By Resa E Lewiss MD

The candidate for an open position at a hospital had previously worked there and was applying to come back. Everyone was talking about it. The hospital leaders spoke excitedly about his potential return and anticipated his positive contribution to the workplace culture. The trainees and staff spoke with a markedly different tone. The discussion focused on why he left and included his sexual predatory behavior at work and turmoil at home. They were concerned, and disappointed that he may be hired back.

The scenario, a fictional composite based on real accounts, is quite common. To what extent should an institution consider past behavior when contemplating rehiring someone? Supervisors may have forgotten events, may not have been in leadership roles at that time, and may not feel it’s their responsibility to police the behavior of an adult. They adopt a “that was then, this is now, let’s give him a chance” mentality. For understandable reasons, these same leaders may want to avoid discussing one person’s unprofessional and unethical behavior because that would mean holding a difficult conversation, and highlighting workplace transgressions. They also may not make a connection between their purported benefit of bringing someone skilled into a learning and patient care environment with the true cost of that same person disrupting the safety of healthcare team members with less power. Partially, leaders may lack insight into their own privilege. They may not relate to the experience of being made uncomfortable at work. It can be difficult to understand the link between the hiring of a returning employee and the institutional betrayal of that action. Employees are not likely to voice their concerns when the leadership is extolling the return of a “good guy.”

It is not unusual for these situations to go unrecognized by an institution and its leaders. People are hesitant to report illegal and unethical behaviors for reasons, such as negative consequences, retaliation, and gaslighting. When team members and trainees do not feel supported, they lose focus, act hypervigilant, and divert their energy from workplace productivity to tasks which ensure their own safety. In other words, it’s difficult to perform work optimally and prioritize patient care when you feel betrayed by your institution and its leaders.

In their article, 11 steps to promote institutional courage, Drs. Jennifer Freyd and Kathryn Blecker-Bease outline small steps, or microskills, that institutions and leaders - including hospitals and healthcare systems-- can harness and integrate toward building the larger and seemingly overwhelming goal of institutional courage. Institutions with a culture of courage are safer, more respectful, and more equitable places to work. Where there is no record due to a lack of reporting unprofessional behaviors, it is difficult for institutions to act. So institutions are responsible to realize how they can honor the whistleblowers and ensure safety when people come forward. Some actions they can take towards courage:  Respond well to victim disclosures. Institutions and leaders can learn to be good listeners. And bear witness, be accountable, and apologize. Institutions and leaders can support victims in sharing their experiences. And apologize when fitting. The sequential development of these microskills and adoption of these building blocks compound to ultimately shift a culture. The time is now for leaders to support an institutional environment where the victims and a safe culture are valued over predators. Afterall, people accomplish their best work when they feel team psychological safety.

Resa E Lewiss MD is a professor of emergency medicine at the University of Alabama at Birmingham, TEDMED speaker, TimesUp Healthcare founder, and award winning educator, mentor, and point-of-care ultrasound specialist. She hosts the Visible Voices Podcast, amplifying content in the healthcare, equity, and current trends spaces. With co-author Adaira Landry, her book, MicroSkills: Small Actions, Big Impact, (HarperCollins) is forthcoming in April 2024.