Patient Bill of Rights Revised to Support Staff Facing Discriminatory Behavior

For the past several months, an 18-member task force headed by Tim Lahey, M.D., MMSc (at left), and Steven Grant, M.D., has been working on support for staff managing unsafe patient behavior. From violent outbursts to rapidly escalating situations, the group has been helping make sure clinicians can be compassionate and safe at the same time.

This has led to a new policy and a pilot project of a Behavior Response Team on Baird 3 that in time is hoped to expand to the whole institution.

Along the way, team members realized that the Patient Bill of Rights and Responsibilities needed revision. Stephen Graves of Equity, Diversity and Inclusion, and Ira Bernstein, M.D., chair of obstetrics and gynecology, led the effort to revise the document, with key contributions from Drs. Lahey, Grant and others.

The goals was to more clearly articulate a patient’s responsibilities when seeking care at UVM Medical Center. It also reinforces the expectation that all health professionals are to be treated with dignity and respect.

One goal for the task force, says Lahey, is to support the hospital’s commitment to diversity, equity and inclusion by addressing the consequences of disrespectful reference to a person’s “age, ancestry, culture, physical or intellectual disability, ethnicity, gender, gender identity or expression, language, military status, national origin, race, religion, or sexual orientation.” The statement reads that “disrespectful or threatening behavior will not be tolerated and could lead to termination of non-emergent care and/or separation from the clinical site.”

“We’re more explicit about the expectation that you should be respectful, and what respect is,” says Lahey, a professor of medicine and director of clinical ethics at UVM Medical Center.

The new statement also addresses how the medical center approaches patient requests to be assigned a different team member. If motivated by religious or cultural mores, requests are accommodated whenever possible. Beyond those specific circumstances, the medical center does not reassign staff members. The statement reads: “It is not our practice to reassign clinicians, learners or staff based on patient requests that are motivated by race, ethnicity, sexual orientation, or gender identity of the clinician, learner or staff.”

This work dovetails with the broader effort to support clinicians managing unsafe patient behavior. The task force, comprised of physicians from a wide range of specialties as well as nurses, residents, and staff members from across the medical center, continues to develop new ideas and programming. Plans call for an education program focused on strategies to effectively communicate with an upset patient or family member and deescalate a situation. The goal is to strike a balance between ensuring a safe work environment while equipping employees with skills to engage in a positive way.

“It is our responsibility to provide trauma-informed care,” Lahey says, “and recognize what history a patient may be bringing to an encounter, and what is triggering.”

A team to support employees who have experienced inappropriate behavior from a patient or visitor is also in the pilot phase.

The medical center’s efforts recognize that health care “is at the front lines of the war against racism.” The new Patient Bill of Rights sets a foundation for this work to be done.

“We are hoping to be part of a vanguard,” Lahey says. “We can show how it’s done right.”