Stop Disruptive Behavior, Says New Joint Commission Standard

Concerned that bad behavior by hospital medical staff affects patient medical care and safety, The Joint Commission (TJC) has issued a new standard that takes effect in January 2009.

In July, TJC issued a sentinel alert to address the issue of staff misbehavior that causes sentinel events and provides advice for hospitals about how they should handle these issues. According to The Commission, a sentinel event is “any process variation for which a recurrence would carry a significant chance of a serious adverse outcome.”

Given that disruptive behavior may cover everything from criminal assault to haughtiness, policies can be vague and used against outspoken doctors who promote better patient care.

The new standard asks hospitals to squelch such disruptive behaviors by the medical staff that range from operating room squabbling between doctors and nurses to intimidation and assault. The commission wants hospital administrators to define disruptive behavior and establish disciplinary processes for correcting health professionals or medical staff demonstrating improper behavior.

Because hospitals have used already-existing disruptive behavior policies to get rid of doctors with opinions contrary to hospital administration, doctors worry that the new standard will increase the targeting of outspoken hospital staff and give administrators an easier way to remove them.

According to The Joint Commission’s alert, “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.” It goes on to explain that these behaviors not only undermine the medical team’s effectiveness, but compromise patient safety.

The Commission expects hospitals not to tolerate assaults or similar flagrant acts. Instead, it asks hospitals first to educate their team members about acceptable behavior. Then it asks the administration to hold all medical staff accountable no matter their position. Finally, it wants hospitals to establish clearly the process for how and when discipline would be initiated. To protect staff members from retribution, the standard asks hospitals to protect staff reporting misbehavior by mediating between the two parties.

While concerns remain that the new standard puts ethical doctors in a dangerous spot, medical staff needs to understand their behavior can affect patient safety — for better or worse.