Time’s Up Healthcare Sets a Wake-Up Call

Abstract

“I’ve worked since I was 15, and I’ve experienced harassment. I knew something was wrong, but there wasn’t a name for it, and people didn’t talk about things like that,” said Tiffany Love, PhD, FACHE, GNP, ANP-BC, regional chief nursing officer at Coastal Healthcare Alliance in Rockport, ME. For years, many women had similar experiences. They were victims of sexual harassment or discrimination, but they suffered in silence. Sometimes they confided in someone, only to feel shamed or dismissed. Although women make up over 80% of the health care workforce, there are still many instances of sexual harassment, inequity, and bullying. Time’s Up Healthcare was established in response to the common experience of power inequity and unsafe workplaces for women and other underrepresented groups everywhere. Earlier this year, Time’s Up, an initiative spawned out of the #MeToo movement, launched Time’s Up Healthcare to support women in the health care industry. This year during the annual conference of AMDA — The Society for Post-Acute and Long-Term Care Medicine in Atlanta, GA, closing keynote speaker Lakshman Swamy, MD, MBA, showed a powerful video of allies in health care at various levels talking about harassment and inequity issues and their support for this effort and their colleagues. Time’s Up Healthcare’s goals include uniting health care workers across fields, improving care for targets of harassment and inequity, raising awareness and knowledge, supporting health care organizations in making this issue central and visible, and advocating for meaningful standards. Even though this effort may be new, harassment and inequity have a long history in health care. According to the U.S. Equal Employment Opportunity Commission, between 1995 and 2016 there were 1,500 sexual harassment claims in nursing homes, 380 in physician offices, nearly 2,000 in ambulatory care, and more than 3,000 in medical and surgical hospitals (BuzzFeed News, Dec. 5, 2017; http://bit.ly/2UhX3zH). A study published in JAMA documented that almost one-third of women in academic medical faculties reported having experienced sexual harassment on the job (2016;315:2120–2121). The same study showed that women have perceived and experienced more gender bias than men. As he learned more about Time’s Up, Dr. Swamy said, “It was eye-opening. This was happening all around me, and I was blind to it. I had no idea that this was happening when I was growing up or in even medical school.” He added, “I became more aware, and if you listen, you hear a lot more stories.” He observed that his mother is a physician, and he realized that while these issues were going on for a long time, it wasn’t spoken about. “The conversation is a lot bigger now. There are cultural and structural issues we need to address, but we also need to recognize our own implicit biases and work on correcting these.” “It’s essential to identify and confront biases in language and behavior in ourselves and others. We need to make it a habit. When we do it more, it’s easier for people to be open and say, ‘You’re right.’ We’ll have a better marker as a culture,” said Dr. Swamy. “We have to do a much better job at policing our own behaviors,” noted Thomas Varghese Jr., MD, MS, a thoracic surgeon and chief value officer at the University of Utah’s Huntsman Cancer Institute in Salt Lake City, UT. “This can be challenging, but it can start by treating others the way you want to be treated,” he suggested. This means, for instance, not interrupting others when they are speaking, not mocking or making fun of people, even in jest, and just generally being respectful of others. “Being a good listener goes a long way,” said Reshma Jagsi, MD, DPhil, Newman Family professor and deputy chair of the Department of Radiation Oncology at the University of Michigan. “Listen when people are talking. Listen for feedback and be open to it.” It’s important to realize that sexual harassment and inequity aren’t limited to the most egregious examples, Jessica Gold, MD, MS, assistant professor with the Department of Psychiatry, Washington University, St. Louis, MO, said. “It also means more subtle things — women not being introduced with their degree at grand rounds when men are, women not being called on or given the opportunity to talk in meetings, or women being passed up for promotions or awards for men with comparable or less experience/qualifications.” She noted, “Awareness is the first step. If we can talk about it, people begin to realize what’s happening and do something about it.” Try a test, Dr. Swamy suggested. Count the minutes until a woman or person of color says anything during a meeting. When they do speak, are they interrupted, dismissed, or contradicted? “Sometimes it’s shocking. We need to be able to call these instances out. Ideally, we should be able to deal with this