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By Jock Hoffman, CRICO

Related to: Communication, Nursing, Other Specialties, Surgery, Teamwork Training

“Are you stupid, or just incompetent?”

In the midst of a busy day at the hospital, an invective like that uttered by one member of the health care team to another is, undoubtedly, harmful to whomever it is directed. If it delays or adversely alters the course of care, it certainly could be harmful to the patient. If it is repeated in court, under oath, in front of a jury, it will definitely be harmful to the defense of an allegation of malpractice. Regardless if the person being berated was posing a risk, it will be the berater’s behavior that the jurors assess.

Unrestrained physicians and other health care professionals who are accustomed to speaking their minds profanely, throwing around their weight (and the occasional clamp), intimidating subordinates, or berating non-compliant patients—because they can—are about to lose that privilege. Institutions that previously looked the other way when the local rainmaker slapped a tardy float nurse can no longer take that risk. Hospitals, motivated both by concerns for patient safety and by new Joint Commission requirements, are starting to take notice—and action—when a clinician’s behavior disrupts the process of care or threatens a co-workers job or well-being.

The Joint Commission standard, which went into effect January 1, 2009, dictates that hospitals 1) have a written code of conduct that defines disruptive or unacceptable behaviors and 2) a process for enforcing the conduct code and managing violations. While the Joint Commission encourages health care leaders to have zero tolerance (especially for assaults), and suggests a range of responses for disruptive behavior, from requiring apologies to suspending privileges, each accredited organization will need to develop and enforce its own policy. That much leeway is of concern to the American Medical Association (AMA), which fears that the standard will be employed too broadly or for reasons other than protecting patients and providers—for example, ousting whistleblowers or competitors. To date, the Joint Commission has not responded to the AMA’s request to delay enforcement of the behavior standard for one year.

Fighting to delay the standard may only exacerbate intolerance for dysfunctional health care teams. Witnessing or being a part of verbal or physical abuse by a physician or nurse, or sensing that their care is being hindered by behavior issues, gives patients a platform for formal complaints if their care (or outcome) is suboptimal. Patients rely on caregivers who handle differences before they become conflicts and who resolve conflicts before they disrupt their care and treatment.

No doubt, very good physicians can occasionally lash out in anger at a co-worker or slam a door in bad temper. How hospitals and health care networks respond to isolated events and how they address chronic problems are equally important. Proactive training—for teamwork skills and for reporting and addressing disruptive behaviors—must be part of an organizations core competencies and credentialing criteria. Organizations that lack a training program specific to this issue may want to consider one or more of these options.

Additional Material

January 2, 2009
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