EP 18: Culture Cure: A Prescription for Healthcare Unity

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Renee Thompson:
Plants thrive and grow in a peaceful, nourished environment, right? Well, it's the same with human beings. But what if that environment is not so peaceful? What if it's toxic? Welcome to Coffee Break: Breaking the Cycle of Bullying in Healthcare – One Cup at a Time. In this podcast, you'll get practical, evidence-based strategies to help you cultivate and sustain a healthy and respectful work culture by tackling an age-old problem in healthcare: bullying and incivility. I am your host, Doctor Renee Thompson.

Renee Thompson:
Hi everyone! Welcome back to another episode of the Coffee Break podcast. As bullying and incivility happen because they can. And it truly takes dedicated leaders like all of you who are listening to do something about it. And it's not just nursing leaders, okay? We cannot solve this problem in a silo. To really eradicate bad behavior in healthcare, we need to fully embrace that interprofessional team approach, and that is your nurses, your physicians, your providers, support staff. I mean, it's everybody on the healthcare team. And today we have an opportunity to chat with Doctor Rishi Garg, who is the chief medical officer at Inova Fairfax Hospital. Welcome to Coffee Break, Rishi.

Dr. Rishi Garg:
Thanks for having me, Renee. I really look forward to the conversation.

Renee Thompson:
Yeah, me too. Me too. I just want to tell you a little bit more about Doctor Garg. He serves as the Chief Medical Officer at Inova Fairfax Hospital. He's been on staff at Inova as an adult hospitalist since 2004, and has been in the CMO role since 2019. His primary responsibilities include patient safety, quality, efficiency, and oversight of clinical care while also serving in a triad model, and I love this, with the chief nursing officer and chief operating officer to oversee hospital operations. It's a team. Prior to his role as CMO, Doctor Garg has served as the medical director of Hospitalist medicine, physician advisor for case management, quality director for the Department of Medicine, and Associate Chief Medical Officer. And I was thinking when I read all of that, do you sleep at all?

Dr. Rishi Garg:
Oh, it's, no, I was just going to say it's been a complicated journey for me, pretty much all at Inova, but yeah, it's been a wild ride since I started here in Oak Board.

Renee Thompson:
I was thinking about that since 2004. That was quite a while ago, and I really would love to learn, first of all, a little bit more about your clinical background and then how you ended up as the chief medical officer of a ginormous organization. I think Inova has over 1000 beds, doesn't it?

Dr. Rishi Garg:
We have 948 licensed beds, but oftentimes, we're flexing well above that. Yeah, my journey pretty much started in '04 at Inova. I was I did an internal medicine residency at Georgetown Hospital in Washington, DC, and as part of our residency, we would rotate at Inova Fairfax on the clinical wards. So I spent some time here doing inpatient medicine as well as intensive care. And so we used to rotate here as part of our residency, second-year and third-year residents, and I remember vividly getting a call from the hospitalist director at the time; when I started back at Inova, there was like just a handful of quote-unquote hospitalist. Hospitalist wasn't really a thing. It was more of a thing out on the West Coast, but became a profession that people went into pretty soon after I started here. So I was one of the original, I would say, 4 to 8 hospitalists who started here, and I started right out of residency in 2004. Started doing clinical work, doing shifts in hospitalist medicine, taking care of patients whose primary care physicians did not come to the hospital or who were, quote-unquote, unassigned, meaning they did not have a physician that had privileges at Fairfax. So they would get admitted by the House doctor, which in that we used to call ourselves the doc of the day, or we were the physician that was on call. So we would admit these patients take care of them throughout their hospitalization, collaborate closely with the outpatient physician, and then discharge them back to the care of the primary care physician. So I did that for a good 3 or 4 years, and then was asked to take over the hospitalist group. When I took over the group, we were about 10 to 14, 10 to 15 physicians, And since then, it's grown tremendously. Now, hospitalist medicine is probably about 60 physicians, 20 APS, They cover almost 450 patients in-house. So it's grown exponentially since I was doing this more on a full time basis. Once I left the directorship, that's when I got involved in case management, did some physician advisor work for case management, did that for a couple three years, and then shifted up to the quality side, did quality work within the Department of Medicine, really oversaw peer review, safety events, professionalism, concerns with providers or otherwise, and then ultimately associate chief medical officer in '17, And then in this role since the beginning.

