddles and online education – the leadership team continued to develop its own guideposts through queries such as: How do we encourage others to speak up? How do we show appreciation for everyday work? How do we role model and hold others accountable?

A survey conducted after RFP training revealed that 77% of team members agreed or strongly agreed with the statement: “I feel a greater sense of personal ownership for how I respect, support and appreciate coworkers.” For the 54% who agreed or strongly agreed with the statement, “I have noticed a positive change in my work environment,” the culture shift at Virginia Mason Medical Center was well underway.

Respect, a precursor to trust, is critical to optimizing our work as an effective health care team. Research has illuminated the importance of also treating our patients with respect. We know patients can suffer emotional harm when they don’t feel respected. This, in turn, can negatively affect their health care outcomes. Like many other types of harm in health care, emotional harm is preventable.

Our RFP initiative has a significant strategic benefit and helps us continue to attract and retain the very best people, while also contributing to better patient care. Most importantly, we know it’s simply the right thing to do. Just as we care deeply for our patients, we also care for our team members and strive to treat everyone with the respect they deserve.

Gary S. Kaplan, MD, is co-CEO of Virginia Mason Franciscan Health, a member of the ABIM Foundation’s Trust Practice Network. Katerie Chapman is president of Virginia Mason Medical Center in Seattle.