2020 Salus Global Patient Safety Award Winner

Hospital: St. Mary’s Hospital
City: Montreal, Quebec, Canada
Initiative: Foster a respectful and inclusive environment for working and learning

Background and Overview

Describe your objectives

Establish an effective communication practice. Thus fostering a professional and enjoyable working environment.

Allow residents, medical students, interns and all new members who join the mother-child team to work in an environment conducive to learning in obstetrics and gynecology

What existing issue did it address?

  • Complaints from McGill University medical residents and medical students regarding mistreatment on the unit
  • Conflicts between employees vs. expectations among roles and responsibilities
  • Lack of professionalism / incivility
  • Difficulties in effective learning practices, namely, fear of being judged

How did you measure success?

A survey was conducted to determine the lived experience on the unit completed April-May 2019

A survey was conducted following workshops and presentations October-November 2020

Provide a short description of the key strategies and associates timelines.

A literature review was conducted on professionalism and civility at work and interventions to decrease certain behaviours.

A survey using the Health Canada questionnaire on mistreatment in the work environment was disseminated amongst unit staff and McGill residents and students who rotated through our unit in the last year. The survey was disseminated April to Amy 2019.

Analysis of survey results, presentations of the results to the core team and presentation preparation for the MORE Ob workshop

Scenarios for workshops and videos depicting mistreatment and opportunities for interventions were filmed on the unit with unit staff as actors.

Scheduled moreOB workshops were attended by professionals on the unit: physicians, nurses, residents and students. The moreOB team also presented at grand rounds in the Obstetrics and Gynecology department. The strategy was:

  • Use of a commitment tool where the staff who attended the workshops and agree to decrease mistreatment publicly committed to and signed the mission statement. The mission statement with the signatures is displayed publicly in a central location on the unit
  • Education on the structure of bullying and mistreatment, the negative effects on the victim and the negative effects incivility has on the working and learning environment
  • Planned to use the power of bystanders to intervene in cases of mistreatment
  • Scenarios and role play was used to have participants practise the 4 D’s of bystander intervention direct, distract, delegate, delay.

Questionnaires distributed to all maternal child unit staff and McGill residents and students who rotated through our unit in the previous year. The survey was distributed October-November 2020.

Analysis of redistributed survey results

Presentation revised and adjusted regarding the second questionnaire.

Deploying cancelled workshops from last year (cancelation due to the pandemic, only 3/6 workshop)

Body of Submission

How were front-line Participants involved in this initiative?

There was  alarge number of people who participated in the surveys, the first survey had 134 and the second 118 respondents (including nurses, physicians, residents, medical students, respiratory therapists, unit agents and PABs)

The moreOB workshops were divided into a theoretical presentation which also included slides and the videos on incivility at work. In the second half of the workshop the attendees were divided into small groups. This is where participants discussed mistreatment and were allowed to describe their own experiences of mistreatment or witnessing of mistreatment.

How did senior leaders support this initiative?

In recent years, the head of Obstetrics Department has made the moreOB workshops mandatory for all Obstetricians, and Family Medicine physicians.

Nursing staff (namely, nurses and auxiliary nurses) have a day reserved in their schedules for moreOB Workshops every year.

There 6 workshops per year.

How was information and analysis of the Program reports or assessments utilized?

Following the culture assessment survey

We note from the element of open communication :

  • I am able confortable sharing my observations or concerns in multidisciplinary patient review meetings =51%
  • We are able to communicate our points of view without fear of reprisal = 58%

We noted also from the element empowering people :

  • I feel free to question the decisions or actions of others, regardless of their level of authority= 49%
  • I am asked for suggestions on how to improve patient care and safety =32%

This was a concerning gap from what we aim as a good team in the Birthing Center. We realize the low rate from the culture assessment survey.

Also, local project on professionalism had started. A survey was done. A grand rounds presentation was given to the Obstetrics and Gynecology Staff.

A decision was made between the professionalism committee and moreOB core team to joint together the 2 committee for the communication aspect.

How was progress and success shared?

Presentations were presented to multidisciplinary teams during moreOB workshops.

The improvement in the mistreatment rate was shared at a Grand Rounds presentation of the Obstetrics and Gynecology department. There is a continuing commitment to decreasing the mistreatment rate further.

Provide examples of interprofessional collaboration as you worked on this initiative.

The workshop was brought to fruition thanks to the initiative from core team doctors (namely, Obstetricians and Family Doctor for the presentation). The nurses who were part of the moreOB core team actively participate and were part of the planning and designing of the strategy for the intervention. 2 family medicine residents also actively participated and gave their input.

The clinician nurse specialist conducted research on the topic.

Questionnaires were distributed o the unit. Personnel from the core team encouraged staff to complete the inquiry for. The questionnaires were analyzed by 2 residents. The videos were produced by Residents, Obstetricians, Family Physicians and Nurses from the unit.

Describe the results and impact of this initiative. (Example: Describe any unit or practice changes. Provide quantitative or qualitative information, where available. Did the initiative result in any cost savings/efficiencies? Improved patient outcomes? If so, please describe).

After the intervention there was a reported 25% decrease in people who experienced mistreatment on the unit. The rate of repeated mistreated decreased 50%, from 13% to 5.9%. The intervention had 6 workshops planned and was cut short to 3 because of the COVID pandemic. The plan was to continue the same topic the following year.

Fewer complaints were made to McGill University in 2020 regarding the Maternal Child Unit.

There has been a decrease in complaints and conflicts among staff on the department. The people seem to be more aware of the impact of non-civility at work.

A poster bearing the signatures of employees who want to work in a pleasant working climate was mounted. The poster has been signed by 65% of different team members thus after the 3 workshops realized from last year. We decided to continuous this important topic this year in the moreOB workshop day to reach more people.

2020 st mary 1

Provide quantative or qualitative information, where available

The rate mistreatment after the first survey April -May 2019 was 50%(68 of 134 respondents). The rate of frequent mistreatment was 13%.

The rate of mistreatment following the intervention decreased by 25% to 37.3% in October-November 2020. The rate of frequent mistreatment decreased by 50% to 5.9%.

2020 st mary 2

Participation at the workshop last year after only 3 workshops.

2020 st mary 3

Did the initiative results in any cost savings/efficiencies?

In the past year, there have been zero new nurses who departed due to incivility.

In the past year, there was been zero new nurses / or any nurses is salary insurance for stress related to the environment at work.

Training nurses is extremely costly. It especially squanders unnecessary financial resources when staff members leave after a few months due to conflicts with team members.


Improved patient outcomes? If so, please describe.

A survey on patient satisfaction will be done in the spring 2021. Results to follow

Are you hospital leadership?
Learn more about how MOREOB can improve performance outcomes at your hospital.
Are you part of an OB team?
If you think that your hospital could benefit from MOREOB:
More than OB

We can apply a similar approach to communication and teamwork that we bring to OB to adjacent maternal/infant care departments and even other hospital units such as emergency, ICU, cardiology, and other risk management areas.