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July 9, 2008, Issue 40

 

[Editor's Note: Numbers in parentheses refer to the numbered reference list at the end of this article.]

BEHAVIORS THAT UNDERMINE A CULTURE OF SAFETY

Intimidating and disruptive behaviors can foster medical errors (1, 2, 3), contribute to poor patient satisfaction and preventable adverse outcomes (1, 4, 5), increase the cost of care (4, 5), and cause qualified clinicians, administrators, and managers to seek new positions in more professional environments (1, 6). Safety and quality of patient care is dependent on teamwork, communication, and a collaborative work environment. To assure quality and to promote a culture of safety, healthcare organizations must address the problem of behaviors that threaten the performance of the healthcare team.

Intimidating and disruptive behaviors include overt actions such as verbal outbursts and physical threats, as well as passive activities such as refusing to perform assigned tasks or quietly exhibiting uncooperative attitudes during routine activities. Intimidating and disruptive behaviors are often manifested by healthcare professionals in positions of power. Such behaviors include reluctance or refusal to answer questions, return phone calls or pages, condescending language or voice intonation, and impatience with questions (2). Overt and passive behaviors undermine team effectiveness and can compromise the safety of patients (7, 8, 11). All intimidating and disruptive behaviors are unprofessional and should not be tolerated.

Intimidating and disruptive behaviors in healthcare organizations are not rare (1, 2, 7, 8, 9). A survey on intimidation conducted by 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 (2, 10). While most formal research centers on intimidating and disruptive behaviors among physicians and nurses, there is evidence that these behaviors occur among other healthcare professionals, such as pharmacists, therapists, and support staff, as well as among administrators (1, 2). Several surveys have found that most care providers have experienced or witnessed intimidating or disruptive behaviors (1, 2, 8, 12, 13). These behaviors are not limited to one gender and occur during interactions within and across disciplines (1, 2, 7). Nor are such behaviors confined to the small number of individuals who habitually exhibit them (2). It is likely that these individuals are not involved in the large majority of episodes of intimidating or disruptive behaviors. It is important that organizations recognize that it is the behaviors that threaten patient safety, irrespective of who engages in them.

The majority of healthcare professionals enter their chosen discipline for altruistic reasons and have a strong interest in caring for and helping other ...

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