NewYork-Presbyterian CXO Rick Evans: We need to have our teams' backs when they face racist, discriminatory patient behavior

The pandemic has shined a light on some of  the weaknesses that were present in the healthcare system before the arrival of COVID-19. Across the nation, this has included an escalation of incidences of verbal and physical violence in healthcare settings. Behaviors that were becoming more common before the pandemic have now intensified as tempers and patience have grown short and divisions within our nation have persisted. 

This is manifesting in increased incidences of patients and families acting in a racist or discriminatory manner toward our employees on our hospital units and in clinic exam rooms. The scenarios play out in many ways: outright racist remarks toward our team members, demands for certain staff to be reassigned for inappropriate and discriminatory reasons, or offhanded aggressive remarks that single out team members for who they are as people. Norms that previously governed our behavior seem to have eroded. The result is psychological and sometimes even physical harm to our workforce.

How do we address this effectively? Our mission and the regulations that govern healthcare require that we treat all who need care. This includes people who are racist, bigoted, misogynistic and homophobic, among others. We cannot, in most cases, simply discharge these patients to the streets when they violate basic norms of respectful behavior. We need to find a way to be true to our mission and have our employees’ backs at the same time. At NewYork-Presbyterian, we are trying a constellation of interventions meant to help us bring the whole team to bear when confronted with this disruptive behavior. 

A core part of our approach is our Respect Credo, which outlines expected behaviors that we will observe with each other as colleagues and in relationships with patients and families. The Credo is meant to strengthen the norms we have all learned are so precious and fragile in our society. We communicate aspects of the Credo in signage in public spaces, in materials presented to patients and other ways.  We expect everyone to observe these important rules. 

Communicating norms and expectations is a start, but not enough. Like many organizations, we have also trained our staff in conflict management and resolution. We've brought our security, human resources and behavioral health experts to the table to help us develop both the strategies and the training. The goal is to supplement our Credo norms by promoting an environment where issues are identified early and de-escalated wherever possible.

While these actions are helpful, they still do not address some of the impacts to our colleagues when they are treated in racist or discriminatory ways. Our teams need support in real time when de-escalation is not possible or appropriate. To attempt to address this, we have developed a policy and protocol that allows for quicker escalation and brings immediate support from the team to the staff member experiencing this behavior.

When a staff member is confronted by racist behavior or remarks and needs assistance, our protocol encourages immediate escalation to a supervisor for back-up and assistance. Further escalation to higher leadership is also outlined if needed. The affected staff member immediately knows they are not alone. They do not have to endure the behavior in silence. They know they are surrounded by the support of the team as a person and as a professional. 

Options for addressing the situation in real time are also outlined, including strategies such as boundary resetting with the patient and/or their family members, possible reassignment of staff if agreed upon and other strategies to mitigate the effects of the discriminatory behavior. After an event, the protocol also calls for debriefing with the staff member and the team to address injury and distress.

This new protocol is a work in progress. We are monitoring how it is working and anticipate that it will need to evolve as our experience evolves and as we gather feedback from our colleagues who have used it in practice. Having said that, it has been warmly received by our staff. I believe that is because we are doing several important things by promulgating this new policy and protocol. First, we are acknowledging a problem in a very public and deliberate way that is taking a toll on our teams. Second, we are putting forth effort to show that we will be as creative as possible in addressing this complicated issue. Finally, we are letting our teams know that they are not alone, that they do not have to suffer these assaults in isolation and that the team is ready to stand behind them. Confronting racism and discrimination must be done in clear terms and with clear actions.  

This work is part of our journey to become ever more inclusive and to promote diversity and belonging within our walls. Given the national nature of this problem, it’s a journey every healthcare system should be on.   

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