Risk managers must act on disruptive behavior, says Alan H. Rosenstein, MD, vice president and medical director at VHA in Irving, TX. Do not dismiss disruptive behavior as merely an unfortunate fact in any work environment because in health care, the result is not a bad batch of widgets. It’s a patient who is needlessly harmed.
"Disruptive behavior needs to be addressed at the organizational level," he says. "Hospitals need to invest time and resources into performing self-assessments, increasing staff awareness of the issue, opening lines of communication, and creating greater collaboration between peers. If hospitals don’t do this, the problem will continue to grow and patients will continue to needlessly suffer."
This is what Rosenstein recommends:
• Raise awareness. The first step often is simply raising awareness among health care staff and physicians, say Rosenstein and Michelle O’Daniel, director of member relations. Present the evidence to show that disruptive behavior is dangerous to patient safety and establish that your organization will not tolerate it.
• Assess the severity of your own problem. Do an internal assessment, looking for the problems that may have been kept secret because no one thought leadership was interested in helping. This may require a confidential survey or some other method that allows people to report problems without retribution.
• Provide structured educational programs. Topics might include communication skills, phone etiquette, conflict management, and diversity training. The idea is to train people to prevent disruptive behavior and also how to respond so that initial confrontations do not escalate. One of the most effective ways to improve relationships between physicians and nurses, for instance, is to train nurses in the proper way to call physicians at home.
• Establish a zero-tolerance policy for disruptive behavior. Such a policy must apply across the board, O’Daniel notes. "It can’t just be for the physicians or just for the physicians who don’t bring in a lot of money," she says. "It has to apply to everyone and they must know what happens when they don’t adhere to it."
Many organizations already have a code of conduct that is applied unevenly or ineffectively, O’Daniel says. Merely having a code of conduct or a zero-tolerance policy doesn’t help unless you are willing to enforce it, she says.