Renee Thompson:
We have similar paths in a way, because first of all, I did some work at Washington Hospital Center, which is part of MedStar, and it enabled me to actually leave a really great job that I love to start my own company. I went there and did some interim work, but I think about, you did some work with quality. I used to be the quality manager for Aetna US Healthcare, and case management, I did a lot of comprehensive disease case management, and I think especially being a hospitalist, you have to almost be a specialist in every body system. You can't just be a specialist in cardiac care or neurology because you're caring for these patients that, it's not just one diagnosis. And being a hospitalist, I remember when I was working as a staff nurse, we relied on them because there are many situations, even in a teaching hospital, that we weren't able to access the attending physician. And so we relied on the hospitalist, so it's really interesting how you got to this role. And it makes a lot of sense. Like I said, I think we have similar paths in how we got to where we are.

Dr. Rishi Garg:
Hospitalists are often described as the quarterback of the team, right? They're the ones kind of taking in all the information, making sure that all the players are aligned, making sure that they're in the right place, making sure that the consultants are communicating with the family, making sure that the family and patient are hearing the same message, making sure the primary care doctor is in the loop. So it really is the quarterback, kind of the commander, I guess, of the team.

Renee Thompson:
You're right about that. And I can only imagine that sometimes those people that you're throwing the ball to aren't very receptive or aren't very nice to you. And I'm going to use that word nice for a reason for right now. But I can imagine that they're probably, you've probably experienced some communication issues, some conflict, a little bit of incivility, not only from the patients and their family members, but from your colleagues. I can only imagine the challenges being in your role, the challenges you've experienced. Can you talk about that at all?

Dr. Rishi Garg:
Again, when hospitalist medicine started, it was seen a little bit as a way of trying to box the community physicians out. And so the early incivility or early challenges that we had were really with the primary care physicians who wanted to continue to see patients in the hospital. But I think what they recognized and what was in the best interest of the patients. Sure, there is absolutely something lost for that primary care physician-patient relationship that existed for years, lots of times when a patient would then need hospitalization, but the ability to be able to respond to that patient's needs, to be able to consult the right individual, to be able to get the proper test ordered to communicate with nursing, to communicate with case management, to make changes on a dime. Oftentimes, that was very difficult for a primary care physician to do when he or she was trying to manage their outpatient practice and then try to take care of a hospitalized patient on top of that. And so I think the movement towards hospitalist medicine was not an easy one. I think, again, there was a lot of pushback, some challenges, some frustrations, because, like I said, primary care physicians thought they could do it. But I think soon after they realized that they managing the team, like you said, though, can be challenging. You as the quarterback, you're responsible for making sure that everybody is working together. Lots of times, that can be a bit of a challenge. You may run into conflict with somebody that you consulted. You may not agree with the management that they're coming up with. You may not agree with the direction of the care that they're providing. And so having those cordial conversations, making sure that you are communicating that you're transparent, I think that's key, and it didn't come easy.

Renee Thompson:
I could almost imagine that especially early on, primary physicians may have felt a little threatened by your role and not fully embrace your role. However, it's the same or similar behaviors that we see now, even though, yes, I think the hospitalist role is fully integrated into healthcare, we absolutely see the benefits. It is a win. It's a win for the physicians. It's a win for the nursing staff. It's a win for the patients and their families to have somebody there who can intervene and make decisions on the primary physician that attending physicians behalf. But yeah, any time we're starting something new, we're going to meet resistance. And it's because people are uncomfortable with change, because I know what I'm doing now, and that doesn't require a lot of energy for me. But if you're asking me to do something different now, I'm going to have to think about it now. I'm going to have to expend more energy than I want, and it can meet with a lot of resistance for a lot of different reasons. And I use the word nice before, and I said I was going to circle back to that. I want to shift gears and talk a little bit about culture change. And for those of you who are listening, Rishi and I are actually working together and something we're calling our Certified Culture Change initiative, where we're working with all of Inova, the entire health system, and really partnering with the team, the leaders, the providers, the physicians, and the entire team to create an environment of respect and professionalism where bullying and incivility are immediately washed. We don't tolerate that here. And professionalism can become the new norm. And we've been doing this work together. And one of our big challenges always when we're doing this type of work, is getting the physicians and providers engaged in culture change. And I'll never forget, I was out on the West Coast, and we were starting to do this work in a large health organization, and they wanted me to meet with the medical director from the emergency department. And I'll never forget, we're sitting in a conference room, and it's just this medical director and me, and I'm explaining what this culture change initiative is all about. And the whole time he had his, like he was turned to the side. He wouldn't even face me, wouldn't even look at me. And then he said, so you just want us to be nice to each other? Is that what this is all about, being nice? And it took every ounce of professionalism in me not to say, oh my gosh, have you seen the evidence that's out there right now? This is not about being nice. There is evidence. There's research that shows a detrimental impact to the team and to your patients when people treat each other with such disrespect. And we've talked about this a lot, and I've heard this from others, that there are many times where physicians don't see the value in working on what they consider the soft skills, which we consider the essential skills. So I'd love your input on this challenge that we're facing getting physicians involved. So I guess I should start by saying, what made you realize that, no, this is important. We need to get involved. I need to get involved as a Chief Medical Officer.

