Perelman's Jody Foster discusses Penn Medicine's new campaign to encourage professionalism in the workplace.

Companies expect every employee to behave respectfully in the workplace, but that doesn’t always happen. A lack of professionalism can imperil an employee’s future, isolate co-workers, upset customers and infect the wider corporate culture. Workplace incivility in health care can be especially harmful because mistakes made by distressed employees can have grave consequences. The Perelman School of Medicine at the University of Pennsylvania has launched a Campaign for Professionalism to mitigate such conflicts.

Jody Foster, clinical associate professor of psychiatry at Perelman and chair of the Department of Psychiatry at the Pennsylvania Hospital, is the executive clinical director of the professionalism campaign. She spoke to the Knowledge at Wharton radio show on SiriusXM about why Penn Medicine is leading the charge to bring civility back to the workplace — and perhaps the culture at large. (Listen to the podcast at the top of this page.)

An edited transcript of the conversation follows.

Knowledge at Wharton: You were co-author of a book that came out two years ago, The Schmuck in My Office: How to Deal Effectively With Difficult People at Work. This campaign brings that book to mind because unprofessionalism is a growing concern. Tell us about the campaign.

Jody Foster: This is an absolutely ubiquitous issue, and it’s become much more of a cultural conversation these days. The culture is changing. You really can’t read an article or hear the news without hearing something about somebody’s behavior in some way lately. The cultural threshold for tolerance of incivility and lapses in professionalism has really just dropped.

[Perelman School of Medicine Dean] Larry Jameson was reviewing some of the comments from our medical students about their experiences on some of the clinical rotations. In reading some of the comments, it really drove home that professionalism is an issue right here at home and that we need to really address it in a structured way.

The announcement of the campaign came in May, and there was a decision to have an assistant dean for professionalism. I was happily chosen to take on that role. We’ve been doing a number of things to try to lay the foundation and the scaffolding to build a professionalism structure that will, over time, change our culture. One of those things is a value statement. What is professionalism at Penn Medicine? What is our code of conduct?

I think code of conducts can be a little funny because when you’re about to act out in some way, if you’re going to do something terrible, you don’t say, “Hey, wait, let me check the code of conduct to see if I can do this.” At the same time, it lays out what you believe in and what your value system is. This becomes important in pretty much every aspect of work, particularly as you’re bringing someone into an organization.

The clearer you are when you’re interviewing somebody about what your culture and value system is, the more able you’re going to be to convey those rules of engagement. In so doing, you’re going to be able to convey to the people who are interviewing for jobs at your organization that this is a place that melds with who I am or does not. It helps people make better decisions about fitting themselves in appropriate cultures. That alone can bypass a number of the conflicts that come up in a workplace.

Knowledge at Wharton: Is it at that human resources point where professionalism starts for the entire company?

Foster: I would say that cultural misfits are a big reason for conflicts that occur in the workplace. That’s just one part of our campaign for professionalism, but it’s a super important part. It’s so important that we are in the process of developing something that we’re calling a success profile, where we’ve collected the five or six top lapses or breaches of professionalism that occur.

These are stories that occur over and over again, and we’re turning it on its side and saying, “If this is what the behavior that we don’t support looks like, what does behavior that we want to encourage look like?” We’re creating a success profile template based upon that, so that when we’re thinking about promoting someone or giving an award to somebody, we can say, “This person really does embody or exemplify these qualities.”

“People don’t set out to be disruptive. People are people, and we all have traits.”

It’s certainly my belief, and I think an appropriate belief, that people are not inherently malicious. People don’t set out to be disruptive. People are people, and we all have traits, we all have characteristics. We bring those characteristics around with us all the time — at home, at work, whatever. If we have inadvertently found ourselves in a culture where the way that we navigate the world doesn’t work, we are going to have conflicts.

Knowledge at Wharton: Many companies have wellness programs to improve the physical health of the employee. Should there be programs to improve the mental side as well?

