MacRMI Facebook MACRMI Twitter MacRMI LinkedIn


-A patient with limited English proficiency arrives for an elected procedure but is told that there is no interpreter for her visit. Therefore, no consent can be obtained and her procedure must be rescheduled.

-A patient arrives at a doctor’s appointment, is greeted, and brought to an exam room.  After 35 minutes, she comes out to ask about the delay, discovering that her doctor is not in the clinic that day. When she asks how this could happen, a staff member responds “It is not my job to schedule appointments.”

-A patient who is a transgender woman is addressed as “Mister” at the reception desk. When she corrects the staff, they giggle and roll their eyes.

All of these examples are upsetting to read, let alone having to experience.  Until recently, these types of cases have also fallen outside the scope of what hospitals traditionally consider harm. These types of episodes are now often referred to as “disrespect” or “emotional harm” - non-physical harms that can arise out of interactions with one’s healthcare provider. In some circumstances, these harms can be every bit as detrimental to a patient as physical harm. MACRMI’s communication, apology and resolution work has been important in this area by establishing processes that promote respect after preventable harm. While that work focuses on medical harm to patients, there is also the subject of addressing non-physical harm.

The Practice of Respect: The Next Frontier in Preventing Patient Harm

In the summer of 2016, leaders at Beth Israel Deaconess Medical Center (BIDMC) convened a meeting to discuss steps healthcare leaders can take to promote “the practice of respect.” The meeting was funded by the Gordon and Betty Moore Foundation and included experts from around the world.  The day started with leaders from BIDMC, Pat Folcarelli and Lauge Sokol-Hessner, presenting scenarios of disrespect and detailing the institutional process BIDMC has established by which such cases are collected, categorized by severity and risk of reoccurrence, and addressed.  From there, attendees participated in breakout sessions and large group discussions focused on issues ranging from strategies for detecting, categorizing and responding to emotional harm, to disrespect in special settings, to challenges for implementing change in this area. 

After the convening, a team at BIDMC spent the next few months developing a draft consensus statement and mapping out a plan for finalizing that statement.  They invited all the June 2016 participants to participate in a modified Delphi process, which resulted in five rounds of surveys.  The resulting statement constitutes recommendations for hospitals leaders seeking to implement an infrastructure around promoting respect in their institutions. This “roadmap” was published in The Joint Commission Journal on Quality and Patient Safety in August.

A Roadmap for Advancing the Practice of Respect in Health Care

  • Champion a culture of respect and dignity. Hospital leaders have a critical role in setting the example and detailing the expectations around this culture change.
  • Promote accountability. There must be transparency, fairness and a just culture within a framework of accountability in this area.
  • Engage and support the health care workforce. Health care professionals work in high-stress environments. It is crucial to a culture of respect that they have a healthy work environment and are adequately educated about the key elements of the practice of respect.
  • Partner with patients and families. Organizational leaders should not only set as a goal that patients and families always be treated with respect by health care professionals; they should also recognize the key role these constituencies have in developing this shared vision.
  • Establish systems to learn about and improve the practice of respect. Hospitals should have systems that acknowledge and address episodes of disrespect in a timeline fashion.  Institutions should also establish learning processes that include recognizing, capturing, categorizing, and analyzing episodes of disrespect.
  • Expand the research agenda and measurements tools, and disseminate what is learned. Demonstrating positive results prior to spreading specific initiatives can be key - both for improvement and maintaining engagement. Hospitals should establish measures to track progress, and sharing the results of research can help to accelerate improvement.

Looking Forward

Health care professionals and organizations are increasingly recognizing the previously neglected category of preventable harm that is disrespect. Just as the MACRMI work is a critical part of building a holistic practice of respect, the issues addressed through this collaborative effort should help continue positive change in this area.

Authored by Catherine L. Annas, JD, Senior Project Manager, Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center

Loading Conversation