Dr. Rishi Garg:
Thanks for that question, Renee. And I think the first place I'll start, and not to make an excuse, but we didn't learn this stuff in medical school. You're right. I mean, I think we did. You know, at least when I was in training, we did some simulation. We had some simulated patients. And so you learned a little bit of the soft skills doing that. When I grew up in medicine, this is kind of what you saw is that the physician was kind of at the top of the hierarchy and kind of what he or she she said went. And so you didn't really learn a whole lot of the soft skills, the importance of culture, collaboration, building relationships, being vulnerable with your team. And so that's kind of what a lot of us went through. And we didn't train either in teams. It was you trained all the, you know, student medical students trained on the the medical side and nursing trained over here and RTs and pharmacy trained over there. So wasn't a lot of team-based stuff. So only until I got in the hospital did I realize that it takes a whole team of people to actually care for patients. And so that's when I think some of the softer skills started. I at least started to learn some of those softer skills. And I will tell you, it's taken me time. I'm not the softest of people either, both at work or at home. And you can ask my wife that question. You can ask her later, but I will say it takes time. And the thing that drove me most significantly towards why this is important is because it has a direct impact, like you said, on the patient as well as the rest of the team. There are so many safety events that if you were to do a root cause analysis and keep asking why, the root cause of it was a lack of good communication, clear communication, and where does that lack of clear communication come from? Oftentimes, it's because there is not psychological safety to be able to challenge, to ask a question, to ask why are we doing something. And oftentimes, people just fall in line when they actually had a serious concern. And so that culture that we're trying to build here at Inova, as well as across all of our hospitals and care sites, has a direct impact on patient safety, quality of care we provide, but then also the team. Who wants to come work on a team where you don't feel like your voice matters, where you feel like you're going to be talked down to, where you feel like your opinion is not heard? So I think it's very important not just for obviously for the, for first and foremost, which is patient safety, then also team member being and team member retention. So that's why I'm heavily involved. And I think part that I will say is so vital is this cannot be nursing-driven or safety-championed. This has to start with the physician who is seen as the leader of the team promoting that culture of safety, asking the question when they start rounds or when they enter the operating room. I want you to challenge me today. I want you to tell me everything that could potentially go wrong, and then we'll work together to try to solve it. So I think it has to start with the physician. And are we there yet? No. Are we working towards that? Absolutely.

Renee Thompson:
You've said so many really profound things related to culture change and the fact that when you think about it, that hierarchy and the physician is always seen at the top, and if the physician at the top, and we'll just say it like that is someone who invites criticism, invites someone to speak up if they're not comfortable with a decision that this physician has made, that's when you truly have a team where people, again, are not afraid to speak up. And ultimately, the patients receive better care, and people feel better about the work that they're doing, and they'll stay. I use this example a lot, where it's 2:00 in the morning, and you're concerned about your patient, and you look on the on-call schedule, and you see that the physician on call is one that is notoriously known for screaming and yelling at nurses and making them feel stupid. What do you say? I'm not calling them. They'll rip my head off. And you're saying that and a new nurse is overhearing that? And then in six months, when she's in that same situation, she's going to make the same decision. And so how do we get to that point where, okay, I'm not asking or suggesting that everybody walk around, everything is wonderful today, there's nothing bad out there yet. People are human beings, and sometimes you're just having a bad day. But how do we create that environment where if I'm having a bad day and I get testy with you, or I lash out, especially in a crisis situation, I can come back to you and say, look, I'm really sorry for how I treated you, and you might make excuses. I was having a really bad day for these reasons, but are we okay? And to create that environment where it doesn't matter who you are, the way we treat each other matters just as much as that care that we're providing. And because when you don't have that bad things happen to those patients, because I always say, if that's, people say, that's just my personality, I'm direct, and I'm this is just the way I am. If your personality affects whether or not someone is willing to communicate with you, then you need to adapt your personality. Because when anybody on the healthcare team isn't comfortable communicating with anyone else, it stops the flow of information. And when we stop the flow of information that affects someone's mom, to your point earlier about the root cause can always be pinpointed to a communication issue. All right. What do you do? Because obviously, you get it, and you're still working on it. We're still working on it too. I'm personally still working on how I show up every day. But what do you do if you understand this? But you're working with a group of physicians who don't, they don't see the value, and you can show them study after study, and they still don't get it. How, what are some strategies that you recommend to really try to? You can't force people to see things from your perspective, but how do you get them to at least how do you raise awareness and get them to be a part of the solution?

