Connecting the Dots You Don’t Want to Ignore

Unprofessional and disrespectful behavior among colleagues in health care is often dismissed as part of working in a high-stakes environment. Yet the evidence tells a different story and industry leaders, such as the Joint Commission and Institute for Healthcare Improvement, continue to stress the need for safe, harassment-free workplace cultures to protect both patients and providers from measurable risks.

A recent Candello webinar brought renewed attention to this connection between behavior and safety: Annette Roberts, MSN, RN, Patient Safety Program Director at CRICO, discussed how structured 360° staff behavioral feedback can reveal patterns that traditional reporting systems and patient surveys often miss.

From a risk perspective, unprofessional behavior shows up at several levels:

• Direct employment practices liability (EPL) costs, for example the cost of claims, defense, and settlements
• Medical professional liability (MPL) exposure when disrespect, intimidation, or poor communication contribute to clinical error
• Turnover and morale, especially among nurses and early-career clinicians, who frequently cite “problematic physicians” and toxic work environments as reasons for leaving

Using 360° Feedback to Change Behavior, Not Just
Document It

A promising way to address behavior proactively is through a 360° evaluation paired with coaching. In CRICO’s PULSE 360 pilot program, nearly 1,700 participants (consisting of physicians, advanced practice clinicians, nurses, and leaders) received structured feedback drawn from anonymous surveys completed by their day-to-day colleagues. Roberts explained, “The overarching goal of the program was to help organizations achieve a culture change that led to significant and sustained increases in professionalism, which can in turn reduce EPL and MPL claims.”

Participants were classified into one of the following three categories based on their results:

• Green: strong teamwork and professionalism
• Yellow: worrisome behaviors needing attention
• Red: behaviors with clear negative impact requiring active intervention

Key behavioral themes were gleaned from the entire survey sample:

Crucially, the program pairs results with external coaching, not internal punishment. Participants develop targeted improvement plans and are re-surveyed about six months later; most show measurable improvement. Roberts emphasizes, “Culture and risk go hand in hand, and feedback tools and coaching support for individuals can help them be more effective working and communicating with others.”

Two insights matter for insurers and leaders:

1. Early, structured feedback can avert crises. Many “problem providers” show a pattern of concerning behavior long before it blows up into a claim.
2. Culture change isn’t just about tamping down Reds. The data highlights high-performing “quiet professionals” who are essential to a healthy culture and worth actively retaining.

What Insurers and Clinicians Can Do Now

For MPL insurers:

• Encourage insured organizations to align EPL and MPL strategies instead of treating them as separate worlds.
• Consider supporting or incentivizing behavioral feedback and coaching programs as part of risk-reduction efforts.
• Ask specifically about EPL reporting, code of conduct enforcement, and leadership training during underwriting and risk assessments.

For clinicians and leaders:

• Treat unprofessional behavior as a patient safety signal, not just a personality clash.
• Advocate for transparent reporting pathways and insist on non-retaliatory responses.
• Use tools like 360° feedback, TeamSTEPPS, and simulation as ongoing culture work.

Professionalism is a live variable in the risk profile, and one of the most powerful levers organizations have to protect both patients and the people who care for them.

Additional Resources:

• CRICO Employment Practices Liability Resources - CRICO
• 360 feedback for physicians, nurses, and healthcare professionals – PULSE Program
• Not just a ’soft skill’: How academic hospitals are embedding professionalism into strategy – Becker’s Hospital Review