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Management Consulting in Healthcare as an Innovative Means of Addressing an Organizational Cultural Crisis
Abstract
An increasing number of reports of sexual harassment in the workplace and medical education is challenging the current state of medical education and healthcare. The trauma and long-term consequences of sexual harassment are well documented, yet the issue of sexual harassment has been overlooked mainly in healthcare, leading to a culture of silence and a lack of meaningful and practical solutions. These dynamics represent a significant crisis. This chapter examines the prevalence of sexual harassment in the healthcare and medical education workplace and explores the need for innovative solutions and prevention strategies. The chapter concludes by discussing potential innovative solutions and prevention strategies developed by a management consulting group at Sunshine Health Regional Hospital and Medical Education Training Center, which has experienced a sexual harassment crisis. The intent is to find innovative solutions to influence the world of practice.
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Background
Sexual harassment (SH) includes unwelcome sexual advances, requests for sexual favors, or hostile conduct that targets someone based on gender, and overlaps with some types of sexual assault (SA). SH/SA in healthcare can occur between providers, or between patient and provider; most studies about SH in medicine focus on SH perpetrated by one healthcare provider to another, with very few studies examining SH experienced from patient to provider.
Objective
To describe the prevalence and impact of SH/SA from patient to provider, with a particular focus on SH/SA experienced by dermatologists and trainees.
Methods
Anonymous electronic survey sent to professional listservs and an online forum, which included representatives from multiple institutions, practice settings and medical specialties. Trainees and dermatologists were particularly targeted.
Results
Three hundred and thirty complete responses were included. In all, 83% of respondents reported experiencing SH from a patient. SH from a patient was more frequently reported by women compared to men (94% vs 52%; p=0.001). Behaviors consistent with SA were experienced by 31% of respondents and were more frequently experienced by women (35% vs 15%; p=0.001). Women were more likely to report that patient to provider SH contributed to burnout (33% of women vs 9% of men, p=0.002). Women trainees were significantly more likely to have experienced SH compared to women attendings within the past year (86% (94/110) vs 65% (83/127); p=0.001). There was no significant difference in the proportion of women reporting ever experiencing SH when comparing dermatology and non-dermatology specialties.
Limitations
Relatively small sample size, over-sampling of trainees, gender-biased sample.
Conclusions
Patient to provider SH/SA is widespread, particularly among women and trainees, and may have a significant impact on burnout.
Two decades ago, the Supreme Court vetted the workplace harassment programs popular at the time: sexual harassment grievance procedures and training. However, harassment at work remains common. Do these programs reduce harassment? Program effects have been difficult to measure, but, because women frequently quit their jobs after being harassed, programs that reduce harassment should help firms retain current and aspiring women managers. Thus, effective programs should be followed by increases in women managers. We analyze data from 805 companies over 32 y to explore how new sexual harassment programs affect the representation of white, black, Hispanic, and Asian-American women in management. We find support for several propositions. First, sexual harassment grievance procedures, shown in surveys to incite retaliation without satisfying complainants, are followed by decreases in women managers. Second, training for managers, which encourages managers to look for signs of trouble and intervene, is followed by increases in women managers. Third, employee training, which proscribes specific behaviors and signals that male trainees are potential perpetrators, is followed by decreases in women managers. Two propositions specify how management composition moderates program effects. One, because women are more likely to believe harassment complaints and less likely to respond negatively to training, in firms with more women managers, programs work better. Two, in firms with more women managers, harassment programs may activate group threat and backlash against some groups of women. Positive and negative program effects are found in different sorts of workplaces.
Peter B. Vaill is both pioneer and thought leader in the fields of organizational behavior (OB) and organization development (OD). Over the past 60 years, Peter’s ideas have influenced and informed numerous strands of thinking in the fields of management, leadership, and change. The common thread among these streams of thought: the relationship between organizational practice, theory, and learning. This chapter offers readers a glimpse into the career and work of Peter Vaill. Through several interviews with Peter, others who worked with him, and close readings of his writing, in this chapter we explore the themes and thinking that shaped Vaill’s contributions to the field of change.