openly.”Take responsibility for being a role model, initiating and supporting ongoing conversations, and sending a clear message that people can step forward. “It’s not fair to put all of the onus on the victims of harassment, inequity, or disrespect. We all have a responsibility to speak up when we observe something,” said Dr. Swamy. “We need to build a culture where anyone can speak up by creating a circle of trust,” said Dr. Varghese. “Do you trust each other and believe that you are all committed to the higher goal of caring for patients? Do you trust that everyone is speaking up with this interest at heart? When you have this level of trust, it becomes easier for people to speak up.” He added, “That is the leader’s job — to create an environment where people are willing and able to speak up without fear.” It’s easier to speak up and address issues in real time, Dr. Varghese noted. He admitted that this can be difficult, but he suggested that there are ways to do this. For instance: “Excuse me, I was speaking. Please let me finish, then you can respond.” Or “I prefer to be called Dr. Jones, not Nancy. Thank you.” Or even “It makes me uncomfortable when you grab my arm like that.” The best part of real-time feedback, Dr. Varghese said, is “the ability to have the information right there and then, so you can slow down and have a conversation.” Sometimes victims of sexual harassment and related problems aren’t comfortable coming forward. They are encouraged to start in a safe place. For instance, Dr. Jagsi said, “If you have someone you know who will listen and be open, those are good people to start with.” Elsewhere, talking to a psychotherapist can make it easier to talk to others later. Dr. Gold stressed, “If you have had an experience and you’re not ready to talk, you don’t have to. But being present and hearing others’ experiences can be valuable.” Employee assistance programs may also be a good place to start a conversation. If someone speaks up about something you do or say, said Dr. Jagsi, “Try to think of it not as criticism and more as a growth opportunity. People make mistakes, and no one is expected to be perfect. It’s a learning experience.” “If you create an environment where people feel comfortable speaking up, you will get more information and insights, and you will learn from this,” said Dr. Swamy. Jane van Dis, MD, CEO at Equity Quotient in Los Angeles, stressed that it’s not enough to show a video or do a training session. “This does nothing to change the culture of the organization,” she said. There needs to be role modeling from leadership, ongoing conversations, and a clear message that people can step forward, be honest, and not fear punitive action or retribution. Formal processes are essential, even in small organizations. This includes detailed policies and procedures about when and how to report concerns or incidents. These need to make it clear to employees, said Dr. Love, that “we want you to speak up, we want to address the problem, we want you to feel safe at work. Employees need to know that they can speak out without fear of retribution or retaliation.” It must be clear that there is zero tolerance for certain behaviors and that everyone is expected to treat others with respect and courtesy. Posters and signs in break rooms and common areas, as well as notices on websites, can serve as reminders about the organization’s culture of respect. Training programs should not be one-and-done. Consider book or journal clubs where team members can discuss articles and other writings about harassment and equity issues. In the nursing home setting, ethics committees can be an avenue for such discussions. Role-playing activities can help people to experience and understand what others are thinking and feeling. The culture of respect should be communicated to residents and families early on. “It’s a two-way street that they need to understand. We don’t expect people to be perfect, but there are some behaviors that can’t be tolerated,” said Dr. Varghese. He added, “However you address it, the message should be clear: residents will be treated with respect and dignity, and they are expected to respond in kind.” Organizations, particularly those beginning the journey, shouldn’t assume that having no or few complaints means that all is well. “If people aren’t stepping forward, it’s probably because they don’t feel safe,” said Dr. van Dis. She observed, “There’s a difference between a proactive and a reactive culture. Traditionally, it’s been reactive around this issue.” Leaders know how to be proactive around health and patient care issues, she suggested, “but they haven’t thought about sexual harassment as an issue to address proactively. You have to reframe measurement and success.”Action PointsEvery organization can take steps — from simple, everyday actions to commitments requiring careful implementation — to prevent harassment and create a culture of respect. Here’s how you can take action.If you are a victim of harassment:•Start talking about your experience in a safe place. Employee assistance programs may also be a good place to start a conversation.