Designing a novel post-incident intervention to address patient harassment of staff in VA primary care settings

项目背景：97%的女性和77%的男性内科医生在 退伍军人事务部(VA)最近的医疗机构调查报告了来自患者的性骚扰。工作人员可以 通过忽略护理要素、匆忙完成临床任务和疏远患者来应对患者造成的骚扰 无论是从情感上还是从身体上。此外，患者实施的骚扰与 工作人员幸福感下降，职业倦怠和离职率增加，而这反过来又与减少 护理质量下降，患者满意度下降，医疗差错风险增加。麦克多诺部长 最近誓言要结束退伍军人管理局的一切形式的骚扰和歧视，以及新的黛博拉·桑普森法案 要求设施实施反骚扰程序。然而，先前的研究表明，VA缺乏 系统、循证的干预措施，用于应对预期的工作人员对患者的骚扰 骚扰，阻止事件，传达骚扰是不受欢迎的，促进事件报告，以及 支持受影响的员工。这一试点项目的目标是设计一种新的干预措施，以引导患者在 事件工作人员、诊所和设施对患者对初级保健工作人员进行性骚扰的反应。 意义/影响：由此产生的干预措施将解决ORD战略优先事项4：积极促进 多样性、公平性和包容性，传达退伍军人事务部不容忍基于社会身份的骚扰 特点。此外，它还将有助于高铁和研发的优先领域：初级保健实践和复杂性 通过提供与患者造成的骚扰相关的支持来管理慢性病 提供者和员工士气，“改善员工与提供者之间的互动，提高病人护理的质量。 创新：这一试点项目利用一个独特的机会来应对前所未有的领导力和 为解决退伍军人管理局骚扰问题的干预措施提供政策支持。由此产生的干预将填补 以经验数据为基础的应对患者骚扰和支持退伍军人管理局的程序 工作人员，并将补充退伍军人管理局持续的反骚扰努力。我们的设计过程将由一个 创新框架，确保干预符合退伍军人管理局的优先事项和利益攸关方的需求。 具体目标：具体目标是：1)根据现有的和理想的确定干预措施的组成部分 应对病人骚扰工作人员的做法；以及2)完善事件后干预 通过迭代的利益相关者反馈。 方法：由运营合作伙伴、退伍军人管理局领导层和主题组成的指导委员会指导 专家们，我们将遵循基于步骤的转生过程，即与利益相关者共同设计干预措施 从一开始就符合当地的情况。我们将把重点放在初级保健环境中，这些环境已经确定了 骚扰，并作为进入退伍军人管理局护理的主要端口。我们将通过采访退伍军人事务部小学来实现目标1 护理提供者(例如医生、医学实习生)、监督员(例如初级保健主任、研究员 教师)、领导者(例如，设施主任、研究员主任)和其他主题专家(例如， 伦理学家，颠覆性行为委员会成员)(n=30)，以吸引现有和期望的员工、诊所和设施 应对患者骚扰和支持受影响员工的程序。我们将通过a)实现目标2) 聘请一个由指导委员会成员和目标1工作人员组成的专家小组(n=12)参加经修改的 德尔福进程，就目标1中确定的干预措施的重要性和可行性达成共识； 和b)与妇女保健实践研究网络网站的工作人员举行互动网络研讨会 评估干预采用的可能性和潜在的采用障碍。 实施/下一步：项目完成后，我们将寻求高铁和研发资金，以测试 有效性实施试验中的干预，最终目标是适应其他临床 病人造成偏见的背景和形式(例如，种族/民族歧视)和传播。

Project Background: Ninety-seven percent of women and 77% of men internal medicine physicians in a recent Veterans Affairs (VA) healthcare facility survey reported sexual harassment from patients. Staff may cope with patient-perpetrated harassment by omitting elements of care, rushing clinical tasks, and distancing from the patient emotionally and physically. Further, patient-perpetrated harassment is associated with decreased staff well-being and increased burnout and turnover, which are in turn associated with decreased quality of care, decreased patient satisfaction, and increased risk of medical errors. Secretary McDonough recently vowed to end all forms of harassment and discrimination at VA, and the new Deborah Sampson Act requires facilities to implement anti-harassment procedures. However, prior work indicates that VA lacks systematic, evidence-based interventions for responding to patient harassment of staff that anticipate harassment, stop the incident, communicate that harassment is unwelcome, facilitate incident reporting, and support affected staff. The goal of this pilot project is to design a novel intervention to guide immediate post- incident staff, clinic, and facility responses to patient-perpetrated sexual harassment of staff in primary care. Significance/Impact: The resulting intervention will address ORD Strategic Priority 4: actively promoting diversity, equity, and inclusion by communicating that VA does not tolerate harassment based on social identity characteristics. Additionally, it will contribute to HSR&D priority domain: Primary Care Practice and Complex Chronic Disease Management by offering support related to patient-perpetrated harassment that can “improve provider and staff morale,” improve staff-provider interactions, and increase quality of patient care. Innovation: This pilot project leverages a unique opportunity to respond to unprecedented leadership and policy support for interventions to address harassment at VA. The resulting intervention will fill a critical gap in procedures grounded in empirical data for responding to patient-perpetrated harassment and supporting VA staff, and will complement VA’s ongoing anti-harassment efforts. Our design process will be guided by an innovative framework that will ensure that the intervention fits with VA priorities and stakeholder needs. Specific Aims: The Specific Aims are to: 1) identify intervention components based on existing and ideal practices for responding to patient-perpetrated harassment of staff; and 2) refine the post-incident intervention through iterative stakeholder feedback. Methodology: Guided by a Steering Committee of operations partners, VA leadership, and subject matter experts, we will follow a step-based process of transcreation, i.e., co-designing interventions with stakeholders to fit with local contexts from the outset. We will focus on primary care settings, which have established rates of harassment and serve as the main port of entry into VA care. We will achieve Aim 1 by interviewing VA primary care providers (e.g., physicians, medical trainees), supervisors (e.g., primary care chiefs, fellowship preceptors), leaders (e.g., facility directors, fellowship directors), and other subject matter experts (e.g., ethicists, disruptive behavior committee members) (n = 30) to elicit current and desired staff, clinic, and facility procedures for responding to patient harassment and supporting affected staff. We will achieve Aim 2 by a) engaging an expert panel of Steering Committee members and Aim 1 staff participants (n = 12) in a modified Delphi process to build consensus on importance and feasibility of intervention components identified in Aim 1; and b) conducting interactive webinars with staff from Women’s Health Practice-Based Research Network sites to assess likelihood of intervention adoption and potential adoption barriers. Implementation/Next Steps: Following project completion, we will seek HSR&D funding to test the intervention in an effectiveness-implementation trial, with the ultimate goals of adaptation to other clinical settings and forms of patient-perpetrated bias (e.g., racial/ethnic discrimination) and dissemination.