Dear Colleagues,

Stanford Medicine 2020 Doctor Survey - Mistreatment Summary

Watch Stanford Medicine Chief Wellness Officer, Tait Shanafelt, MD, summarize the key learnings from the 2020 Stanford Doctor Survey about physician mistreatment (including data by race, gender, and department) and learn about Stanford Medicine’s next steps.

Physician mistreatment has been a growing concern for healthcare organizations nationwide. Stanford Medicine strives to provide an environment free from mistreatment, so we’ve taken a number of steps to ensure that we as an organization are responding effectively to and working to reduce incidents of mistreatment against our faculty, fellows, residents, and other healthcare professionals.

One such step was including questions related to mistreatment experiences in our latest Stanford Doctor Survey so that we can both evaluate our current state and track our progress creating effective organizational protocols and strategies to ensure the safety of our faculty, fellows, and residents at all times. I want to thank you for providing invaluable input in that survey and report back to you a summary of the results.

Prevalence and types of mistreatment

The 2020 Stanford Doctor Survey measured mistreatment experiences across five areas: complaint or criticism about professionalism, complaint or criticism about work quality, sexual harassment or abuse, verbal mistreatment or abuse, and physical intimidation, violence, or abuse. Close to 40% of our faculty physicians reported experiences with at least one of these mistreatment forms in the past year, at the time of the survey. While verbal mistreatment or abuse was most common, incidents across all five categories were reported in the data.

Mistreatment originating from patients, family, and other visitors to our facilities was the most commonly reported source of abuse, and was reported by >60% of physicians reporting mistreatment. Mistreatment from colleagues was the second-most commonly reported kind of abuse, illustrating we have opportunities for improvement on multiple fronts.

Mistreatment incidence by gender, race, department, and rank

The data also revealed how mistreatment experiences vary across gender, race, department affiliation, and position. While faculty and residents reported largely consistent experiences, significant variation was observed across other domains. Perhaps most notably, women faculty members reported significantly higher levels of sexual harassment and twice the rate of verbal mistreatment compared to men, while half of our Black faculty members reported experiencing some form of verbal mistreatment in the last 12 months.

Correlation with professional fulfillment and burnout

Another noteworthy finding of the analysis was that experiencing any form of mistreatment in the last 12 months, including verbal mistreatment, strongly correlated with decreased professional fulfillment and higher levels of occupational burnout. The effect size of these associations was large. Perceptions of whether Stanford has good systems in place to mitigate the impact of mistreatment varied widely by race and also correlated with the risk of burnout and professional fulfillment. Additional details of the survey findings on mistreatment, including data for faculty and residents/fellows as well as variability by race, gender, and department, can be found in the 11-minute video linked here.

Our next steps as an organization

To make improvements in these critical arenas, we must continuously work to ensure that the right systems are in place to prevent and address mistreatment. Stanford Healthcare, Stanford Children’s Health, and the School of Medicine are continuing to actively implement the policy and cultural changes recommended in our Mistreatment Task Force Report shared with leadership in early 2020. Details on the task force recommendations can be found at on the WellMD & WellPhD mistreatment webpage and an update on progress is described in this separate task force update video. We’ll continue to ask for your feedback and collect this data longitudinally to assess the impact of our actions and ensure that we achieve this needed progress.

The WellMD & WellPhD Center has distributed results on physician mistreatment experiences to school and hospital leaders as well as the leadership within each department. In addition to the system-level interventions already underway, we have asked the Department Chairs to help drive necessary changes specific to their department and clinical work areas. We encourage you to work with your Chairs on these efforts. Please also consider taking advantage of the training resources that are available as an adjunct to these efforts, including De-escalation Training from the Security Services Team and Upstander Training from the Office of Faculty Development and Diversity.

Finally, we ask that you remain vigilant and speak up if you witness any of your colleagues being mistreated. At the same time, it is just as important to report mistreatment of any kind that you experience yourself. Healthcare Professionals and Staff experiencing mistreatment from a patient or visitor can contact Security at 650-723-7222. There are also a number of resources available for aiding those encountering mistreatment, including WellConnect, a counseling program for residents, fellows, and faculty as well as the Ombudsperson.

Thank you for your collaboration and input. We look forward to continuing to work with you to support the ongoing improvement efforts related to physician mistreatment at Stanford Medicine.

Thank you,

Tait Shanafelt

Tait Shanafelt, M.D. Jeanie & Stewart Ritchie Professor of Medicine | Chief Wellness Officer, Stanford Medicine | Director, WellMD & WellPhD Center | Associate Dean, Stanford School of Medicine | 500 Pasteur Drive, Suite P354 | Stanford, CA 94035


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