Dr. Rishi Garg:
It starts with the relationship. It has to start with the provider valuing or seeing the value of developing a relationship with the team around. Lots of times when you ask a physician, who is your team, he or she may answer the group of physicians that I work with, and making them realize that the team is so much bigger than that, the group of providers that they work with, that it's nursing, it's RTs, it's pharmacy. It's everybody who's at the bedside caring for the patient. So I think it starts with the relationship. And then the second it has to be a difficult conversation if one needs to have happen. And I think that the … that I've always tried to take is like, what is, where do you see your involvement in this case? And lots of times, you'll know very quickly if there is no self-awareness, if there's no personal accountability as to how he or she might have contributed to how that interaction went negative, then you know you're going to have a challenge on your hand. But if that person is willing to listen and say, hey, wait a minute, of course, I want them to be able to call me. Of course I want to be able to, um, do what's in the best interest of patient care or developing the team or building up the team. And if my actions are contributing to not allowing that, and of course, I want to hear about it, and of course, I want to do something about it. It's worked for me when I've done it a couple of times, I will tell you, there have been instances where it hasn't. There has been no self-awareness whatsoever, and you have to have that difficult conversation of potentially selecting somebody out. And that's not ideal, that's not what anybody wants to ever have to do. But sometimes, that's the situation that we get put in. And I will just add one thing in my role as I'm in a, you know, as the chief medical officer, I'm supposed to be able to play both sides, right? I'm supposed to be very physician-centric. I, that is my role is I want to be able to hear what's plaguing our physicians. And so, it's incumbent upon me to understand what system issues may have led to a physician acting in a certain way, right? They don't have the equipment that they need. That case never starts on time. They, the nursing staff is not ready to round. I need to hear those things, and I need to work on all of those things at the same time. But that does not forgive bad behavior. I've actually been accused of being not physician-friendly, that I'm actually too far on the other side. And so I have to balance that myself is I have to hear all sides. I have to make sure that I understand the situation that's going on. But again, when it comes down to professionalism, behavior developing that culture, I'm going to hold pretty strong on those values.

Renee Thompson:
So do you, would you say, especially at Inova, when you bring in a group of physicians, residents, I know it's a teaching hospital, is there any conversation where, right, from the beginning, you're setting some type of behavioral expectations with your physicians and providers?

Dr. Rishi Garg:
We actually do. So that's actually part of our physician orientation. So we have a couple slides where I try to attend every new provider orientation, and I usually make a couple comments. And that's, that tends to be where I make my comments is as it relates to professionalism, behavioral concerns. Again inviting, saying that my door is always open. If there are things from a system perspective that you think are need to be improved upon, but that the professionalism, behavior things are things that absolutely, we mandate of all of our providers, residents get the same type of thing during their orientation.

Renee Thompson:
Now, I think that's very wise. And you said something before about, yes, they may act out okay. Every single human being on earth has the potential of acting out, lashing out at people when they're especially when they're stressed. I mean, we're human beings. We can all have one of those days or moments or many of them. But what I find is that a lot of times, they go right to that excuse where I didn't have the equipment. This happened, that happened. But then you spin it, and okay, but what could you? What do you control in this situation? You control your response to it. And it's one of those things where I think initially that's that defense mechanism that all human beings have. If you're going to call me on something, either performance issue or behavioral issue, the tendency is to go right to, oh, this is why it was this person or that situation, and to have the patience and willingness to continue that conversation. And it may take three conversations to really help that person take a step back. And then, after they get that all off their chest, okay, what role did I play in this situation? How could I have handled it differently? And I could only imagine that you probably get complaints from nurses too, about some of the physicians. Or you have to review those complaints, because many times when we're working with nurses, they'll say, oh, but what about the physicians? Or this physician is untouchable. Nothing is ever done about it. I'm like, well, that may not be entirely true, but are you, receive, on the receiving end of complaints about other physicians and providers?

