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AMA sets new policies on bullying prevention in healthcare and racism

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November 19, 2020

The American Medical Association has adopted new policies this week, including prevention of bullying among healthcare professionals and recognition of racism as a public health threat.

According to The Joint Commission, intimidating and disruptive behavior in healthcare settings is associated with medical errors, poor patient satisfaction, and preventable adverse outcomes. In June, the AMA Board of Trustees recognized the health consequences of violent police interactions and called racism an urgent threat to public health.

Taking a stand against bullying

Bullying in healthcare settings has far-reaching impacts, AMA Board Member Willie Underwood III, MD, MSc, MPH, said in a prepared statement. "Bullying in medicine not only negatively impacts the mental and physical health of the professional being bullied, but can also have lasting adverse effects on their patients, care teams, organizations, and their families."

Healthcare organizations and other stakeholders need to take actions to prevent bullying, he said.

"Bullying has no place in the medical profession and we must do everything we can to prevent it for the sake of the wellbeing of the healthcare workforce. Putting an end to bullying in the practice of medicine will require the healthcare industry, local organizations, and individual members of the healthcare team to acknowledge the problem, accept responsibility, and take action to address it at all possible levels."

The new AMA policy, which was approved this week at the Special Meeting of the AMA House of Delegates, includes an eight-point guidance framework to establish an effective workplace policy to prevent bullying in healthcare settings.

 

  • Describe the leadership team's commitment to providing a safe and healthy workplace that does not tolerate bullying and unprofessional behavior
  • Define workplace violence, harassment, and bullying, including intimidation, threats, and other forms of aggressive behavior
  • Specify to whom the policy applies such as medical staff, students, administration, patients, employees, contractors, and vendors
  • Define both expected and prohibited behaviors
  • Outline steps for individuals to take when they feel they have been targeted in workplace bullying
  • Provide contact information for a confidential means for documenting and reporting workplace bullying incidents
  • Prohibit retaliation as well as ensure privacy and confidentiality
  • Document training requirements and establish expectations about the training objectives
     

The new policy sets a definition for workplace bullying.

"The AMA defines 'workplace bullying' as repeated, emotionally or physically abusive, disrespectful, disruptive, inappropriate, insulting, intimidating, and/or threatening behavior targeted at a specific individual or a group of individuals that manifests from a real or perceived power imbalance and is often, but not always, intended to control, embarrass, undermine, threaten, or otherwise harm the target," the AMA said in a prepared statement.

Racism as public health threat

Racism is linked to healthcare inequities, AMA Board Member Willarda Edwards, MD, MBA, said in a prepared statement. "The AMA recognizes that racism negatively impacts and exacerbates health inequities among historically marginalized communities. Without systemic and structural-level change, health inequities will continue to exist, and the overall health of the nation will suffer."

Physicians can play a key role in addressing racism, she said. "As physicians and leaders in medicine, we are committed to optimal health for all, and are working to ensure all people and communities reach their full health potential. Declaring racism as an urgent public health threat is a step in the right direction toward advancing equity in medicine and public health."

The new policy declaring racism as a public health threat, which was approved this week at the Special Meeting of the AMA House of Delegates, calls on the physician organization to take six steps to combat racism.
 

  • Acknowledge the harm caused by racism and unconscious bias in medical research and healthcare
  • Identify tactics to address racism and its health effects
  • Encourage medical education curricula to promote greater understanding of racism
  • Support external policy development and funding to research racism's health risks and negative impacts
  • Work to prevent the influences of racism and bias in healthcare technology innovation
  • Identify a set of best practices for healthcare institutions, physician practices, and academic medical centers to address and mitigate the effects of racism on patients, providers, international medical graduates, and populations

Other house of delegates actions

The Special Meeting of the AMA House of Delegates adopted several other new policies and calls to action, including the following:

The House of Delegates called for a multifaceted approach to addressing social determinants of health.

  • "Addressing social determinants of health requires an all-hands-on-deck approach that is not limited to stakeholders within the healthcare system. By addressing social determinants of health in their benefit designs and coverage, health plans can be part of the effort to improve patient health outcomes," David Aizuss, MD, a member of the AMA Board of Trustees, said in a prepared statement.
  • A new policy prescribes actions to mitigate the negative effects of high-deductible health plans. "The new policy encourages research and advocacy to promote innovative health plan designs that respect patients' unique healthcare needs. Moreover, to ensure that innovative health plans are likely to achieve their goals of enhanced access to affordable care, the new policy encourages active collaboration among organized medicine and payers during plan development," AMA Board Member Mario Motta, MD, said in a prepared statement.
  • A new policy targets misinformation about the efficacy and safety of COVID-19 vaccines through a public education campaign. "We will continue to monitor the scientific data regarding safety and effectiveness during and after the vaccine development process to ensure the proper safeguards are in place to deliver a safe and effective vaccine," AMA President Susan Bailey, MD, said in a prepared statement.AMA ethical guidance on physician immunization was amended. "Physicians who are not or cannot be immunized have a responsibility to voluntarily take appropriate actions to protect patients, fellow healthcare workers and others," the amended ethical guidance says. Appropriate protective actions include non-immunized physicians refraining from direct patient contact, according to the amended ethical guidance.

Christopher Cheney is the senior clinical care? editor at HealthLeaders.




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