By Dr. Stuart Hanson… Much has been written about work unit efficiency, effectiveness and productivity. But what underlies these outcomes is the health of our workers and the health and safety of their work environment. In the 1980’s the Twin Cities Medical Society in Minnesota began studying abusive behaviors as they applied to medical practice. We found beaten children, broken jaws, bruised bodies and traumatized patients occupying our emergency departments, hospital beds and private offices. We found the common response by the medical community was to treat the acute injury and too often return the patient to their original surroundings. If the abuse was flagrant, law enforcement was notified. Mental health professionals might be asked to get involved, but frequently law enforcement and mental health were absent in the patient’s treatment. The reluctance on the part of the victims and their initial medical professionals to intervene further was common.Looking into the resistance thirty years ago, we found several factors promoting inattention and inaction. First and foremost was the lack of awareness by health professionals of what represented abusive behavior. Yelling, screaming, hard spanking or using fear, intimidation and harassment were often considered family matters best left alone in a medical encounter. We would be opening Pandora’s Box was a common response. Second, was the resistance to get involved in emotional and psychological issues where their training and professional competence was incomplete or completely lacking. Physicians told us these were societal issues and not medical issues. We had a responsibility to fix the physical injuries, but the underlying issues of interpersonal violence and abuse were generally beyond medical intervention and it was best not to get involved. These attitudes may sound archaic today, but they are still prevalent.We assessed the attitudes of medical professionals and where we might go in addressing our patients’ problems. Surveys of physicians revealed they were seeing many patients who were in abusive relationships and were frustrated they were limited in what they could do to help them. We also found the medical workplace was more abusive than was overtly understood. Many healthcare workers were experiencing abusive behaviors by their superiors in an ongoing basis without a means to address their situation. Some were classic medical industry stories of physicians yelling or throwing instruments when they were upset. Other behaviors like creating fear, intimidation or harassment were more subtle, but often just as abusive. Respondents reported feeling demeaned, put down and discouraged by their leaders in the medical workplace.Healthcare workers reported they took more sick time because their work environment was not pleasant. They were less committed to their jobs because sometimes it was not pleasant to come to work. Some reported more subjective illnesses like headache, stomach and back pain that kept them from coming to work. Most all respondents thought medical illnesses, absenteeism, employee retention and work productivity were adversely affected. This was our medical workplace in the early 1990’s.As the saying goes, “If you want things to change, be the change”. Mahatmas Gandhi probably was not the first person to think this way. It fit the situation we found in the Minnesota medical work place at the time. How could we expect improvement in our ability to care for patients who were experiencing abuse, if we did not recognized the symptoms in the patients we saw, and if we did, we’re not prepared to intervene effectively? The problem became clear. The medical workplace had abusive behaviors that affected its ability to respond to patient needs. In order to be effective, efficient and productive, health professional and their support staff needed to work well together as a team. They needed to treat each other with respect and support. A healthy workplace was necessary and essential. The best chance of improving our treatment of abuse victims, was to clean up our own act first!Has much changed in the last thirty years? Is the medical workplace a safe, nurturing, ideal culture that provides the best care possible in a safe environment? While there are some individual leaders and organizations, and much has been learned, most organizations can and should do better. The work of the Behavior at Work Collaborative is to raise the issues and to assist individuals and organizations in improving interpersonal behaviors of their staff and the resultant organizational culture. We think this is an important subject for all workplaces to address. With decades of experiences and developed best practices, it is time for all healthcare organizations to invest in improving their workplace cultures.