Problem Docs

The Hospitalist. 2009 May;2009(05):

May 11, 2009|The Hospitalist

In a survey distributed to 50 member hospitals by Allen Rosenstein, MD, and his colleagues at VHA Inc. (an alliance of 2,400 nonprofit health care organizations) more than 1,500 participants responded to questions pertaining to their colleagues’ behavior.1 Of the 965 respondents to the question Have you ever witnessed disruptive behavior from a physician at your hospital?, nearly 68% said yes. Of the 675 nurses who responded to the question, 86% said they had witnessed it; almost half of the 249 physician respondents said they had witnessed it from their peers. Most respondents estimated the number of either nurses or physicians who exhibited disruptive behavior to be 1%-3%.

Of the 1,416 respondents who answered the question How often does physician disruptive behavior occur at your hospital?, 22% answered “weekly,” 26% answered “1 to 2 times per month,” and 33% answered “1 to 5 times per year.” Interestingly, 11% of the respondents said that such behavior by physicians never occurs, but 8% said it’s a daily occurrence.

I think what has changed is people are less willing to tolerate this persistently. I think people used to put up with the disruptive physician, the badly behaving physician, and if he was bringing in lots of research dollars or if he was a great scientist, [they’d be more likely to] accept bad behavior.

—Scott Flanders, associate professor of medicine at the University of Michigan and director of the Hospitalist Program, Ann Arbor

Disruptive Behavior Defined

Disruptive behavior includes anything that interferes with the ability of a healthcare professional to effectively perform his or her duties or any behavior that undermines confidence in the hospital or its workers.2-4 In general, “disruptive” refers to behaviors that are abusive, disrespectful, sexual, angry, critical, negative, inappropriate, or unethical.2 (See “What Is Disruptive Behavior?” p. 40.) Individuals termed “impaired” are those who have active addictions or psychiatric problems and who exhibit the disruptive, intimidating, or abusive behavior.

Most respondents to the above-mentioned survey reported that disruptive behavior had negative or worsening effects on stress, frustration, concentration, communication, collaboration, information transfer, and workplace relationships. (See Figure 1, p. 41.)

“Physicians whose performance persistently falters pose a substantial threat to patient safety that is often unrecognized or unsatisfactorily addressed in hospitals and other healthcare organizations,” writes Lucian Leape, MD, adjunct professor of health policy in the Department of Health Policy and Management at the Harvard School of Public Health.2

“Whoever tells you that they have not experienced any kind of disruptive behavior is either lying or … in neglect, because there are always certain types of disruptive behaviors [among healthcare workers],” says Martin Izakovic, MD, medical director, Hospitalist Program, Mercy Hospital, Iowa City, Iowa.

What is Disruptive Behavior?2-4

Profane or disrespectful language, including condescending intonation and verbal abuse;
Demeaning behavior, such as name-calling;
Threatening body language;
Sexual comments or innuendo;
Inappropriate touching, sexual or otherwise;
Racial or ethnic jokes;
Outbursts of anger;
Impatience with questions;
Throwing instruments, charts, or other objects;
Direct physical abuse;
Criticizing other caregivers in front of patients or other staff;
Comments that undermine a patient's trust in other caregivers or the hospital;
Comments that undermine a caregiver's self-confidence in caring for patients;
Failure to adequately address safety concerns or patient care needs expressed by another caregiver;
Intimidating behavior that has the effect of suppressing input by other members of the healthcare team;
Deliberate failure to adhere to organizational policies without adequate evidence to support the alternative chosen; and
Retaliation against any member of the healthcare team who has reported an instance of violation of the code of conduct or who has participated in the investigation of such an incident, regardless of the perceived veracity of the report.