A Culture of Disrespect Can Be Deadly

The sad case of Jonathan Carey, highlighted in an extensive investigative report by the New York Times shows the specific impact of a dysfunctional human resource management system. A staff member smothered Jonathan by sitting on him. Another staff member, driving a van at the time, witnessed the incident through the rear-view mirror. The incident followed a series of suspected physical abuse of Jonathan and documented abuse of other residents at the same facility.

The article describes hiring practices that convey a low level of selectivity. The description gives the impression that the agency is desperate for employees and will hire anyone. Poor training and a weak culture compound hiring mistakes.

Structured research (eg, the Stanford Prison Study) and widely reported new (eg, the Abu Graib prison incidents) have made the point repeatedly that people behave badly when given absolute power over others. For much of their working day, employees of facilities for people with developmental disabilities work without direct oversight. They have all the power.

What to do?

Play Seriously or Go Home. Positions with responsibility for vulnerable people require deep commitment to core values. If you can’t make that commitment, move onto a position that fits you.

Establish Ongoing Conversations on Core Values. Working with people with developmental disabilities makes serious demands on one’s energy, compassion, and emotions. Few employees have the stamina to maintain a constructive focus on their own. Sharing feelings and experiences with colleagues helps.

Make Civility, Respect, and Quality Care an Active Force. It’s unrealistic to assume that all employees arrive with the wherewithal to demonstrate respect and emphasize patient safety throughout their work days. Workgroups need a format to experiment with innovative approaches to challenging situations. One effective format is CREW.

Challenging work requires exceptional organizational resilience. Employees need sufficient psychological safety to raise volatile issues at work. They need to know how to challenge one another and how to be challenged by others.

Simply assuming that everyone is on the same page is unrealistic and fraught with peril.

What management practices have you witnessed that assure care for vulnerable individuals?

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