by Pamela D. Tyner
Physicians and healthcare workers devote years to improving the quality of their patients’ lives. Despite the Hippocratic code and compulsory non-retaliation policies, incidents of disruptive behavior from physicians and healthcare workers, though largely shielded from the general public, continue to frequently surface internally at healthcare environments. Amidst recent jarring headlines of workplace violence and bullying, news media have discovered this same trend is also on the rise as healthcare facilities across the nation struggle to effectively resolve these alarming concerns.
Reasons for Under-Reporting of Disruptive Behavior
Most healthcare organizations will not readily admit there are under-reported and unresolved disruptive behavioral problems from its physicians and healthcare workers due to a number of factors. First, there is an underlying history and culture of tolerance and indifference to intimidating and disruptive behaviors in health care. Turning the other cheek becomes easier if the verbally abusive physician is one of the facility’s top physicians. In addition, physicians serving on professional activity or peer review committees fear retribution, ostracization and even liability from their participation in attempting to resolve such incidents.
For example, in a nationally publicized case, Poliner v. Texas Health Systems, a Texas jury awarded Dr. Lawrence Poliner $366 million in damages against a hospital and several physicians for malicious peer review after his privileges were terminated. In July 2008, the United States Court of Appeals for the Fifth Circuit reversed the ruling and entered judgment in favor of the defendants based on application of immunity for the hospital and three physicians under the Federal Health Care Quality Improvement Act (“HCQIA”). This legal battle highlights both the fear of retribution for service on a peer review committee and the cost of lengthy litigation.
Joint Commission Redefines “Disruptive Behavior”
In July 2008, the Joint Commission published a sentinel event alert regarding intimidating and disruptive behavior that highlighted the following potential negative outcomes:
- fosters medical errors;
- contributes to poor patient satisfaction;
- causes preventable adverse outcomes;
- increases the cost of healthcare; and
- increases rate of turn-over of qualified clinicians, administrators and managers.
As a result, the Joint Commission issued a disruptive behavior standard (LD.03.01.01) to include mandatory policies, training, code of conduct and reporting structures for any inappropriate outbursts. In its November 9, 2011 newsletter, the Joint Commission revised its definition of “disruptive behavior” to a more refined interpretation of “behavior or behaviors that undermine a culture of safety” after it received complaints that the term “disruptive behavior” was both ambiguous and not always viewed favorably. For example, some argued that advocating for patient care improvement might be incorrectly labeled as “disruptive behavior.” The revised definition becomes effective in 2012 .
Lessons Learned – A Balanced Healthcare Environment
From verbal abuse by physicians and healthcare workers causing fear to serve on hospital committees, potential patient safety issues and high turn-over rates, healthcare facilities and organizations must quickly strengthen existing human resources policies and reporting lines to incorporate the revised definition of “disruptive physician” and to avoid becoming the latest headlines. Above all, the historical tolerance for disruptive behavior must instead more highly value the promotion of patient safety and respect in the medical workplace.