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Healthcare Workers Still Face Intimidating and Disruptive Behavior

Cheryl Clark, for HealthLeaders Media, September 3, 2009

Disruptive, offensive behavior on the part of providers is still such a significant and frequent problem in health settings, it jeopardizes patient safety, and can affect quality of care, despite Joint Commission guidance that took effect Jan. 1 to prevent such breakdowns.

Of more than 1,500 providers responding to an e-mail questionnaire, three-fourths said they had been the target of unprofessional, intimidating or inappropriate behavior within the last 24 months. Two-thirds said they considered leaving their job because of it and 41% said they actually did.

The 64-question survey was designed and distributed in May and June by the Center for Patient and Professional Advocacy of Vanderbilt University Medical Center and the Studer Group, an outcomes-based health consulting firm devoted to teaching evidence-based tools and processes, which works with providers to prevent such incidents. Healthcare professionals were solicited through blogs and by e-mail and were promised confidentiality.

The survey defined such behavior in almost the exact terms used by The Joint Commission: Intimidating and disruptive 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.

"Such behaviors include reluctance or refusal to answer questions, return phone calls or pages; condescending language or voice intonation; and impatience with questions. Unprofessional behavior impairs or disrupts a healthcare team member's ability to achieve intended outcomes."

The survey asked respondents not to consider acts of sexual harassment or age, gender or racial discrimination in their responses because they are governed by specific laws.

In a sentinel event alert issued July 9, 2008, the accreditation agency said, "There is a history of tolerance and indifference to intimidating and disruptive behaviors in health care. Organizations that fail to address unprofessional behavior through formal systems are indirectly promoting it."

James Pichert, professor of medical education and co-director of the Vanderbilt Center that guided the survey, says the project was launched in part to learn what factors influence a patient to sue his or her caregiver. It is known that patients who do sue would often report to offices of patient relations that they had witnessed disruptive behavior during their care, he says.

"And when the patient had a bad outcome, the patients felt that it was because the team was not working together," says Pichert.

In one case, for example, someone was on the operating table not fully anesthetized, and would hear an argument breaking out between staff members who gathered around, Pichert explains. "They'd say 'I could feel the tension in the room, and it did not give me confidence. And when I had a bad outcome, I had to wonder whether it was because they were more focused on the argument than they were on me.'"

Pichert says the study cannot be called a scientific one because it was not conducted in a random fashion, and those who answered may have been more likely to respond because they have fresh memories of a hostile encounter.

Only 15% of the 1,521 people responding said they had not been a target of such behavior, according to Colleen Thornburgh, Studer Group coach and speaker.

But Thornburgh adds that the graphic experiences described by those responding raises concerns that such behavior may very well affect quality of care and patient safety.

For example, she says, one technician responded that after being yelled at by a medical superior for asking a question, he now delays asking that person again or doesn't ask at all. "And that delay may be just enough to make a difference in outcome," Thornburgh says. "That's where we see a real threat to quality and safety, maybe not at that moment, but maybe downstream from that moment."

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