Tolerating Disruptive Behavior

In a recent survey of nurses, physicians, and administrators 96% of respondents say they had witnessed or experienced disruptive behavior from a physician.

In my first post, I wrote about becoming a "Topgun" or being the best of the best. In that post I mentioned the major difference between healthcare and aviation I have seen is the willingness of healthcare organizations (as compared to aviation organizations) to tolerate "selective compliance."

I can think of few examples of selective compliance that are more egregious than disruptive behavior. No organization will truly be SAFE or provide the highest level of care when it tolerates disruptive behavior. Intimidation, violence, abusive language, and angry or dismissive responses to patient needs or staff requests torpedo safe patient care. Patient safety just cannot flourish in that environment. That sort of behavior also leads to exceptionally strong staff dissatisfaction and high turnover. And when your patients see it, it will affect your HCAHPS surveys.

The problem of disruptive behavior and its effect on quality care is becoming so important the Joint Commission is weighing in on the subject. They have released draft standards on behavioral expectations. The standards will require hospitals to develop and enforce a code of conduct.

Based on my experiences with over 75 healthcare organizations, the Joint Commission effort can't come too soon. Rarely do I work with an organization where the nurses and staff don't say something like this, "What about Dr. Jones? (or What about Nurse Smith?) Until I see the administration crack down on his behavior, I won't believe they are serious about changing the culture around here. We've been complaining for years and still the behavior persists."

I am often asked about the keys to creating and sustaining a "Just Culture" or a "Culture of Safety." One of those critical, but often overlooked, keys to success is having the courage to confront and change disruptive behavior. Culture change is often as much "caught" as it is "taught." Meaning that leadership has to demonstrate the strength and willingness to do the right things and model the right behaviors.

If, in the interest of patient safety, leadership expects nurses and staff to use assertive, cross checking communications and be willing to speak up at the right time with the right words, then leadership must display the willingness to do the same. Nowhere is this more important than dealing with disruptive behavior. The patient's welfare demands nothing less.