•Speak up when you observe harassment toward yourself or others. It’s easier to speak up and address issues in real time.If you are an employee:•Don’t interrupt others when they are speaking, or mock or make fun of them. Listen when people are talking, and be open to their message.•Introduce women with their degree and give them an opportunity to talk in meetings by calling on them and not interrupting when they speak.If you are a leader:•Take responsibility for being a role model. Initiate and support ongoing conversations, and send a clear message that people can step forward, be honest, and not fear punitive action or retribution.•Let employees know that they can speak out without fear. Establish and publicize detailed policies and procedures about when and how to report concerns or incidents.•Post signs in break rooms and common areas, as well as notices on websites, to remind employees about the organization’s culture of respect.•Establish book or journal clubs where team members can discuss articles and other writings about harassment and equity issues, or role play activities that can help people experience and understand what others are thinking and feeling.•Don’t assume that no or few complaints means all is well. If people aren’t stepping forward, it might be because they don’t feel safe.•Sign up on the Time’s Up Healthcare website (https://www.timesuphealthcare.org/sign_up) to receive news, become a signatory organization or sponsor, or donate. Every organization can take steps — from simple, everyday actions to commitments requiring careful implementation — to prevent harassment and create a culture of respect. Here’s how you can take action. If you are a victim of harassment:•Start talking about your experience in a safe place. Employee assistance programs may also be a good place to start a conversation.•Speak up when you observe harassment toward yourself or others. It’s easier to speak up and address issues in real time. If you are an employee:•Don’t interrupt others when they are speaking, or mock or make fun of them. Listen when people are talking, and be open to their message.•Introduce women with their degree and give them an opportunity to talk in meetings by calling on them and not interrupting when they speak. If you are a leader:•Take responsibility for being a role model. Initiate and support ongoing conversations, and send a clear message that people can step forward, be honest, and not fear punitive action or retribution.•Let employees know that they can speak out without fear. Establish and publicize detailed policies and procedures about when and how to report concerns or incidents.•Post signs in break rooms and common areas, as well as notices on websites, to remind employees about the organization’s culture of respect.•Establish book or journal clubs where team members can discuss articles and other writings about harassment and equity issues, or role play activities that can help people experience and understand what others are thinking and feeling.•Don’t assume that no or few complaints means all is well. If people aren’t stepping forward, it might be because they don’t feel safe.•Sign up on the Time’s Up Healthcare website (https://www.timesuphealthcare.org/sign_up) to receive news, become a signatory organization or sponsor, or donate. It can be uncomfortable for leadership to open the conversation and hear some unpleasant truths. They may know that sexual harassment exists, for instance, but they think it’s contained. However, Dr. van Dis said, “Leadership needs to know what’s happening in their culture. They need to take culture metric surveys and hold themselves accountable for moving the needle on sexual harassment and discrimination, and they need to understand what workers are feeling and experiencing day to day.” Progress is being made. As Dr. Swamy said, “Because of social media, conversations are more open and constant, and fewer people are suffering alone. Now we have an entire infrastructure of women in medicine saying, ‘Time’s up.’ While we have work to do, I think the messaging is getting through.” Dr. van Dis added, “It’s progress to start the conversation, and that is where we are.” She further observed, “We need to unite the work organizations are already doing. We need to highlight the work and best practices of other organizations. We are looking to create a unified body of information. We are advocating for women across all jobs in health care. We are there to support every worker in every workplace.” Senior contributing writer Joanne Kaldy is a freelance writer in Harrisburg, PA, and a communications consultant for the Society and other organizations.