This is the second in a series of articles on promoting professionalism. You can read the first article Nurses’ essential role in supporting professionalism.

Consider this scencario: After a particularly busy shift in the intensive care unit (ICU), the assignment board indicates that your colleague Mary is taking your patient assignment at shift change. As you’re leaving the unit, your patient’s fall alarm goes off and you hear Mary yell, “Someone turn that thing off…they’re always alarming and driving me crazy…trust me—that patient isn’t getting out of bed any time soon.” You’re concerned because during report you told Mary the patient’s mental status had improved slightly, making him more of a fall risk than in previous shifts.

Would you know what to do in this situation?

The first article in this series introduced the Promoting Professionalism Pyramid, a tiered intervention process for fostering professionalism and professional accountability. This article focuses on the first tier, the Cup of Coffee conversation, which provides a way to informally discuss with a colleague how his or her observed behavior seems to undermine the organization’s culture of safety and respect. (See Promoting Professionalism Pyramid.)

What is a Cup of Coffee conversation?

The goal of Cup of Coffee conversations is to deliver a single story or observation and let the recipient know the behavior was observed. (See Who, what, when, where, why, and how.) This approach promotes accountability for a single observation of what seems to be nonegregious unprofessional conduct or behavior.

The pyramid highlights two important exceptions to providing informal feedback: Allegations of behavior contrary to law, regulation, or organization policy (for example, working while under the influence of drugs or alcohol, sexual boundary violations, and physical assault) that require investigation by appropriate authorities, and other serious breaches of behavior that affect the work environment and may be considered sufficiently egregious that they require urgent review and action by a supervisor or institutional authority.

Benefits of conversation

The skills used in Cup of Coffee conversations form the basis for all interventions outlined in the Promoting Professionalism Pyramid. Many professionals who act in ways that undermine a culture of safety and respect don’t recognize the effect of their actions, so a lack of early intervention might result in a persistent pattern of behavior. But because few clinicians have had training in addressing unprofessional behavior, they may talk about their colleagues, rather than speak with them as peers. Think of it this way—if people were talking about your behavior, wouldn’t you want another colleague to let you know?

We believe most incidents giving rise to Cup of Coffee conversations don’t require investigation or documentation. Whether you observe or receive a report of a nonegregious incident, the concern should be shared. Some may object, thinking validation and documentation are required to set the stage for more formal reviews. Concerns recorded by patient relations representatives or institutional incident systems will be preserved, but informal conversations about these reports may not need to be formally documented (unless required by law or policy). After all, professionals for whom a pattern emerges and persists should have sufficient documentation of original reports for receiving Awareness and Authority interventions, which are the focus of the next two articles in this series.

When you use Cup of Coffee conversations to non-judgmentally share a single incident with your colleague, you help promote accountability for safe, respectful health care and increase the likelihood patients will receive the kind of care you would want for yourself and your loved ones.

All authors work at Vanderbilt University Medical Center in Nashville, Tennessee. Marilyn Dubree is the executive chief nursing officer in clinical enterprise administration; April Kapu is associate chief nursing officer of advanced practice; Michelle Terrell is the director of advanced practice at Monroe Carell Jr. Children’s Hospital; James W. Pichert is professor of medical education and administration at the Vanderbilt Center for Patient and Professional Advocacy; William O. Cooper is professor and vice chair in the department of pediatrics, professor in the department of health policy, and director of the Vanderbilt Center for Patient and Professional Advocacy; Gerald B. Hickson is senior vice president for quality, safety and risk prevention, clinical enterprise administration, center for quality, safety and risk prevention.

References

Cooper WO, Guillamondegui O, Hines OJ, et al. Use of unsolicited patient observations to identify surgeons with increased risk for postoperative complications. JAMA Surg. Published online February 15, 2017. [Epub ahead of print]

Dubree M, Kapu A, Terrell M, et al. Nurses’ essential role in supporting pursuit of professionalism. Am Nurs Today. 2017;12(4):6-8.

Hickson GB, Pichert JW, Webb LE, Gabbe SG. A complementary approach to promoting professionalism: Identifying, measuring, and addressing unprofessional behaviors. Acad Med. 2007;82(11):1040-8.

Joint Commission, The. Sentinel Event Alert, Issue 40: Behaviors that undermine a culture of safety. July 9, 2008.

Martinez W, Pichert JW, Hickson GB, Cooper WO. Programs for promoting professionalism: Questions to guide next steps. Jt Comm J Qual Patient Saf. 2014;40(4):159-60.

Rosenstein AH, O’Daniel M. Disruptive behavior and clinical outcomes: Perceptions of nurses and physicians. Am J Nurs. 2005;105(1):54-65.

Webb LE, Dmochowski RR, Moore IN, et al. Using coworker observations to promote accountability for disrespectful and unsafe behaviors by physicians and advanced practice professionals. Jt Comm J Qual Patient Saf. 2016;42(4):149-64.