The popularity of New Year's resolutions suggests that people are more likely to tackle their goals immediately following salient temporal landmarks. If true, this little-researched phenomenon has the potential to help people overcome important willpower problems that often limit goal attainment. Across three archival field studies, we provide evidence of a “fresh start effect.” We show that Google searches for the term “diet” (Study 1), gym visits (Study 2), and commitments to pursue goals (Study 3) all increase following temporal landmarks (e.g., the outset of a new week, month, year, or semester; a birthday; a holiday). We propose that these landmarks demarcate the passage of time, creating many new mental accounting periods each year, which relegate past imperfections to a previous period, induce people to take a big-picture view of their lives, and thus motivate aspirational behaviors.
Data, as supplemental material, are available at http://dx.doi.org/10.1287/mnsc.2014.1901 .
This paper was accepted by Yuval Rottenstreich, judgment and decision making.
Sexual harassment within the doctor-patient relationship is typically discussed in terms of male doctors harassing female patients. We investigated the sexual harassment of female doctors by patients.
Surveys were mailed to a random sample of 599 of the 1064 licensed female family physicians in Ontario, Canada. Respondents were asked about their experiences of sexual harassment by either male or female patients and about the nature and frequency of harassing behavior. Suggestions for prevention were requested.
Seventy percent (422) of the questionnaires were completed and returned. More than 75 percent of the respondents reported some sexual harassment by patient at some time during their careers. Physicians had been harassed most often in their own offices and by their own patients. However, in settings such as emergency rooms and clinics, unknown patients presented a proportionately higher risk. The physicians' perceptions of the seriousness of the problem varied with the frequency and severity of the incidents.
Sexual harassment of female doctors appears to occur frequently, and it is therefore an important topic to address in medical school and professional development.
The field of sexual assault prevention is shifting attention to educational interventions that address the role of men in ending violence against women. Recent studies document the often-misperceived norms men hold about other men's endorsement of rape-supportive attitudes and behaviors. The authors provide further evidence supporting the design of population-based social norms interventions to prevent sexual assault. Data from this study suggest that men underestimate the importance that most men and women place on consent and willingness of most men to intervene against sexual violence. In addition, men's personal adherence to only consensual activity and their willingness to act as women's allies are strongly influenced by their perceptions of other men's and women's norms. These findings support the proposition that accurate normative data, which counters the misperception of rape-supportive environments, can be a critical part of comprehensive campus efforts to catalyze and support men's development as women's social justice allies in preventing sexual violence against women.
Background:
Patient-perpetrated sexual harassment toward staff and patients is prevalent in Veterans Affairs and other healthcare settings. However, many healthcare facilities do not have adequate systems for reporting patient-perpetrated harassment, and there is limited evidence to guide administrators in developing them.
Objective:
To identify expert recommendations for designing effective systems for reporting patient-perpetrated sexual harassment of staff and patients in Veterans Affairs and other healthcare settings.
Design:
We conducted qualitative interviews with subject matter experts in sexual harassment prevention and intervention during 2019.
Participants:
We used snowball sampling to recruit subject matter experts. Participants included researchers, clinicians, and administrators from Veterans Affairs/other healthcare, academic, military, and non-profit settings (n = 33).
Approach:
We interviewed participants via telephone using a semi-structured guide and analyzed interview data using a constant comparative approach.
Key results:
Expert recommendations for designing reporting systems to address patient-perpetrated sexual harassment focused on fostering trust, encouraging reporting, and deterring harassment. Recommendations included the following: (1) promote a climate in which harassment is not tolerated; (2) take proportional, corrective actions in response to reports; (3) minimize adverse outcomes for reporting parties; (4) facilitate and simplify reporting processes; and (5) hold the reporting system accountable. Specific strategies related to each recommendation were also identified.
Conclusions:
This qualitative study generated initial recommendations to guide healthcare administrators and policy makers in assessing, developing, and improving systems for reporting patient-perpetrated sexual harassment toward staff and other patients. Results indicate that proactive, careful design and ongoing evaluation are essential for ensuring that reporting systems have their intended effects and mitigating the risks of inadequate systems. Additional research is needed to evaluate strategies that effectively address patient-perpetrated harassment while balancing patients' clinical needs.
Context:
Although sexual harassment frequently occurs in medical education and medical workplaces, doctors who have been sexually harassed or assaulted by other doctors remain a largely invisible population. This study aimed to identify, using personal accounts, the impact on doctors of sexual harassment and assault by doctors in the workplace.
Methods:
This narrative study used in-depth interviews, legal reports and victim impact statements, tracing trajectories from the event's pre-history to its aftermath and impact on professional practice. Participants were six Australian women doctors who had been subjected to one or more non-consensual sexual acts through coercion or intimidation by another doctor in their working environments, within hospital training programmes.
