Using coworker observations to promote accountability for disrespectful and unsafe behaviors by physicians and advanced practice professionals.

Webb LE, Dmochowski RR, Moore IN, et al. Jt Comm J Qual Patient Saf. 2016;42:149-164.

Disrespectful behavior and lack of speaking up are hallmarks of dysfunctional safety culture, which can be resistant to change. In this pre-post study, investigators implemented a voluntary reporting system to allow health care team members to report "disrespectful or unsafe conduct." Designated trained peers had cup-of-coffee conversations to discuss reports with the associated individuals, and after receiving this feedback most providers did not have a repeat report completed about them. Even when there were two or more complaints about a provider, the vast majority of individuals were able to regulate their behavior following receipt of feedback. The number of reports increased during the intervention, suggesting that team members saw a benefit to reporting disrespectful or unsafe behaviors. This comprehensive, system-wide intervention demonstrates that safety culture can improve over time.