Disruptive Practitioner Behavior

The image of a malcontent genius like Dr. Gregory House, a character on the television show House M.D., snapping at coworkers and patients alike, is a television-created idea. The majority of healthcare professionals enter the field for altruistic reasons and have a strong interest in helping other people. However, for many reasons—including the high-stress nature of the job and the inevitable friction between different personalities—disruptive practitioner behavior occurs. (Joint Commission "Behaviors That Undermine")

Sometimes called "abusive behavior," disruptive practitioner behavior is a style of interaction between providers and others—including coworkers, patients, and family members—that interferes with patient care or adversely affects a team's ability to work together. Disruptive behavior can have a negative effect on morale, focus, collaboration, and communication and thus may undermine patient safety. (Sanchez)

Examples of disruptive behaviors range from overtly abusive actions and bad behavior, such as throwing items in the operating room, to less overt and yet still insidious behaviors that may be so embedded in an organization's culture that they have come to be considered normal, such as gossiping about a coworker. The Institute for Safe Medication Practice (ISMP "Disrespectful") defines abusive behavior as "any behavior that influences the willingness of staff or patients to speak up or interact with an individual because he or she expects the encounter will be unpleasant or uncomfortable."

Since 2009, Joint Commission has required organizations to address disruptive behavior as part of its leadership standards. Joint Commission first raised the issue in a 2008 sentinel event alert that concluded, among other things, that disruptive behaviors are not rare and are not limited to one gender or to specific disciplines. (Joint Commission "Behaviors That Undermine")

In 2012, in light of evidence that such behaviors contribute directly to medical errors, Joint Commission doubled down on its emphasis on safety and revised its definition from "disruptive and inappropriate behavior" to "behaviors that undermine a culture of safety" (Joint Commission "Leadership Standard"). This refocusing underscored an essential point. Disruptive behavior is about more than someone's feelings getting hurt. It must be treated as a critical patient safety issue. Such behavior is incompatible with a culture of safety.

Risks of disruptive practitioner behavior include the...