Healthcare Workers Still Face Intimidating and Disruptive Behavior

Thornburgh and Pichert believe the questionnaire's responses are a strong indication that a significant problem remains in healthcare settings. For example, some of those who participated gave these examples of their anger and frustration with their interactions with superiors or peers:

• "A physician wanted to do something that put the patient in an unsafe situation, violated State and Federal laws and regulations and JCAHO standards. When I informed the physician he couldn't do this, and that he put patients at risk, he told me I couldn't do that and he would have me fired...The physician was yelling and using many expletives."
• "I have been targeted by a physician that exhibits unprofessional behavior on a regular basis. He yells, throws charts and degrades nurses always looking for something wrong and someone to blame. He has told patients not to listen to the nurses; they don't know what they are talking about. His behavior is not addressed—he is one of our biggest admitters."

Those initiating such behavior most often were nurses, physicians, managers or administrators, according to the survey results.

The issue of intimidating and disruptive behavior among workers in healthcare settings is bound to receive more attention as hospitals attempt to comply with new rules and recommendations from the Joint Commission.

Effective Jan. 1, 2009, all Joint Commission accredited programs must have adopted leadership standards that address "disruptive and inappropriate behaviors" in two ways:

1. 1. The hospital or organization has a code of conduct that defines acceptable and disruptive and inappropriate behaviors
2. 2. Leaders create and implement a process for managing disruptive and inappropriate behaviors.

Additionally, the agency suggests 16 other actions, including adoption of "zero tolerance" for intimidating and/or disruptive behaviors, especially the most egregious instances...such as assault and other criminal acts," and "reducing fear of intimidation or retribution and protecting those who report or cooperate in the investigation of intimidating, disruptive and other unprofessional behavior."

The commission's Sentinel Event Alert references studies showing that disruptive and intimidating behavior "can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care and cause qualified clinicians, administrators and managers to seek new positions in more professional environments."