Results:
All women identified long-term personal and professional impacts of their experience. Three women had never reported the abuse. The meaning and impact of sexual abuse for the doctors followed a trajectory with discrete phases: prelude, assault, limbo, exposure and aftermath. Discounting the event and its impacts, and returning to the workplace were characterised as 'being professional'. Those who sought legal restitution said it damaged their personal well-being and their standing among fellow doctors.
Discussion:
Understanding the phases of experience of abuse enables the development of effective interventions for different phases. Interventions to minimise the risk of occurrence of sexual abuse must be distinguished from interventions to increase reporting rates, and interventions to mitigate harm and impact on victims' futures. Idealised notions of professionalism can act as obstacles to doctors responding to sexual abuse.
Although Title IX, the federal law prohibiting sexual harassment in educational institutions, was enacted in 1972, sexual harassment continues to be distressingly common in medical training. In addition, many women who experience sexual harassment do not report their experiences to authorities within the medical school.
In this article, the authors review the literature on the prevalence of sexual harassment in medical schools since Title IX was enacted and on the cultural and legal changes that have occurred during that period that have affected behaviors. These changes include decreased tolerance for harassing behavior; increased legal responsibility assigned to institutions; and a significant increase in the number of female medical students, residents, and faculty. The authors then discuss persisting barriers to reporting sexual harassment, including fears of reprisals and retaliation, especially covert retaliation. They define covert retaliation as vindictive comments made by a person accused of sexual harassment about his or her accuser in a confidential setting, such as a grant review, award selection, or search committee.
The authors conclude by highlighting institutional and organizational approaches to decreasing sexual harassment and overt retaliation, and they propose other approaches to decreasing covert retaliation. These initiatives include encouraging senior faculty members to intervene and file bystander complaints when they witness inappropriate comments or behaviors as well as group reporting when multiple women are harassed by the same person.
This survey study of recent National Institutes of Health career development (K) award recipients assessed the proportion who reported gender bias and advantage and sexual harrassment in their professional careers.Recent high-profile cases of sexual harassment illustrate that such experiences still occur in academic medicine.1 Less is known about how many women have directly experienced such behavior. Most studies have focused on trainees, single specialties, and non-US settings or lack currency.2 In a 1995 cross-sectional survey,3 52% of US academic medical faculty women reported harassment in their careers compared with 5% of men. These women had begun their careers when women constituted a minority of the medical school class; less is known about the prevalence of such experiences among more recent faculty cohorts.
This article has no abstract
Sexual harassment in medical education has been studied in the Americas, Europe and Asia; however, little is known about sexual harassment in Middle Eastern cultures. Our initial aim was to describe the sexual harassment of female doctors-in-training by male patients and their relatives in Turkey. During our analysis of data, we expanded our objectives to include the formulation of a framework that can provide a theoretical background to enhance medical educators' understanding of sexual harassment across cultures.
Questionnaires were provided to female resident doctors. Respondents were asked about their experiences of sexual harassment, about their reactions and about any precautionary measures they had used. Descriptive statistics were generated using SPSS software. Qualitative data were analysed using content analysis.
Forty-nine (51.0%) of 96 distributed questionnaires were completed. Thirty-three (67.3%) participants stated that they had been sexually harassed by a patient or patient's relative at some point in their career. 'Gazing at the doctor in a lewd manner', selected by 25 (51.0%) participants, was the most common form of harassment. The methods of coping selected by the highest numbers of respondents involved seeking the discharge of the patient (24.2%), avoiding contact with the patient or relatives (24.2%) and showing rejection (21.2%). Participants' comments about the prevention of sexual harassment revealed a deep sense of need for protection. The interface between quantitative and qualitative findings and a review of the literature supported the development of a value-based, cross-cultural conceptual framework linking the valuing of hierarchy and conservatism with the occurrence of sexual harassment.
We relate our findings to issues of patriarchy, power and socio-cultural influences that impact both the perpetrator and the target of sexual harassment. Medical educators are responsible for the control and prevention of sexual harassment of students. The globalisation of medical education requires that medical educators use a multi-cultural approach which considers socio-cultural influences and the diversity of female and male students' actions and perceptions of sexual harassment.
