Stepping In: Creating a Culture of Respect and Inclusion-An Institutional Program Evaluation.

Episodes of disrespectful, biased behavior toward health care personnel occur with distressing frequency. This article describes a comprehensive approach to address this problem. This institutional change strategy includes (1) setting expectations for respectful behaviors in the health system environment through messaging and policy, (2) setting expectations among team members that when disrespectful behavior occurs, it is everyone's duty to step in, and (3) providing employees and trainees with an interactive educational experience that provides resources and skills to step in effectively when disrespectful behavior occurs, in a manner, ie, effective, consistent with our values, and that strives to engage the therapeutic relationships that characterize the health care environment. This article describes in detail the training component of this innovation, including the response framework developed for this training. We describe perceived barriers to stepping in reported by participants before the workshop, which include insecurity about how to proceed, concerns about safety and about escalating the situation, a desire to continue in a relationship with the person, and concerns about hierarchy. The pre-post and 6-month longitudinal evaluation of the training workshop demonstrates a statistically significant improvement in employees' comfort in stepping into situations of disrespect. Promoting institutional culture change requires significant time and resources but can promote sustained positive changes in addressing respect in the health care environment. The authors hope that other institutions will develop strategies appropriate for their settings that will enable their constituents to step in when the need arises.