Bullies Will Be Bullies

Having attended a small, private high school, I'm rather familiar with codes of conduct. On the first day of school, we were all told to sign a document that said we'd read the school's disciplinary code and were aware of the consequences of misbehaving. But that didn't mean the school principal sat back with his feet on the desk. There were still those who insisted on pushing the limits.

Does this scenario sound familiar? Probably. As much as I'd like to say that bad behavior got left behind in the high school hallways, most of us have been witness to a co-worker misbehaving in our adult lives. We've all met that colleague who enjoys making people feel bad at meetings, is continually rude to patients, or can't seem to ever be on time for a meeting. They're unpleasant and bad for business in every industry-but according to the Joint Commission, in healthcare, bad behavior puts patients at risk.

That's why the accrediting body issued a safety alert earlier this month calling for hospitals to develop their own codes of conduct for dealing with "bully doctors" before January 1, 2009. But will these "codes of conduct" really change the behavior of the industry's worst offenders?

The answer is probably not. Just as a week's worth of detention didn't stop my high school's biggest bully from terrorizing his classmates, a simple code of conduct won't go very far in deterring your hospital's highest grossing surgeon from yelling at a nurse or fellow physician during surgery. But this isn't to say that I don't give the Joint Commission credit for trying.

Bully doctors—and really, any employee that bullies—are a problem everywhere, but for some reason, it's particularly bad in healthcare. It's something that we as an industry have ignored for years. Why? Well, for one, healthcare has always been a very individualized profession. Physician training is very focused on the individual-how well they score on exams, how well they perform certain procedures, and how their individual performance is evaluated during residency and fellowships. It isn't until they start working in a hospital setting that they are suddenly considered part of a team. As one physician executive I talked to recently said, it's like the star of the track team suddenly becoming a member of the football team.

And of course, there's the old idea that men were meant to be doctors and women were meant to be nurses. That, thankfully, is changing, but I think most hospital executives would admit that there's still a little bit of that old philosophy in the back of the minds of the physicians who cause the most problems. It's changing—but change doesn't happen overnight.

To really make a difference, our hospitals need more than a code of conduct. We need to make sure that our hospitals are a culture where bullying isn't tolerated—at all. CEOs need to show the highest level of leadership, applying a no tolerance policy to hostile behavior, even when the offender is a high-profile, and high-grossing surgeon. While there's certainly a risk in disciplining your organization's top money-maker, there's plenty of risk in not doing so. When employees work in a climate where there is fear, they're less likely to speak up when they see that something isn't right. This hesitancy can lead to a serious medical error that could not only kill a patient, but also put the hospital in serious financial jeopardy.

So where do you start? If your organization's culture hasn't addressed bully behavior before, don't expect to magically solve the problem by putting the word out that it won't be tolerated. Gerald B. Hickson, MD, director of the Vanderbilt Center for Patient & Professional Advocacy, says it has taken Vanderbilt University Medical Center almost 10 years to refine its credo—or culture of no tolerance for unprofessional behavior. He says building this culture has been an ongoing process—one that has seen many changes along the way. He offers the following first steps:

1. Make your administration aware that unprofessional behavior is a threat. If your team doesn't recognize that there is a problem, Hickson says, they won't have a plan to do something about it, nor recognize the threats to quality care.
2. Educate your entire staff—from physicians down to custodians-about why unprofessional—or hostile—behavior is a problem. If your staff recognizes that you, as a leader, are concerned about bullying, they're more likely to come forward when they feel that bullying has occurred, or better yet, tell their co-worker that their behavior is inappropriate.

Will these, or any steps, completely eliminate bully behavior in our hospitals? Not likely. But I do give the Joint Commission credit for putting this issue on the radar and reminding us that it's not just an issue of the workplace, but one that can have dire consequences for quality and patient safety efforts.