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Grand Rounds Speakers Emphasize Improving Workplace Culture

June 05, 2019
by Riley Davis

“Envision what a world without gender biases and with equal pay would look like,” Esther Choo, MD ’01, MPH, urged emergency medicine students, faculty, and residents during her May 22 grand rounds lecture titled “Safe, Fair, and Dignified: Envisioning the Healthcare Workplace of the Future.”

“What would your workplace look like if I weren’t even here because this is a moot issue?” Choo continued, “If you have this equitable environment where people walk in and the presumption is that they will be treated in a respectful and dignified manner?”

Workplace culture was a prevalent theme during grand rounds lectures in May. Choo addressed the subject in talks on May 22 and 23, co-sponsored by the Department of Emergency Medicine, the Committee on the Status for Women in Medicine (SWIM), and Women’s Health Research at Yale (WHRY), and presented by the Department of Radiology and Biomedical Imaging as its annual Boroff-Forman lecture.

On May 24, Jo Shapiro, MD, associate professor of otolaryngology at Harvard Medical School and director of the Center for Professionalism and Peer Support at Brigham and Women’s Hospital, delivered a grand rounds lecture on professionalism, titled “Respect and Trust: Key Drivers of Safety Culture” to faculty, residents, advanced practice professionals, nurses, and staff across the surgical services, including the departments of Surgery, Anesthesiology, Orthopaedics, Urology, Neurosurgery and Ophthalmology.

Choo, an associate professor of emergency medicine at Oregon Health & Science University, is a founding member of the health care chapter of TIME’S UP—an organization founded in 2018 in the wake of the #MeToo movement—which is dedicated to combating sexual assault, harassment and inequality in the workplace.

Choo spoke about the impacts of sexual harassment in the health care profession and highlighted both social and financial motivations to make health care a gender-equitable field.

“Sexual harassment undermines women’s professional and educational attainment,” Choo said. “It has profound negative effects on mental and physical health, and it leads to attrition from leadership roles from institutions.”

Improving gender equity in medicine won’t just improve the overall health and happiness of employees, Choo added. It may also improve the financial performance of an institution.  She cited data from a McKinsey study, which found that companies ranked in the top third for gender diversity are 15 percent more likely to have increased financial returns.

“So how do we get there?” Choo asked. “Part of culture change is everyone accepting responsibility.” She pointed to several work environments that warrant particular attention: those that are male-dominated or male-led, and also those that are otherwise prone to perpetuating cultures that tolerate sexual harassment.

Organizers of the grand rounds say both Choo and Shapiro have catalyzed change for the better in the medical profession.

“Dr. Choo was invited to further illuminate the disparities and challenges that women and other marginalized groups in health care face compared with men, so that we can continue to address them, and hopefully see a future where all physicians are fully engaged in our workforce, are treated equally and fairly, and are valued appropriately,” says Howard P. Forman, MD, MBA, professor of diagnostic radiology and director of Yale’s MD-MBA Program, who introduced Choo on May 23. Forman says Choo was an appropriate speaker for the Boroff-Forman lecture series, which he co-founded seven years ago with a goal “to invite speakers who bring unique vantage points in the realm of health policy, but do not otherwise fit neatly into a clinical specialty area.”

Nita Ahuja, MD, MBA, chair and William H. Carmalt Professor of Surgery, who invited Shapiro to deliver the inaugural, combined grand rounds lecture on professionalism, says psychological safety is particularly important in high-stress surgical departments. “In an environment often fraught with tension, building a culture of professionalism is especially important to ensure respect and safety for our patients, students, nurses, faculty, residents, and colleagues,” Ahuja says.

In her lecture, Shapiro stressed the importance of workplace cultures in health care, and the essential role professionalism plays. “Culture drives outcomes,” Shapiro said. “We are very behind most other professions in holding ourselves and each other accountable for high levels of professionalism.”

In the past, Shapiro added, physicians were trained with the mindset that it may be acceptable to teach by humiliation, or to have outbursts in the operating room. But that fosters a sense of hierarchy that diminishes performance.

“Hierarchy doesn’t need to go away,” Shapiro said. “But the hierarchy of responsibility has to change so that everyone feels like they can speak up if they see something wrong or are worried about something.”

She said that data support the idea that teamwork leads to better outcomes, including evidence that better teamwork among health care professionals correlates with improved risk-adjusted rates of illness among patients.  

Both lecturers urged the residents in the audience to be champions of the changes they wish to see implemented in health care, while also acknowledging that perceptions of women and ingrained cultures in the workplace are likely to prevent those changes from coming soon.

“You need to create a way for people to come forward with concerns,” Shapiro told her audience on forming workflows that encourage professionalism.

Of gender equity in health care, Choo said, “It won’t happen in my professional cycle, but it may start to happen in yours.”

Submitted by Robert Forman on June 05, 2019