The national media has exposed numerous cases of sexual harassment and related issues creating hostile work environments in the news recently. Each day seems to bring a new case to light. Hospitals and healthcare systems are not exempt from these issues.
How is sexual harassment defined?
Sexual harassment is generally defined as uninvited and unwelcome verbal and/or physical behavior of a sexual nature, creating a potentially hostile work environment. Sexual harassment is considered a form of sex discrimination under Title VII of the Civil Rights Act (1964). Occurrences of sexual harassment are predominantly reported in employment situations where there are significant differences in power between classifications of employees and where these differences convey risk to the less powerful when reporting sexual harassment claims.
The U.S. Supreme Court has ruled that there are two types of sexual harassment covered by the Civil Rights Act, which recognizes sexual harassment as an infringement on employee’s civil rights.
Quid pro quo: “Advancement, benefits, or job security are tied to sexual favors. This type includes unwelcome sexual advances, requests for sexual favors, or physical or verbal conduct of a sexual nature that are tied directly or implicitly to employment.”
This type of harassment is relatively straightforward (“Meet me in my motel room, and we will talk about your promotion”). It also applies to retribution/punishment for rejecting a person’s advances (“If you do not go out with me, I am demoting you”).
Hostile work environment: “Inappropriate behavior is so pervasive and severe that it permeates the workplace and interferes with the individual’s ability to carry out the duties of the job.”
This type is more subjective and covers a variety of bad behaviors: unwelcome jokes, graphic images, insults, threats, gestures, touching of a sexual nature. Typically, most quid pro quo cases also include hostile work environments.
Individual organizations will need to define these terms within their own environments and according to their own policies, as well.
Could incidents of sexual harassment affect accreditation status?
Our experience in hospitals across the country is that issues in the news influence surveyors’ sensitivity and alertness to related Conditions of Participation (CoPS) and standards enforcement. The recent headlines referencing potential issues of non-disclosure at a major clinic focused on alleged patient assault/rape will likely increase attention during surveys to practitioner appointment and renewal to the medical staff, and to the peer review process. Also, expect attention to Human Resources issues on hostile work environments, workplace violence, and the impact on communication and patient and staff safety, as illustrated by the recent Sentinel Event Alert on physical and verbal violence.
Who is at risk?
The general emphasis on assuring a positive patient experience and attitudes toward patients as recipients of care frequently masks the potential for harassment directed at staff from patients. Yet healthcare employers have been found liable for harassment from received from patients and have experienced award of significant monetary damages. Though sexual harassment is not yet perceived as a usual part of Accreditation and or Regulatory focus, CMS CoPs do require a safe environment for care extending that definition of safety to staff providing care.
What are some reasons incidents of this type escape detection?
Historically it’s been cultural and communication barriers that are unique to the healthcare system causing under-reporting, or no reporting. The hospital environment can be rife with unequal power relationships, cultural structures and communication barriers that enhance and increase opportunities for sexual harassment. Because of this, hospitals and health systems can anticipate an increased reporting of perceived sexual harassment as media reports further sensitize employees to the issue and prompt more reporting.
We already have policies in place to address these issues. So I am covered, right?
It is often easy for healthcare leaders to feel a false sense of security because of the presence of a sexual harassment policy and dedication of human resources staff that should prevent and mitigate any allegations, but policy is not enough.
The most important part of sexual harassment and hostile work environment policy is to prove that it does not exist on paper only. It has to be part of the culture. You have to live your values and your policy, to ensure that no matter who is accused, there is a thorough, credible, and fair investigation. Moreover, if the complaint is substantiated, the appropriate steps must be taken in response. All members of the organization at all levels should know the policy, live the policy, and uphold the policies in their words and actions.
Where would you start in reviewing an organization’s vulnerability to sexual harassment or workplace violence events?
Five steps to immediately consider:
1. Evaluate your current environment status
• Communication and reporting
• Past and current incidents
• Areas of higher potential risk (periop, ed, laboratory, frontline service staff in dietary, environmental services, etc)
• Training & education
Incorporate a review of various unequal power relationships and impact on potential Sexual Harassment;
• Positional power
• Professional power
• Gender-based power
3. Preparation for proactive stance
• Audit communication plans and implementation procedures
• Have no tolerance of these types of events regardless of position, systems, and procedures for reporting and responding
4. Response and recovery
Post public incident assurance that interventions and future prevention strategies are appropriate and effective.
5. Don’t overreact
Do not overreact and create issues where none currently exist. Focus on prevention and early intervention in an unobtrusive, non-dramatic manner.
How would you start to create a safe, productive, harassment-free environment for patients and staff?
First, look at the big picture. Address concerns of harassment and hostile work environment from multiple angles, including clinical, leadership, and human resources, as well as accreditation and regulatory compliance. There are three critical components to assuring a safe and productive care environment: prevention, detection, and remediation (PDR).
What is the PDR process?
The implementation of a PDR process includes a range of tactics, including but not limited to;
- development of policies and communication plans;
- document reviews;
- interviews with hospital staff, medical staff, and leadership; and
- audits of past and current incidents, including call records and investigations.
The PDR approach also includes focused surveys of areas of higher potential risk, and review of training, education, and – most importantly – culture, including power relationships and how they contribute to potential incidents or patterns of harassment.
Also, leadership and human resources offices must establish confidential and anonymous methods to report policy noncompliance, whether involving self or observed incidents. Through this process member of the organization have to know they can safely share their concerns without fear of retribution or retaliation.
Preventing harassment in the healthcare environment requires a defined institutional policy that is communicated, implemented, and enforced. The Board and the C-suite need to be involved in developing or improving the organization’s harassment policies. Education plans and training should be the protocol at every level of the organization. The rights of patients and staff to a safe, productive care environment should be clearly and frequently communicated as part of the organization’s culture.
Victims or observers of harassment must be able to report within a transparent structure of non-disclosure and without fear of punishment. Detection must be fair and fairly reported. To achieve this goal, healthcare organizations must have in place multiple avenues for reporting noncompliance. Key to detection are timely resources for reporting that ensure confidentiality and anonymity.
Medical staff and leadership must make clear that members of the organization at every level take seriously the need for a safe, harassment-free work environment. Communicating incidents and responses within the organization and the external community are essential. Additionally, public relations and legal departments need to be part of the equation for managing incident and response reporting.
I don’t want to be caught off-guard by sexual harassment or workplace violence events. What do I do?
Be proactive. Stay vigilant, educate, communicate, and follow a PDR assessment process. Healthcare organizations should expect increased scrutiny for allegations by patients and staff of sexual harassment. Many organizations are caught off-guard, as they have not developed policies and procedures to address how to respond to staff’s complaints of sexual harassment or how to treat a patient’s allegation of sexual assault while an inpatient. And, all too often, leaders have received little to no training to provide guidance in helping them to respond in a sensitive manner that promotes a culture of patient safety and staff safety, nor has staff been provided training on ways to limit their potential liability of being accused of sexually harassing a staff member or a patient.