When you think of disruptive behavior that occurs in a health care setting, you might think of patients or their family members. However, disruptive behavior among healthcare workers has come under increasing scrutiny in recent years, to the point where the Joint Commission that accredits health care organizations now charges institutions who are seeking certification with the responsibility for addressing undesirable behaviors.

“Disruptive behaviors among healthcare workers threaten the safety and well being of both patients and staff,” according to a 2010 study published in the Online Journal of Issues in Nursing, Combating Disruptive Behaviors: Strategies to Promote a Healthy Work Environment.

Silent support

The study notes that the problem has often gone unchecked, or even worse, has been accepted as part of the system. “By not addressing these behaviors, organizations silently supported and reinforced them.”

Those behaviors prevent the collaboration among health care providers that is considered vital to establishing and sustaining a healthy work environment. That’s not the only consequence. Individuals on the receiving end may experience stress, frustration and physical and psychological disorders. Nurses have cited disruptive behaviors as a reason for leaving a particular place of employment – which stresses hospital resources and can further compromise care.

Verbal abuse such as making threats, making demeaning, humiliating or intimidating comments or facial expressions or sending nasty emails often comes from other nurses. Physically disruptive behaviors are also a problem.

Causes and consequences

Displaced frustration and unresolved conflicts were cited in the study as frequent causes of disruptive behaviors cause a breakdown in communication and collaboration among healthcare personnel, thereby threatening patient and staff well being. Patients may suffer from adverse events like medication errors. Healthcare providers can suffer a range of physical effects, such as tiredness, headaches, gastro-intestinal complaints and feelings of sadness. Home life may also be negatively impacted.

Reluctance to report

“One of the reason that disruptive behaviors have been allowed to flourish is that often employees are reluctant to report these behaviors,” according to the study. “Reasons for this reluctance include concern for their job, fear, lack of confidentiality around the report, lack of managerial follow-through on complaints.”

What healthcare facilities should do

The study’s authors recommend, as a first step, taking a zero-tolerance stance towards disruptive behaviors.

That must be followed up by implementation of a policy that:

• applies to all employees
• defines unacceptable behaviors
• describes a process for dealing with unacceptable behaviors

Corrective action may include referrals to:

• employee assistance programs or anger management classes
• individual executive coaching/mentoring
• mental health professionals (if the underlying problem is stress or substance abuse)

If the disruptive behavior is the result of conflict, that conflict must be addressed – possibly through mediation, where a neutral third party guides two parties to a an agreement to resolve a particular issue.

A new book from the American College of Physician Executives (ACPE), Taming Disruptive Behavior, is intended to help physician leaders deal with the problem. In it, therapists Phillip Hemphill, PhD, and William "Marty" Martin, PsyD cover:

• The impact, costs and risks of disruptive behavior
• Addressing disruptive behavior from an organizational perspective
• What are the special considerations when working with physicians?
• How to deal with nurses and other members of the care team
• Dealing with sexual misconduct at work
• What is the role of human resources, the legal department, quality management and medical staff?

Click here to learn more about Taming Disruptive Behavior.