CMSA Today - Issue 7, 2016 - 24


communication, appears in the "other"
category, it is easy to consider how the
concept can transcend the additional
categories as well. Table 1 provides a listing
of medical error categories.
The Joint Commission cited medical
errors as a concerning outcome of bullying
in 2008, validating how intimidating and
disruptive behaviors fuel medical errors
and lead to preventable adverse outcomes
(Joint Commission, 2008, Larson, 2014). With
continual emphasis across practice settings
on patient quality and safety, it is alarming
to accept how disruptive behaviors by
healthcare team members contribute to the
medical error equation. Studies show nearly
30 percent of medical errors contribute to
patient deaths, as high as 250,000 deaths
a year (Brown, 2011; Cha, 2016; Painter,
2013). Most errors are reflective of systemic
problems that include:
* poorly coordinated care
* fragmented insurance networks
* the absence or underuse of safety nets
and other protocols, and
* unwarranted variation in physician
practice patterns that lack accountability
(McMains, 2016)
Yet, again, consider the impact of
communication in each of these instances.
When professionals feel disempowered
in their dialogues with team members and/
or other healthcare professionals due to
bullying behaviors (e.g. insults, harassment,
threats of employment sabotage), there will
be an impact to the quality and safety of
patient care. Outcomes will have potentially
deadly consequences when members of
the healthcare team lose the ability to
effectively communicate with each other.
Consider how often case managers seek
to clarify orders, medication dosages, or
treatment plan objectives. Now reflect
on the potential detriment caused to the
patient and his or her overall care process
when these conversations are unable
to occur.
The impact of bullying on workforce
retention wields an equally heavy hand.
Twenty-one percent of workforce turnover
in healthcare alone is related to incivility
in the workplace (Robert Wood Johnson
Foundation, 2013). More than 20 percent
24

CMSA TODAY

Table 1 Medical Error Categories (adapted from Leape, et al., 1993)
Category of Errors

Diagnostic

Treatment

Types of Errors
* Error or delay in diagnosis
* Failure to employ indicated tests
* Use of outmoded tests or therapy
* Failure to act on results of monitoring or testing
* Error in the performance of an operation, procedure, or test
* Error in administering the treatment
* Error in the dose or method of using a drug
* Avoidable delay in treatment or responding to an abnormal test
* Inappropriate (not indicated) care

Preventive

* Failure to provide prophylactic treatment
* Inadequate monitoring or follow-up of treatment

Other

* Failure of communication
* Equipment failure
* Other system failure

of bullying victims meet the criteria for
post traumatic stress disorder in the
new Diagnostic and Statistical Manual of
Mental Disorders, 5th ed. (DSM-5). Over 80
percent experience debilitating anxiety,
49 percent clinical depression that is
either new for the person or exacerbated
by the bullying event, and 52 percent
experience panic attacks (Workplace
Bullying Institute, 2016).

ACTION ON THE HORIZON
At the time of this writing, there continues
to be no federal law to protect healthcare
professionals from workplace bullying. High
levels of advocacy persist by professional
associations and organizations to manage
workforce issues, with a bevy of guidelines,
standards and policies released in recent years
to address incivility across practice settings
(American Nurses Association, 2015; American

Table 2: The Healthy Workplace Bill FAQs (Data from The Healthy Workplace Bill, 2016)

Issue 7 * 2016 * DIGITAL

For
Employers

For the
Workforce

What the
HWB Does
Not Do

* Precisely defines an "abusive work environment" - it is a high standard
for misconduct.
* Requires proof of health harm by licensed health or mental health professionals
* Protects conscientious employers from vicarious liability risk when
internal correction and prevention mechanisms are in effect
* Gives employers the reason to terminate or sanction offenders
* Requires plaintiffs to use private attorneys
* Plugs the gaps in current state and federal civil rights protections
* Provides an avenue for legal redress for health-harming cruelty at work
* Allows you to sue the bully as an individual
* Holds the employer accountable
* Seeks restoration of lost wages and benefits
* Compels employers to prevent and correct future instances
* Involve state agencies to enforce any provisions of the law
* Incur costs for adopting states
* Require plaintiffs to be members of protected status groups (it is "status-blind")
* Use the term "workplace bullying"



