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A critical look at latest academic and publications research including The Joint Commission Journal on Quality and Patient Safety as well as Health Research Services initiatives with partner organizations.

The Consequences of Unchecked Disruptive Behaviors in Health Care

30/01/2020

By:

By Kyle J. Rehder, MD, medical director, Duke Center for Healthcare Safety and Quality
 
The cynical, angry doctor. The dismissive, callous nurse. The condescending administrator.
 
These characters are so often associated with hospital culture that each of them seems to have a position of honor on every fictional medical television show. While these individuals do not represent the vast majority of highly professional and caring health care workers, their impact on organizational culture is disproportionately large. 
 
Think about the last time someone was rude to you: How many hours later was that moment still negatively affecting your mood? How long  were you still thinking about what they said or how you wish you would have responded to them in the moment? Incivility and unprofessionalism erode a culture of safety through disastrous effects on:
  • open communication
  • psychological safety
  • organizational learning. 

Our recent study in The Joint Commission Journal on Quality and Patient Safety demonstrated the prevalence and impact of health care worker disruptive behaviors in a large U.S. health system. Over half of health care workers reported exposure to one of six specified disruptive behaviors, ranging from hanging up the phone before a conversation was over to physical aggression towards others. These behaviors were reported by staff in 98% of clinical and non-clinical work settings. 

More concerning was the impact of disruptive behaviors on culture within that work setting. There was a strong and significant unfavorable association between the reported prevalence of the behaviors and:

  • safety and teamwork climate
  • job satisfaction
  • perception of management
  • work-life balance
  • staff burnout and depression

Prior studies also have reported associations between disruptive behaviors and:

Our study highlights the high number of health care workers who are exposed to disruptive behaviors on a routine basis. Not only is there a lack of recognition of incivility as a safety risk, avoidance of conflict and fears of retribution often lead to allowance and underreporting of disruptive behaviors


Reducing Disruptive Behaviors
The first step to reducing disruptive behaviors is calling out unprofessional acts as both a safety risk and as conduct contrary to the mission of the organization. The small number of providers who display particularly egregious acts or recurrent unprofessional behaviors have a profound deleterious impact on work culture and patient care. 

These providers’ behaviors must be addressed through intensive corrective actions such as:

  • restrictions on clinical activities
  • removal from leadership roles
  • possible dismissal

The majority of providers displaying a single unprofessional act, however, may have an “off” day or undue stress leading to an uncharacteristic break from their typical professional demeanor. 

Vanderbilt University Medical Center, Duke and other hospitals have had success using peer messenger programs to provide feedback to providers who act unprofessionally. Rapidly addressing unacceptable behaviors drives accountability, while use of peer messengers allows feedback to be delivered in a non-punitive manner. The impact a “cup of coffee” conversation can have on disruptive behaviors is explored in depth in this blog from Vanderbilt University . Only a small number of providers will not self-correct their behavior after such a conversation. 

Unprofessional and disruptive behaviors have wide reaching negative effects on both staff and patients. As health care institutions strive to reach zero harm, it is essential they understand the scope and impact of disruptive behaviors within their organizations and employ effective strategies to address them among their staff.

Kyle J. Rehder, MD, is medical director at the Duke Center for Healthcare Safety and Quality, and associate professor of Pediatrics at the Duke University School of Medicine, Durham, North Carolina. His current research interests focus on patient safety, including assessing and understanding safety culture, new methods to teach and support teamwork, and burnout and resilience in health care providers.