Disruptive Physician Behavior (JCAHO Standards)

Posted by Iris Grimm

When I speak with hospital administrators, many times the topic of disruptive physician behavior comes up. Now that has some obvious reasons. Disruptive physician behavior can damage the hospitals reputation tremendously and it can cost the organization lots of money. It is actually estimated that unnecessary turnover rates alone costs health care organizations more than $150,000 per disruptive physician. Additionally, a new survey about physician-nurse relationships uncovers a strikingly high prevalence of disruptive physician behavior that is affecting nurse retention. It showed that disruptive behavior by physicians is contributing to fuel the nationwide nursing shortage, heavily impacting job satisfaction and morale for nurses.The survey results also revealed the seriousness of the issue and highlight a lack of physician awareness, appreciation, value and respect for nurses.

As a result, disruptive physician behavior has a negative impact on patient quality care and increases the likelihood of medical errors.Now what is disruptive physician behavior? There are many definitions available; however, the American Medical Association sums it up succinctly by “defining disruptive behavior as a style of interaction with physicians, hospital personnel, patients, family members, or others that interferes with patient care.” Obviously, disruptive behavior cannot be neglected and needs to be addressed at the organizational level. Of course every hospital has a process in place how they address those kind of interferences but unfortunately, the success rates are many times not as high as they envision them. So what else can be done to reduce disruptive behavior? When you look at the incidences closely, you can see that disruptive physician behavior is the result of a lack of self-management, a lack of interpersonal skills or both. No physicians gets up in the morning with the intention of cussing a nurse out, interrupting the success of their surgery by throwing instruments through the OR, or screaming at a hospital administrator. I don’t think that any physician has such bad intentions because then they would definitely not be suited for this profession and should look for a job where human interactions are non existent.

Instead, I look at disruptive physician behavior as a sign that their self-management and interpersonal skills are underdeveloped. At the end disruptive behavior is the symptom of an underlying cause, call it frustration with life, overwhelm with their professional responsibilities, inability to cope with the demands of life, incapability to effectively communicate with people. Handing the physician a warning or having a conversations with the physician about repercussions will not cure the behavior but rather only band aid on it. In order to get to the source of the behavior, the conversations and the revelations have to go deeper and need to address topics such as:- how to effectively control oneself in stressful situations- how to resolve conflict with a win-win outcome- how to communicate effectively in any kind of situation- how to resolve frustrations and strive to create more harmony and balance in one’s life and many more.

As a result, rather than educating and lecturing physicians about the negative consequences of their behaviors, hospitals need to invest time and resources into preventative workshops that address those skills, performing self-assessments, increasing staff awareness of the issue, opening lines of communication and creating great collaboration among peers.If hospitals don’t do this, the problem will continue to grow and patients, nurses, and the financial situation of the organization will continue to needlessly suffer. An ounce of prevention is worth a pound of cure.”- Henry de Bracton, De Legibus in 1240. I look forward to your comments and hearing from you.

Iris Grimm