Table of Contents for the Digital Edition of CMSA Today - Issue 7, 2016

PRESIDENT’S LETTER
ASSOCIATION NEWS
CMSA CORPORATE PARTNERS
Are You Culturally Competent?
Return to Culture – Return to Healing
Appalachian Culture: A Guide for Case Managers
Professional Case Management’s Ethical Quartet for 2017: Part 1, Workplace Bullying and End of Life Care
Diversity of Role Reversal: When the Case Manager Becomes the Patient
INDEX OF ADVERTISERS
CMSA Today - Issue 7, 2016 - cover1
CMSA Today - Issue 7, 2016 - cover2
CMSA Today - Issue 7, 2016 - 3
CMSA Today - Issue 7, 2016 - 4
CMSA Today - Issue 7, 2016 - 5
CMSA Today - Issue 7, 2016 - PRESIDENT’S LETTER
CMSA Today - Issue 7, 2016 - 7
CMSA Today - Issue 7, 2016 - 8
CMSA Today - Issue 7, 2016 - 9
CMSA Today - Issue 7, 2016 - ASSOCIATION NEWS
CMSA Today - Issue 7, 2016 - 11
CMSA Today - Issue 7, 2016 - CMSA CORPORATE PARTNERS
CMSA Today - Issue 7, 2016 - 13
CMSA Today - Issue 7, 2016 - Are You Culturally Competent?
CMSA Today - Issue 7, 2016 - 15
CMSA Today - Issue 7, 2016 - Return to Culture – Return to Healing
CMSA Today - Issue 7, 2016 - 17
CMSA Today - Issue 7, 2016 - 18
CMSA Today - Issue 7, 2016 - 19
CMSA Today - Issue 7, 2016 - Appalachian Culture: A Guide for Case Managers
CMSA Today - Issue 7, 2016 - 21
CMSA Today - Issue 7, 2016 - 22
CMSA Today - Issue 7, 2016 - Professional Case Management’s Ethical Quartet for 2017: Part 1, Workplace Bullying and End of Life Care
CMSA Today - Issue 7, 2016 - 24
CMSA Today - Issue 7, 2016 - 25
CMSA Today - Issue 7, 2016 - 26
CMSA Today - Issue 7, 2016 - 27
CMSA Today - Issue 7, 2016 - Diversity of Role Reversal: When the Case Manager Becomes the Patient
CMSA Today - Issue 7, 2016 - 29
CMSA Today - Issue 7, 2016 - 30
CMSA Today - Issue 7, 2016 - 31
CMSA Today - Issue 7, 2016 - 32
CMSA Today - Issue 7, 2016 - 33
CMSA Today - Issue 7, 2016 - INDEX OF ADVERTISERS
CMSA Today - Issue 7, 2016 - cover3
CMSA Today - Issue 7, 2016 - cover4
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http://www.nxtbook.com/naylor/CMSQ/CMSQ0114
http://www.nxtbook.com/naylor/CMSQ/CMSQ1114
http://www.nxtbook.com/naylor/CMSQ/CMSQ0413
http://www.nxtbook.com/naylor/CMSQ/CMSQ1413
http://www.nxtbook.com/naylor/CMSQ/CMSQ0313
http://www.nxtbook.com/naylor/CMSQ/CMSQ1313
http://www.nxtbook.com/naylor/CMSQ/CMSQ0213
http://www.nxtbook.com/naylor/CMSQ/CMSQ1213
http://www.nxtbook.com/naylor/CMSQ/CMSQ0113
http://www.nxtbook.com/naylor/CMSQ/CMSQ1113
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0412
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1412
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0312
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1312
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0212
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1212
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0112
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1112
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0411
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1411
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0311
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1311
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0211
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1211
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0111
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1111
http://www.nxtbookMEDIA.com