Foster: Improving wellness, by design, will improve the mental side. Work is inherently stressful, depending on what you’re doing. It’s the very lucky person whose work is just nothing but joy and relaxation all day long. Even just the statement made by paying attention to wellness, to the things that drag a person down at the workplace, is important because it is these little itty-bitty things that taken together make up the work day. And collections of work days make up a work life.

Knowledge at Wharton: Professionalism isn’t just incumbent on employees. It goes all the way up to the C-suite. We’ve all seen stories about the lack of professionalism at the top level.

Foster: That’s exactly right, and that’s why it’s so important for there to be a bought-into code, an ethical code, an accountable,  social contract that this is how we behave here. If the CEO or someone in the C-suite is not behaving that way and continue to be propagated amidst statements to the contrary, well, that’s going to undermine the entire process. It’s like having a zero-tolerance policy for behavior, and then when somebody breaches it, saying, “Oh, OK, just this once.” It just doesn’t work.

Knowledge at Wharton: More companies are relying on teams of workers, rather than individual employees, to collaborate and tackle projects. That’s a dynamic that requires professionalism.

Foster: We have to create what we call psychologically safe cultures where, if something’s occurring in the team or with a co-worker that is upsetting, disruptive, difficult, whatever it is, it’s safe to say, “I don’t like that” or “That doesn’t work for me” or “I don’t like what you just did.” Because a lot of the noise that occurs around incivility and professionalism has to do with the fact that we simply don’t directly intervene with one another in the moment, when these things come up.

If you have a team where there’s a sore thumb who’s really disrupting various aspects of the flow of the team and nobody feels safe enough to give feedback or to intervene or to make structural changes around it, you’re going to have a problem that’s going to bring the whole team down.

Knowledge at Wharton: Let’s take this into the realm of medicine. How prevalent are some of these issues within a hospital setting and the wider medical industry?

Foster: The issues are ubiquitous, and I would say they are as ubiquitous in the medical industry as everywhere else. The thing about the medical industry is that the stakes are higher because if there is behavior that undermines a culture of safety, then people on edge who are taking care of other people are more apt to make mistakes. And then it becomes dangerous.

We are dealing with people who are sick. The task at hand is to figure out what’s wrong and make people better. If we find ourselves too involved in this noise on the side, that’s obviously going to detract from the mission at hand. That’s why this is such a high stakes area.

“Cultural misfits are a big reason for conflicts that occur in the workplace.”

Knowledge at Wharton: Is creating a standard of professionalism in a hospital setting the same as in any other business?

Foster: Completely. I always joked that when it was time to decide what to call the book, we called it The Schmuck in My Office. But it could just has easily had been The Schmuck In My Doctor’s Office, The Schmuck in My Bedroom, The Schmuck in My Church. Whatever it is, it doesn’t matter where. These situations are everywhere.

Knowledge at Wharton: No matter how smoothly an operation may run, you’re going to have somebody who is that disruptor, who is stirring the pot, who doesn’t want to follow the normal path.

Foster: An interesting data point on that: The person who is being perceived as a disruptor, in so many of the cases, does not even have awareness that he or she is a disruptor. The data shows that in about 80% of the cases, if you simply confront somebody with their behavior, they will say, “Oh, I didn’t know,” and they’ll stop. But we don’t intervene because it’s uncomfortable. We let things spiral, which is an implicit statement to the bad actor that the behavior is fine. And that’s how these things grow like viruses.

Knowledge at Wharton: How can a company start doing a program like this?

Foster: A lot of it has to do with knowing one’s self. Again, this is why we start with our values and our code of conduct. The clearer we are on what is and is not acceptable in our culture, the clearer we are going to be in terms of our boundaries. What are we seeking in somebody that we hire, that we promote, that we reward? What kind of place do we want this to be? This is as relevant to an individual person as it is to a corporation. The better we know ourselves, the better able we are to convey what is and is not acceptable in our environment. That is part of the strategy system to mitigating the number and intensity of conflictual events that occur.

