She suggests organizing an interdisciplinary committee to deal with formal complaints. Whenever an incident happens, no matter with whom, it then comes before a group of three or four people, including a physician, a nurse, and maybe some people from HR. That group examines the behavior and decides what actions should be taken. The multidisciplinary committee ensures actions are based on behavior, rather than who the complaint is about.
Bartholomew is a proponent of working on relationships on a personal level to help overcome the strong culture of hierarchy and power that plagues physician-nurse relationships. She recommends physicians go up to a charge nurse with whom they work frequently and ask, "What do you like that I do that improves patient care? What do you want to see more of?" And nurses should have similar conversations with the physicians.
Another strategy involves staging a physician and nursing summit. As a group, the nurses discuss and come up with a list of the five things physicians do that really bother them regarding patient care. And the physicians do the same thing about the nursing staff. Then they get together over dinner and discuss the results. For it to work, the focus has to be on patient care, rather than simply the relationships. The groups have to look at what they can do as a team to improve patient care.
Removing barriers that inhibit communication is ultimately one of the best ways to improve relationships and patient safety.
"We don't even have holiday parties together," says Bartholomew. "Doctors have them at a doctor's house and the nurses have them at a nurses' house. Until we can get rid of this segregation, we'll never have safe patient care."
Ultimately, no matter how good you think the relationships at your organization are, they can always be better. And if they are, then patients will be safer.