Sounding the alarm on disruptive behavior

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Work environment

Sounding the alarm on disruptive behavior

Many nurses have experienced disruptive physician behavior and the hostile work environment it can create. Now, there is proof that such behavior contributes to medical errors, poor patient satisfaction, and higher cost of care.

The Joint Commission (formerly JCAHO) issued a Sentinel Event Alert July 9 citing an “Institute for Safe Medication Practices” study. The study reveals some disturbing statistics. For example, 40% of clinicians have refrained from questioning someone who might be providing inappropriate care because that person’s behavior was intimidating.

The Joint Commission’s 2009 leadership standards require hospitals to create a code of conduct defining acceptable and unacceptable behavior and develop a formal process for addressing unacceptable behavior for all healthcare professionals.

Hospitals can put what they have learned from dealing with disruptive physicians to good use when developing a facilitywide system for addressing disruptive behavior.

A toxic environment

Iris Grimm, creator of the Balanced Physician Program, an Atlanta-based coaching and consulting firm, says that 80%–90% of the physicians she works with cite pressures in their professional and personal lives as a cause of inappropriate behavior.

Reasons aside, disruptive behavior can turn a positive hospital culture into a toxic environment. Richard A. Sheff, MD, CMSL, chair and executive director at The Greeley Company, a division of HCPro, Inc., in Marblehead, MA, says disruptive behavior can:

  • Contribute to nursing turnover and low staff morale
  • Tarnish the hospital’s reputation
  • Put the hospital at risk for hostile work environment lawsuits
  • Increase medical errors

To effectively address disruptive behavior, hospitals first need to formally define appropriate and inappropriate behavior in their disruptive behavior policies.

Carolyn Bachamp, CPMSM, a medical staff services professional at Boulder (CO) Community Hospital, says her organization’s disruptive behavior policy defines disruptive behavior as conduct that:

  • Disrupts the operation of the hospital
  • Affects the ability of others to work
  • Does not follow accepted professional-behavior norms
  • Creates an unprofessional or hostile work environment for hospital employees or other practitioners
  • Has the potential to negatively affect patient care

Establish policies to address offenders

Hospitals should also address in their policies processes for dealing with different kinds of offenders.

First-time offenders should be pulled aside and addressed in private by the person on the receiving end of the disruptive behavior. Sheff suggests using the following language: “When you speak to me that way, it is not professional or appropriate, and it is not conducive to our policy. Please do not address me that way again.”

Occasional offenders should be spoken to in private, and if this tactic fails, someone who witnessed the disruptive behavior may file an incident report. If the offender is a physician, a nursing staff leader should initiate a dialogue with the physician to help him or her see how the behavior affects others and take steps toward correcting it.

Chronic offenders are not likely to respond to the above language, and their superiors need to be involved on an ongoing basis. If the offender is a physician, medical staff leaders might need to put his or her privileges or medical staff membership at stake—even if the physician admits a large volume of patients.


Adapted from Medical Staff Briefing, October 2008, HCPro, Inc.