Knowledge at Wharton: How should employees deal with the office disruptor?

Foster: Our natural tendency is to talk about it among ourselves at the water cooler, which is a time-waster, a productivity-downer and a preoccupier that impacts the function of the company. What I would suggest is that direct intervention is the way to go. Like I said, in 80% of cases, that person doesn’t know that this behavior that he or she has been carrying around with them for 30, 40, 50 years is a problem here. Once they hear about it, they may say, “Well, you know, that’s me. Screw you.” In which case, you have a better idea of who you’re dealing with. More likely than not, that person will say, “Oh, I didn’t realize that was a problem. I’m so sorry.”

Because our natural tendencies are to behave in patterns, six months later when that bad actor is doing that behavior again because it’s natural for him or her, you will be able to come back and say, “Hey Joe, you’re doing that thing again that we talked to you about.” It’s so much easier to just do a refresher than to wait six months, one year, 10 years and then say, “This thing you have always been doing is a problem.”

Knowledge at Wharton: But you also have to do it through the proper structure, the proper path of what the company is doing. You can’t fall into the path of the disruptor.

Foster: Look at the data out of [management consulting firm] ghSMART that says that the cost of a bad hire is 15 to 20 times that person’s salary. If that individual was allowed to hire his or her own team, the costs skyrocket exponentially. So yeah, absolutely. But it all starts with direct communication. The more we can nip things in the bud and be direct and intervene early and be clear and concise in what we have to say about what is going wrong, the better the message is going to come across. And the better it’s going to be received.

Knowledge at Wharton: How should management handle the agitator?

Foster: This comes up in every industry. It is not uncommon where the rainmaker gets special treatment, and that really undermines the morale of an institution. So, it really starts at the top. There has to be leadership buy-in. That’s why it’s so great that Penn has initiated a professionalism campaign coming from the dean. There has to be leadership buy-in that this behavior is not tolerated, no matter who you are, no matter where it’s coming from. And you’re not going to thrive here if this is what you’re bringing to the table.

“The cost of a bad hire is 15 to 20 times that person’s salary.”

That message alone is unbelievably important. That allows fertile ground for a safe environment where people may have a lower threshold to directly in the moment, say, “This thing that you are doing right now is a problem for me. Here’s why. Can you please stop?” When that doesn’t work or when that’s too uncomfortable, then there is a leadership structure in place that’s willing and able to receive these complaints or these concerns and do something about it. This is what can really scratch away at morale in an organization when that’s not present.

Knowledge at Wharton: Has the #MeToo movement and the culture in general put greater focus on bringing back civility in the workplace?

Foster: Absolutely. There’s another side effect of that, which is that on the other side of people who are complaining or have concerns are the people who don’t want to engender complaints and don’t know how to act. A lot of people are walking around in emotional straitjackets, saying, “I don’t know what I am allowed to do and not do.” Again, the clearer we are on what’s OK and what’s not OK, it makes it easier for everybody to identify the abhorrent and to intervene with the abhorrent.

Our code is 10 general items. We borrowed from the 10 Commandments and just used 10 basic principles that, if you can’t sign onto these 10 basic things, then you’re almost pointing a finger at yourself saying, “I’m going to be a problem.”

Knowledge at Wharton: Are you already seeing an impact at Penn Medicine?

Foster: We are seeing a tremendous impact. We are having a sharp uptick in the issues that are coming forward. We are having a lot more attention paid to behavior as opposed to some of the other things that we’ve pointed to. We’re doing more interventions. I’m personally taking more than 100 calls a month on my cellphone, with people asking me, “You know, this happened. Is this OK?” And I say, “No, it’s really not OK. That’s exactly what we want to intervene with. Can I help you with that?” It is already raising the bar. I know that the deans of the other schools are saying, “What’s happening at Penn Medicine? I think we maybe need to look at that for our school as well.” And we know it’s happening in the world at large as well.