Dr. Rishi Garg:
All the time. And not to say that I get a lot of complaints, but I am included in any time there's a professionalism concern related to a physician or APP. And I want to be right, because again, it's incumbent upon me to understand, and I need to understand what the truth is, right? And yes, the behavior part, absolutely, there is no excuse for it. But what's driving that behavior is also part of my role is, again, if it is a true quality safety issue, then I need to help solve for that, and so I need to be able to understand both sides while also recognizing that the professionalism, the behavioral thing can't be tolerated.

Renee Thompson:
And I think especially too, if you notice that this is a pattern of behavior with this particular physician or provider, okay. If you've heard this same complaint numerous times, that is a little different than I've never heard anybody complain in this way about this person, because then maybe there's something else going on. But I'll never forget. And I truly think, and I love your opinion on this. I truly think that if we can create a culture where, let's say, Rishi, you and I are working together, and you get testy with me or you openly, you do something, okay? And me as a nurse, that I can speak directly to you, maybe in an hour or so, and say, hey, you yelled at me in front of people or what's going on? Because I was embarrassed, like I talked directly to you instead. What's happening now is people will just they won't say a word to you, but they'll write a complaint letter, and then it ends up going up the chain, and then it ends up at your desk. And I'll never forget I was doing this work in an organization. It was a different one out on the West Coast, but they actually had a behavioral, a physician behavioral committee. They would meet every two months and they would review all the complaints about their physicians that usually the nurses wrote, or sometimes it was other physicians. And if they read a report, a complaint that they thought was significant enough, they would bring that physician to the next committee meeting two months later. And obviously, they would share this complaint with the physician, and the physician would say, I don't even remember this. It was four months ago. And why wouldn't the nurse say something to me? They actually had a form that the nurses could write out. What happened? And I thought, oh my gosh, you're creating a, like you're, we want to encourage direct. If I have an issue, I'm going to speak directly to you about it, and I want you to do the same for me if I'm on acting out. But we find that it's just it's passive, it's easy. It's more comfortable to just write it in a letter and then submit it instead of walking up to someone and say, hey, can we talk about what happened yesterday? Not okay the way you treated me. And that's not always happening, but that's the goal.

Dr. Rishi Garg:
Yeah, and I think, and again, it starts with the relationship, right? I think you're so much more likely to be able to have that conversation with a colleague if you have an existing relationship with them, if you've taken the time prior to that emotional event or whatever that significant event was that happened to get to know somebody, get to know what they like to do outside of work and to know about their family so that when the time does come, you can go up to them and say, hey, you know what? That was a negative interaction. Can we spend five minutes and just chat about it versus what's what you suggested, which is I don't have a relationship with this person. The only time that I ever get involved with them, it's a negative interaction. I'm going to write a note and put it on Garg's desk, or I'm going to enter it onto the online incident reporting system and go through my manager, and it's going to end up in the C-suite to take a look at which is which, then actually leads to further divides in the culture versus trying to promote the culture that we're looking at. It now creates this us versus them. People feel like the incident reporting system is being weaponized. It's used to target certain physicians. It's, that's not what you want to what you said, five-minute conversation right after an event happens debriefing on the event is perfect. It is exactly what we're trying.

Renee Thompson:
Yeah, think about how much time you would save if people would just do that. I always say if people would just talk to each other instead of about each other, and then writing people up again, I keep thinking about that. Four months later, a physician might be made aware of an incident. How do you expect that physician to even respond to that? Are you going to remember something you did for a second four months ago? It's not the best approach, and it's better to then, and I think this is the key, though. You can't just tell people, well, talk to each other. Don't just write them up, just go talk to them. It's hard to do that if you don't know how. That's where a lot of the work that we do, and as is the skill development, how do we have those honest and respectful conversations with each other, independent of the role people are playing? That can sometimes be very uncomfortable, but we're willing to have the conversation anyway. And I think that's the challenge and it's the goal at the same time.

