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    Intimidating and disruptive behaviors

    A JCAHO leadership standard, which became effective January 1, 2009, requires hospitals and other accredited organizations to adopt and implement a code of conduct that defines and manages disruptive or inappropriate behavior by physicians and administrators.

    Leadership Standard LD. was announced in Sentinel Event Alert 40 issued on July 9, 2008, titled “Behaviors That Undermine a Culture of Safety,” posted at Targeted behavior patterns include overt actions such as verbal outbursts and physical threats as well as passive activities such as refusing to perform assigned tasks or quietly exhibiting uncooperative attitudes during routine activities, reluctance or refusal to answer questions, return phone calls or pages, condescending language or voice intonation and impatience with questions.

    While we know that most healthcare workers perform their duties with care, compassion and professionalism, there are times when professionalism breaks down and can devolve into unprofessional behaviors.

    This can threaten patient safety, and therefore it is imperative that healthcare organizations take a stand by clearly identifying such behaviors and refusing to tolerate them.

    But the way healthcare professionals interact with each other is also an important factor—which is why collaborative care is an essential foundation to building a culture of safety.

    Certain forms of unproductive conflict in the workplace can undermine professional collaboration, which may place patients at risk.

    There is a growing focus on the role of prevailing hospital culture as a contributing factor in medical errors, and the healthcare industry has begun to realize that human interaction is an important source or error.

    (TJC Standard LD., EP 4, EP 5, effective January 1, 2009.) EP 4 states “The hospital/organization has a code of conduct that defines acceptable and disruptive and inappropriate behaviors.” EP 5 stipulates that “Leaders create and implement a process for managing disruptive and inappropriate behaviors.” These are the only TJC requirements actually effective January 1, 2009.

    TJC has said that it also will incorporate interpersonal skills and professionalism as part of the core competencies in the credentialing process.

    When relationships break down between providers, patient safety is threatened.

    For example, one survey found shockingly high numbers of providers who reported they had avoided interacting with another provider who was prone to disruptive communication—even to the point of not clarifying vague orders or feeling pressured to dispense a medication despite concerns about its safety.

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