Build a Judgement-Free Environment

As a See Me as a Person facilitator and leader, Tina Martin, MSN, RN, NE-BC, Magnet Program Coordinator Lancasterjudgement-free-zone General Health/Penn Medicine sends out weekly thoughts for sharing in huddles or email communications.  We wanted to share this “thought for the week.”  It is a wonderful example of how leaders can re-mind us to step out of auto-pilot reactive thinking/behavior and be intentionally non-judging. 

We all deserve a “judgment free environment.” A fitness chain even advertises that they have a “judgement-free zone” so people feel comfortable exercising without being labeled. It can be easy to fall into the labeling trap. We know “we can’t judge a book by its cover” but we often do. We judge people by their appearance, by the way they talk, by their behavior. We develop preconceived notions before we really get to know a person.

Think of all the labels we place on our patients. We judge them by the amount of times they use their call bell, by the frequency of their hospital admissions, by their addiction disease. Sometimes these labels can create an unsafe environment for our patient, especially when we label our patient by their room number or a diagnosis, without using their name. What about labels we place on our colleagues? We sometimes label an entire department because of the actions of one person.

We all deserve to work and receive care in a “judgement-free environment.”  For today, stop using labels to refer to other people and encourage your colleagues to do the same. You will be amazed at how this change in behavior will leave your mind open to wondering about your colleagues and your patients…and seeing them as a person.


Attuned Care = Safer Care


Each one-point increase on a scale that measured depersonalization — a feeling of withdrawal or of treating patients as objects rather than as human beings — was associated with an 11 percent increase in the likelihood of reporting an error. Each one-point increase on a scale measuring emotional exhaustion was associated with a 5 percent increase.

Annals of Surgery

You probably know death certificates don’t record when a person dies from a medical error.  Still, with surprising frequency, medical errors in various forms including communication break-downs lead to death, near misses and complications, not to mention human suffering.

Patient harm from medical error can occur at the individual or system level

Significantly, we in healthcare are getting better at understanding how communication breakdowns, and misattunement can directly result in patient harm and death. Nonetheless, we spend just a fraction of our healthcare budgets on building skills and accountability to eliminate ineffective human interactions which lead to medical error.


We imagine a day when highly attuned relationships will be an expected part of high quality medical care. Picture this: relationship-based cultures which honor the human dignity of each person. Clinicians meet and connect intentionally with teammates, patients and families. Partnership replaces hierarchy.

Some people criticize relational aspects of medical care as a “needless luxury”.  We teach people how to attune. It is remarkable how quickly people learn this skill when we de-mystify it. Moreover, the learning spreads.  Very quickly we see people model the behaviors, thus, creating a culture in which attuned and caring communication is an expected norm.

Room 372

Agnes Toth
Written and shared with permission by David Abelson, MD, Former Park Nicollet CEO and Health Partners’ Senior Executive
My daughter recently acted in The Hour We Knew Nothing of Each Other, a one act play by Peter Handke. The play depicts a town square with hundreds of characters including old ladies, lovers, children, joggers, mothers, fathers, brides, musicians, clowns, workmen all wordlessly crossing the stage. We glimpse moments in their lives leaving us to wonder about their past and future stories.

The play reminded me of a hospital. Consider the story told to me by a colleague about the patient in room 372. Some people may perceive “bed 372” as a cranky lady who complains excessively about not getting a warm blanket on demand. After all, why should she make such a “big deal” about not immediately getting a warm blanket?

Her name is Shirley. She is 74 years old, a “warrior” who has survived two open heart surgeries, a stroke and several cardioversions for atrial fibrillation. Following each setback or surgery, she fought her way back. She worked hard in rehab five days per week to stay in shape and subsequently befriended the other phase-three rehab patients and staff.

In March, 2007, her husband died, and one month later, so did her son. Caring for her husband toward the end of his life challenged her as she felt powerless and demoralized. One day while talking with her physician, she broke down and cried, recalling a terrifying incident when she was about 10 years old. She and her family were living on a farm in southern Minnesota. Her grandfather was very ill, and staying with the family. The rest of the family left to work the fields, leaving Shirley alone in the house to care for her grandfather. Her grandfather took a rapid turn for the worse, dying while she was alone with him. She felt helpless about getting the help needed to save him.

After her husband and son died, Shirley fought serious loneliness and depression for a year. About six months ago she met John. A couple of weeks ago she and John were about to go out to dinner, when she collapsed in cardiac arrest. John called 911 and performed CPR. The ambulance brought her to Methodist Hospital where she underwent acute re­opening of a blocked circumflex coronary artery. She was placed on the hypothermia protocol (chilled, sedated, and paralyzed) for the first 24 hours to minimize damage to vital organs. Imagine her with suboptimal sedation, unable to move, feeling powerless, and absolutely freezing.

After being in the ICU on a ventilator for two weeks she graduated to room 372. She lost some of her short term memory as a result of the arrest and appears more impatient than before. She finds swallowing difficult and dislikes the soft diet. She’s slowly increased her capability to exercise, but struggles with the amount of muscle strength she’s lost. Some days she gets kind of “cranky.”

And she sometimes gets cold. When she gets chilly, she becomes terrified by an ill-defined recollection of feeling absolutely freezing, unable to move, and powerless to do anything. She feels desperate for a caring person to bring her a warm blanket, to comfort her, ease the cold, and eradicate her sense of powerlessness. Sometimes she must wait for over an hour and gets really “cranky.”

The hospital, viewed as a set in the play, The Hour We Knew Nothing of Each Other, ­presents a stage on which people cross in an average of 4 days. As a snapshot, we see only a “cranky” lady in room 372, unreasonably demanding blankets. Alternatively, consider the intricate back story preceding the snapshot and our privileged position to create a memorable hospital stay adding to the life narrative of the patient and family.