July 9, 2008 -- Intimidating and disruptive behaviors from health care workers are "not rare" in hospitals and other health care organizations, and a U.S. hospital accreditation group today put that behavior in permanent time-out.
"By allowing this type of behavior to go unchecked, health care organizations are tacitly condoning it," Mark Chassin, MD, MPP, MPH, president of The Joint Commission, said at a news conference. "Enough is enough."
The Joint Commission's new standards -- which go into effect on Jan. 1, 2009 -- require hospitals and other health care organizations to develop a code of conduct and a system to deal with bad behaviors ranging from being uncooperative to being verbally or physically abusive -- even if the offender is a big shot doctor or an administrator.
Range of Bad Behaviors
"We're talking about a spectrum of different behaviors that encompasses passive-aggressive behaviors like refusing to answer questions or answer pages, condescending or demeaning attitudes, verbal abuse, all the way to physical threats that jeopardize safety," says Chassin.
Exactly how common those behaviors are isn't clear. But The Joint Commission says intimidating and disruptive behaviors undermine trust and make for poor communication, which can lead to medical errors and compromise patient safety.
"A surgeon who berates the OR team for daring to ask a question, a nurse who exhibits passive-aggressive behavior with her peers or his peers, a pharmacist who makes it clear that no double-checking of this pharmacist's work is necessary -- these are just a few examples. But these are how the mistakes are made," says Peter Angood, MD, The Joint Commission's vice president and chief patient safety officer.
Most health care workers are usually professional. But "there are very real stresses in health care because the stakes are high," says Chassin. "Health care professionals are often pushed to the breaking point both mentally and physically, but there's a right way and a wrong way to manage that stress."
It's up to hospitals to write their own codes of conduct. The Joint Commission's suggestions include teaching staff about basic business etiquette and people skills, making sure health care workers aren't afraid to report problems, and setting a "zero tolerance" policy for intimidating and disruptive behavior.