Dr. Rishi Garg:
Yeah, completely agree. Completely agree.

Renee Thompson:
As we start to wrap up, okay, we've got a listener who really wants to engage their physicians in working on improving the relationships that they have with each other, improve their culture. Is there any recommendation, maybe just an action that they can take to just start down that path?

Dr. Rishi Garg:
I mean, we've tried a couple things here, and I would say they, some of them are working, some of them may be not so much. I think the one key is, again, that is a dyad relationship with it with a nurse part. I think physicians trying to walk on the units and be a cultural champion when they haven't taken the time to develop that relationship with the nursing staff or other staff, I think that's going to be very hard to accept and to buy in. Oh, wow. All of a sudden this person wants to be my friend or be nice to me, suggested earlier, but actually taking the time to develop that dyad, we call it a dyad model here of physician-nurse collaboration working together. Oftentimes, it can be leaders, but the more impactful ones are the informal leaders who actually take the time to connect. Maybe not even just professionally, but, you know, go grab a cup of coffee, social type thing. And then, when these types of things happen, it's a lot easier to have the conversation. We have the council structure here and a lot of our divisions. We have a council in our cardiac area. We have a council in our tower area. We're talking about developing a council, and we have a council in women's, and women's in particular, it's that informal leadership team members who are involved both on the physician side, nursing side, and they get in a room and they talk about things. They say, hey, we've had some issues that have popped up on the physician side. We've had some issues that pop up on the nursing side. How can we collaborate together so that this type of thing doesn't escalate in future? So I think that model has worked. We're looking to try to expand that. But then also, like I said, just having those difficult conversations, making sure that you're holding people accountable, hearing both sides of the story, and then saying, look, this doesn't align with our values. This doesn't align with where we're going as an institution. Maybe this isn't the best place for you. I know it's not a great conversation or easy conversation to have, but we've had to do that.

Renee Thompson:
Oh, I bet. And I think what you said is spot on. It's all about the relationships. And I appreciate your dyad approach to where, and it's not just us, the physician, and that nursing leader. It's the informal leaders, I think, of the charge nurses who are more influential at times in that department than even the nurse manager is, and to build that relationship. I always think it's hard to be mean to someone when something about them personally, you know, it's easier to have an honest conversation with people, even if it is uncomfortable if you, I'm going to say, know them. I mean, these are work relationships, but you spend a lot of time together. So you really, if you make an attempt, you can really get to know someone, at least on a level that helps you to respect them more and appreciate them more. And that approach where you're looking at, it's not just the physicians working on it, the nurses working on it, but to bridge that gap between the two and work on it together, I think is incredibly valuable, and excited about the work that, of course, that we're doing together, but the work that you're doing at Inova Fairfax and how this is spreading across all campuses, because especially now, there is nothing more important than the culture and coming together as a team. So I want to thank you so much for being a guest on our show. And can you tell our listeners how they can connect with you?

Dr. Rishi Garg:
Absolutely. So I am on LinkedIn, so please feel free to ping me on LinkedIn or I'm happy to take emails, so you can email me at [email protected], that's R I S H I . G A R G @ I N O V A .org.

Renee Thompson:
That's great. Thank you so much. And we'll have Rishi's contact information in the show notes. So make sure you check out the show notes after this episode airs. And I just again want to thank you for being a guest on our show and just keep up the great work that you're doing at Inova Fairfax. It is such important work, so thank you. And I want to thank you for listening. Those of you who are listening to us right now, I just want to thank you for being here and for doing your part to stop the cycle of bullying and incivility in healthcare. I mean, we have important work to do. And as I always say, we have no time for shenanigans. We have that important sacred work. So I just want to thank you. And as we end, just remind you, the way we treat each other is truly just as important as the great clinical care that we provide. Thanks, everyone. Take care.

Renee Thompson:
Thank you for listening to Coffee Break: Breaking the Cycle of Bullying in Healthcare – One Cup at a Time. If you found these practical strategies helpful, we invite you to click the subscribe button and tune in every other week. For more information about our show and how we work with healthcare organizations to cultivate and sustain a healthy work culture free from bullying and incivility, visit HealthyWorkforceInstitute.com. Until our next cup of coffee, be kind, take care, and stay connected.

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