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Presentation at a Rehab Hospital Virtual Grand Round held at King Fahad Medical City, Riyadh on 1st October 2020 by Professor Omar Hasan Kasule Sr. MB ChB (MUK). MPH (Harvard), DrPH (Harvard), Chairman of the Ethics Committee King Fahad Medical City
BASICS
• Code of Conduct: A statement and description of required behaviors, responsibilities, and actions expected of employees of an organization or of members of a professional body.
• Code of Ethics: written guidelines issued by an organization to its workers and management, to help them conduct their actions in accordance with primary values and ethical standards.
• Misconduct: inappropriate or offensive conduct; unwelcomed, unsolicited disrespect of an individual/group and/or property.
• Conflict of Interest: a financial interest or another opportunity for tangible personal benefits of an individual or his/her immediate family that may exert a substantial and improper influence on the individual's professional judgment in exercising any institutional duty or responsibility.
• Malpractice: failure to fulfill the duties of the trust put on the healthcare provider to the patient which results in damage or injury.
MAJOR ISSUES
• Accountability
• Bear the trust ( haml al amanat ) = responsibility
• Truthfulness and honesty
• Show off
• Conflicts of interest
MISCONDUCT
• Disgraceful, distasteful, dishonorable, or infamous conduct.
• Sexual misconduct such as fornication and adultery or homosexuality
• Sexual harassment of patients and / or colleagues
• Abuse of power for personal gain or others
• Drug and alcohol use
• Indecent exposure
• Violence
• Racial discrimination
• Nepotism
• Abusive language
• Misuse of communication tools (fax, phone, or copier) for personal use
PUNISHMENTS FOR MISCONDUCT
• Issuance of a letter of admonition
• Issuance of a letter of reprimand
• Salary deduction based on approved KFMC regulations
• Impose terms of probation
• Imposed requirement for consultation, retraining, additional training or continuing education
• Suspension or revocation of clinical privileges
• Imposed suspension or revocation of medical staff appointment
PRINCIPLES OF A HEALTH CARE TEAM
• A team is several interdependent and interacting persons.
• Team performance is superior to individual performance. In health care, no team = no work
• Group membership has benefits of integration, stimulation, motivation, innovation, emotional support, and endurance.
• Group membership has the disadvantages of arrogance, suppression of individual initiative, member mismatch, and intra-group conflict.
STAGES OF TEAM FORMATION
• Initial meeting, التقاء
• Choosingانتقاء (not possible in a health care team)
• Rising above ارتفاء
DESTRUCTION OF THE TEAM - 1
• Breaking norms, not following agreed procedures
• Secretive behavior, concealment of information, and secret talks
• Failure of communication
• Diseases of the heart
• Envy/jealousy (hasad)
• Hypocrisy (nifaq)
• Rumors (namiimah)
DESTRUCTION OF THE TEAM - 2
• Back-biting (gaybah),
• Lying (kadhb),
• Show off (riyah),
• Pride (kibriyah),
• Love of leadership (hubb al riyasa),
• Spying (tajassus),
• Negative thoughts (dhan al soo).
ETIQUETTE OF TEACHERS (SENIORS) IN THE HEALTH CARE TEAM
• The hospital health care team is complex and multi-disciplinary with complementary and inter-dependent roles.
• Members have dual functions of teaching and delivering health care.
• Most teaching is passive learning of attitudes, skills, and facts by observation.
• Teachers must be humble.
• Teachers must make the learning process easy and interesting.
• Teacher’s actions, attitudes, and words can be emulated.
• Teachers should have appropriate emotional expression, encourage student questions, repeat to ensure understanding, and not hide knowledge.
ETIQUETTE OF LEARNERS (JUNIORS) IN THE HEALTH CARE TEAM
• Learners should respect teachers for the knowledge they have.
• Learners should listen quietly and respectfully, teach one another, ask questions to clarify, and take notes for understanding and retention.
• Leaners should stay around in the hospital and with their teachers all the time to maximize learning.
POSITIVE TEAM BEHAVIORS
• empathy,
• caring for one another,
• leniency,
• generosity,
• patience,
• modesty,
• a cheerful disposition,
• calling others by their favorite names,
• recognizing the rights of the older members,
• self-control in anger.
FIGURE 1: Behavior Reported Incidents by Category April 1 - June 30, 2020
FIGURE 2: Subcategories of Abuse of Power or Position
FIGURE 3: Subcategories of Communication and Interpersonal Skills
FIGURE 4: Subcategories of Professionalism
INCIDENTS - 1
• …. as I relay the message to Mr. Abdul thru the phone, he started calling me stupid several times, I got agitated and drop the call.
• …. she replied with the non-professional way she was very aggressive with me telling me offensive things like you know nothing about your patient …. she was continuously talking attacking me with non -professional way I told her nicely thank you I received your message…
INCIDENTS - 2
• The patient is currently in ICU. He reported to me that while onward ….. he was short of breath and called the nurses multiple times. The nurse shouted at him and asked him to “shut up” and was very rude. He is literally scared to go back to the ward and get abused.
• …. used head covers as the shoe covers when I was telling him not to use head covers as shoe covers, he started screaming at me. I did not argue with him because my main priority at that time was the patient that was on the table.
INCIDENTS - 3
• …. he started screaming at me again telling me that I am not going to tell him what to do. He was so rude, and everyone was so uncomfortable with his behavior.
• …. the nurse asked me my name and when I asked her back, she cut off the phone while I was speaking.
INCIDENTS - 4
• …. I explained to him that is not allowed to make a copy of our medical report and if needed he can request it from the EMS department. After that, he assaulted me and scratched my skin to take the medical report by force.
• …. replied very rudely and in between the conversation he disconnected the call, later we tried to contact them but there was no reply anymore.