(OAKBROOK TERRACE, Ill. – July 9, 2008) Health care is a high-stakes, pressure-packed environment that can test the limits of civility in the workplace. A new alert issued today by The Joint Commission warns that rude language and hostile behavior among health care professionals goes beyond being unpleasant and poses a serious threat to patient safety and the overall quality of care.
Intimidating and disruptive behaviors are such a serious issue that, in addition to addressing it in the new Sentinel Event Alert, The Joint Commission is introducing new standards requiring more than 15,000 accredited health care organizations to create a code of conduct that defines acceptable and unacceptable behaviors and to establish a formal process for managing unacceptable behavior. The new standards take effect January 1, 2009 for hospitals, nursing homes, home health agencies, laboratories, ambulatory care facilities, and behavioral health care facilities across the United States.
Health care leaders and caregivers have known for years that intimidating and disruptive behaviors are a serious problem. Verbal outbursts, condescending attitudes, refusing to take part in assigned duties and physical threats all create breakdowns in the teamwork, communication and collaboration necessary to deliver patient care. The Institute for Safe Medication Practices found that 40 percent of clinicians have kept quiet or remained passive during patient care events rather than question a known intimidator. To help put an end to once-accepted behaviors that put patients at risk, The Joint Commission Sentinel Event Alert urges health care organizations to take action.
“Most health care workers do their jobs with care, compassion and professionalism,” says Mark R. Chassin, M.D., M.P.P, M.P.H., president, The Joint Commission. “But sometimes professionalism breaks down and caregivers engage in behaviors that threaten patient safety. It is important for organizations to take a stand by clearly identifying such behaviors and refusing to tolerate them.”
To help put an end to intimidating and disruptive behaviors among physicians, nurses, pharmacists, therapists, support staff and administrators, the Sentinel Event Alert recommends that health care organizations take 11 specific steps, including the following:
- Educate all health care team members about professional behavior, including training in basics such as being courteous during telephone interactions, business etiquette and general people skills;
- Hold all team members accountable for modeling desirable behaviors, and enforce the code of conduct consistently and equitably;
- Establish a comprehensive approach to addressing intimidating and disruptive behaviors that includes a zero tolerance policy; strong involvement and support from physician leadership; reducing fears of retribution against those who report intimidating and disruptive behaviors; empathizing with and apologizing to patients and families who are involved in or witness intimidating or disruptive behaviors;
- Determine how and when disciplinary actions should begin; and
- Develop a system to detect and receive reports of unprofessional behavior, and use non-confrontational interaction strategies to address intimidating and disruptive behaviors within the context of an organizational commitment to the health and well-being of all staff and patients.
Addressing unprofessional behavior among health care professionals is part of a series of Alerts issued by the Joint Commission. Previous Alerts have addressed pediatric medication errors, wrong-site surgery, medication mix-ups, health care-associated infections and patient suicides, among others. The complete list and text of past issues of Sentinel Event Alert can be found on The Joint Commission’s website.