Actionable sexual harassment is defined as a violation of Title VII of the Civil Rights Act of 1964. In recent years, there have been a number of significant developments in sexual harassment case law and litigation including: (1) nationwide legal recognition for same-sex sexual harassment; (2) increased standards on employer liability for sexual harassment perpetrated by supervisory and managerial personnel; and (3) guidelines for mitigating damages when employers are found liable. These developments are of particular concern in those professions such as healthcare in which women historically have been represented as a significant portion of the workforce. Moreover, because management and supervisory relationships in healthcare are often cloudy, harassment by "supervisors" in healthcare settings can be an issue of special concern. In this article, we review relevant issues related to sexual harassment and provide guidance in dealing with the issue in the workplace.
Prevalence of sexual harassment in medical education: A systematic review.
- Ansaria
- A.Ansari
Ansari, A. (2020). Prevalence of sexual harassment in medical education: A systematic review. Journal
of Medical Education and Curricular Development, 7(1), 1-7.
Prevalence of sexual harassment among medical students in Vietnam: A cross-sectional survey.
- T. H.Nguyen
3 significant ethical issues medical school does not prepare you for
- T Albert-Henry
Albert-Henry, T. (2018, August 2). 3 significant ethical issues medical school does not prepare you
for. American Medical Association. AMA. https://www.ama-assn.org/education/accelerating-changemedical-education/3-big-ethical-issues-medical-school-doesn-t-prepare
Organization change: Theory & practice.
- W Burkew
- W. W.Burke
Burke, W. W. (2018). Organization change: Theory & practice. Sage (Atlanta, Ga.).
Sexual harassment in medical education and healthcare workplaces.
- Collinsk
- K.Collins
Collins, K. (2020). Sexual harassment in medical education and healthcare workplaces. Nursing Forum,
55(4), 573-580.
Sexual harassment in healthcare: Prevalence, prevention, and response.
- Gardinerp
- P.Gardiner
Gardiner, P. (2016). Sexual harassment in healthcare: Prevalence, prevention, and response. Nursing
Standard, 30(31), 8-13.
Creating a culture that puts an end to sexual harassment in healthcare
- M Headley
Headley, M. (2020). Creating a culture that puts an end to sexual harassment in healthcare. Medical
Environment Update, 30(3), 6-8. http://libproxy.lib.unc.edu/login?url=https://www.proquest.com/tradejournals/creating-culture-that-puts-end-sexual-harassment/docview/2355327831/se-2
New data show that the majority of U.S. medical students are women
- K Nadeau
Nadeau, K. (2021, February). New data show that the majority of U.S. medical students are women.
MLO. https://www.mlo-online.com/21206907.
National Guidelines for Behavioral Health Crisis Care
- Samhsa
SAMHSA. (2020). National Guidelines for Behavioral Health Crisis Care. SAMHSA. https://www.
samhsa.gov/sites/default/files/national-guidelines-for-behavioral-health-crisis-care-02242020.pdf
Lots of men are gender-equality allies in private
- D G Smith
- W B Johnson
Smith, D.G., Johnson W.B. (2017). Lots of men are gender-equality allies in private. Why not in public?
Harward Business Review.
Three ways to create a work culture that brings out the best in employees
- C White
White, C. (2019). Three ways to create a work culture that brings out the best in employees. T.E.D.
Talk. https://www.ted.com/talks/chris_white_3_ways_to_create_a_work_culture_that_brings_out_the_
best_in_employees
Sexual harassment in medicine: An analysis of surveys
American Medical Association. (2018). Sexual harassment in medicine: An analysis of surveys, A.M.A.
policies, and best practices. AMA. https://www.ama-assn.org/system/files/2019-03/sexual-harassmentmedicine.pdf
Bystander training: The best defense against sexual harassment. The Energy Law Blog
- K James
James, K. (2021, April 8). Bystander training: The best defense against sexual harassment. The Energy
Law Blog. https://www.theenergylawblog.com/2021/04/articles/business/employment-law/bystandertraining-the-best-defense-against-sexual-harassment/ doi:10.7326/M18-2047
Prevalence of sexual harassment among medical students in Vietnam: A cross-sectional survey
- T H Nguyen
- T T T Bui
- A T T Nguyen
- T H Pham
- T H Ngo
- T T Bui
- N X Hong
Nguyen, T. H., Bui, T. T. T., Nguyen, A. T. T., Pham, T. H., Ngo, T. H., Bui, T. T., & Hong, N. X. (2019).
Prevalence of sexual harassment among medical students in Vietnam: A cross-sectional survey. BMC
Medical Education, 19(1), 1-9. PMID:30606170