SDS Accreditation Update

Are you prepared to address 'health care road rage'? Jan. 1 deadline is looming for TJC

The orthopedic surgeon was running late for two procedures, and there were two new nurses in the room. He became frustrated with a pair of scissors. The surgeon threw them and almost hit a nurse. His hospital requires physicians to treat colleagues with "civility and respect," so he was disciplined. The hospital required team training for all OR staff. The surgeon hasn't had another incident in the year since then.1

At another hospital, an orthopedic surgeon yelled at the staff over six years, including name-calling such as "lame-brain." He called one nurse an "idiot" for seeking additional patient consent before a procedure. He later threw two 10-pound sandbags to the floor, and one hit a nurse's foot. That was the ninth complaint against the surgeon, and he was suspended.1

It's called "health care road rage." And it not only harms staff relations, but it also has the potential to endanger patient safety.

Surveyors with The Joint Commission (TJC) regularly hear stories about offensive language, yelling, and occasional throwing of objects when they visit facilities, says Peter Angood, MD, vice president and chief patient safety officer for TJC. Some attribute the rise in reports to providers' frustration over increasing financial pressures.1 Angood said many health care facilities have tolerated bad behavior to the point where it's become an accepted norm of behavior. That acceptance can be particularly prevalent in surgery, which has high stakes and attracts physicians with intense personalities who are accustomed to being in charge, some say.1

Joint Commission alert issued

The problem has the attention of TJC, which in July issued a Sentinel Event Alert addressing bad behavior. By Jan. 1, TJC is requiring all hospitals and ambulatory centers to adopt a code of conduct and establishes a formal process for managing unacceptable behavior. Standards for the Accreditation Association for Ambulatory Health Care say that organizations should address appropriate behavior and expectations and disciplinary actions as a result of policy infractions.

North Shore Medical Center in Salem, MA, which disciplined the scissor-throwing physician, said in a statement, "Our commitment to civility is promoted, not merely because it creates a better working environment, but also because it creates a safer one." The hospital's Civility and Respect Policy says that, among other things, all employees are expected to refrain from using abusive language, racial slurs, threats of violence, and sexual innuendos; refrain from favoritism and criticizing staff in front of others; and communicate to others with respect and respond to requests appropriately.

"The code of conduct is meant to be one that sets the tone for respectful civil behavior in an organization," Angood says. TJC doesn't prescribe what the contents should be. "In an ideal world, it would state what unacceptable behavior won't be tolerated," he says. "It's up to the individual organization to develop and state which unacceptable behaviors won't be tolerated."


  1. Kowalczyk L. Hospitals try to calm doctors' outbursts — Medical road rage affecting patient safety, group says. The Boston Globe, Aug. 10, 2008. Accessed at