The Joint Commission to hospitals: Monitor, correct disruptive behaviors
The Joint Commission to hospitals: Monitor, correct disruptive behaviors
Bad behavior: Unethical or just inappropriate?
The Joint Commission in Oakbrook Terrace, IL, on July 9 issued a Sentinel Alert that would require hospitals to establish policies that address, manage and correct what it refers to as "intimidating and disruptive behaviors" by health care professionals in the facility setting.
The new requirement becomes effective Jan. 1, 2009.
According to the alert, such behaviors "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."
"Most health care workers do their jobs with care, compassion, and professionalism," says Mark R. Chassin, MD, MPP, MPH, president, The Joint Commission. "But sometimes professionalism breaks down and caregivers engage in behaviors that threaten patient safety. It is important for organizations to take a stand by clearly identifying such behaviors and refusing to tolerate them."
And the edict covers not only physicians, but also nurses, pharmacists, therapists, support staff, and administrators.
"Intimidating and disruptive behaviors in health care organizations are not rare," according to the Sentinel Event Alert Issue 40.
The alert notes that a survey conducted by the Institute for Safe Medication Practices (ISMP) found that 40% of "clinicians have kept quiet or remained passive during patient care events rather than question a known intimidator."
"The presence of intimidating and disruptive behaviors in an organization, however, erodes professional behavior and creates an unhealthy or even hostile work environment — one that is readily recognized by patients and their families," the alert states.
It also cites studies that link patient complaints about disruptive behavior and malpractice risks.
"There is a history of tolerance and indifference to intimidating and disruptive behaviors in health care," the alert states. "Organizations that fail to address unprofessional behavior stems from both individual and systemic factors."
Some of the reasons cited as possible factors contributing to unprofessional behavior are unique to the health care environment, and those include, according to the alert:
- increased productivity requirements;
- cost containment dictates;
- the hierarchal nature of the health care system;
- fear of or stress from litigation;
- changing personnel and/or roles of the health care team.
"I think the important question as to why this occurs in the workplace that's much more important than the psychological issues is this: bullying occurs in the workplace, disruptive behavior occurs . . . because it is allowed to occur in the workplace. That's the answer," says John Banja, PhD, clinical ethicist with the Center for Ethics and professor of rehabilitative medicine at Emory University in Atlanta.
Banja suggests that health care institutions need to understand how disruptive behavior can affect morale and how it affects that institution's delivery of health care to patients. And it is an ethical issue, he says, because people don't have the "moral right" to treat others in a disrespectful fashion.
For example, a nurse who has just been screamed at by a physician is not likely to be at his or her best when treating the next patient.
"Very, very often, people will leave the workplace — and these are good people — because they just can't stand to be around somebody with that kind of profoundly disrespectful behavior."
That results in bottom-line costs to the institution for recruiting new employees and training them.
"It's interesting that a lot of these people who [act out] these unprofessional behaviors actually don't think they're being unprofessional," Banja suggests.
Often, they believe that their behavior is "funny or amusing," especially when sexual innuendo is involved.
One reason that they aren't aware that their behavior creates problems for those around them is that, in many instances, no one has ever addressed the demeaning behavior and held them accountable for it.
One strategy that Banja suggests could be a simple intervention by someone of equal standing or higher in the organization to pull the offending health care professional aside and actually point out that they are being disrespectful, abusive or otherwise unprofessional.
"Often, just that sort of intervention alone, as a matter of fact, is enough to stop that behavior," Banja says. "It may not stop it forever. The person may need a tune-up from time to time. But it has been known to do good."
Suggestions to improve the situation
The Joint Commission has said that effective on the first day of 2009, it has a new Leadership standard for all of its accreditation programs in "two of its elements of performance" requiring both a code of conduct as well as a process for applying corrective measures for those who engage in disruptive behaviors.
The Joint Commission outlined 11 "suggested actions" in addition to the new Leadership standard. Those suggestions indicate that there should be "zero tolerance" for such behaviors, particularly the worst kind of behavior, such as assault or other criminal acts. The Joint Commission also suggests incorporating this policy "into medical staff bylaws and employment agreements as well as administrative policies."
Another suggestion is one to "develop and implement a reporting/surveillance system (possibly anonymous) for detecting unprofessional behavior."
The Commission also suggests "tiered, non-confrontational interventional strategies," beginning with what it calls "'cup of coffee' conversations." The commission also suggests "adequate resources to support individuals whose behavior is influenced by physical or mental health pathologies."
But there's no doubt that the overall message is: hospitals should not tolerate such behavior, or they do so at the risk of negatively impacting the institutional work environment, patient safety — and perhaps their bottom line.
Sources
For more information, contact:
- John Banja, PhD, clinical ethicist, associate professor of rehabilitative medicine, Emory University, Atlanta. E-mail: [email protected].
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.