Thoughtful Discussion on a Tough Topic

By Tarek M. Sabagh, MD, MHSA, medical staff president, Miami Valley Hospital

While disruptive physician behavior is not a widespread issue, its impact on patients and staff can be significant. As leaders of our health care teams, I believe the topic is vital for discussion and further reading.

Disruptive behavior is defined as any behavior that is disruptive to the operations of the hospital or could compromise the quality of patient care, either directly or by disrupting the ability of other professionals to provide quality patient care. Disruptive behavior includes, but is not limited to, behavior that interferes with the provision of quality patient care; intimidates professional staff; creates an environment of fear and distrust; or degrades teamwork, communication, or morale.

In a survey of 5,000 nurses and physicians (Rosenstein, A.H., 2008), 77 percent reported witnessing a disruptive behavior by a physician – typically a verbal abuse of staff; and 65 percent witnessed a disruptive behavior by nurses (Wachter, R.M. 2010).

Many researchers agree that disruptive behavior is confined to a small number of clinicians, comprising less than 5 percent of the total population of clinicians (Weber, 2004; Rosenstein & O'Daniel, 2005; Linney, 1997). However, the Institute for Safe Medication Practices (ISMP) 2003 survey on intimidation raises the possibility that this problem is more widespread than previously thought. Subtle intimidation is more common than overt threatening behavior. 

According to the ISMP survey, the following were the most common of the subtle intimidation behaviors: condescending language or intonation (88 percent), impatience with questions (87 percent), and reluctance or refusal to answer questions or phone calls (79 percent). Overt intimidation behaviors most frequently encountered were: strong verbal abuse (48 percent), threatening body language (43 percent), and physical abuse (4 percent).

In addition to its direct contribution to medical errors, disruptive behavior can undermine a culture of safety through its effect on teamwork and communication. Rosenstein and O’Daniel found a perception of a link between disruptive behavior and adverse events (66 percent), medical error (71 percent), poor quality of care (72 percent), mortality (25 percent), and poor staff satisfaction. 

Creating a culture of teamwork in which opinions can be expressed freely throughout patient care – regardless of rank and without fear of retaliation – is what is needed (Crane, M 2010). 

My goal is to spark a thoughtful discussion among our medical staff. Anyone with suggestions or inquiries is welcome to contact me by email or reach out to Matthew Kramer, MD, chair of the Miami Valley Hospital Medical Staff Wellness Committee, by email.

Sources

• Crane M. Medscape Medical News. December 11, 2010.  (Not an academic source.);
• Disruptive behavior affects hospital financial health;
• Rosenstein, A.H., & O'Daniel, M. (2008). A survey of the impact of disruptive behaviors and communication defects on patient safety. Joint Commission Journal on Quality and Patient Safety / Joint Commission Resources, 34(8), 464-471;
• Rosenstein, A.H. (2009). Disruptive behavior and its impact on communication efficiency and patient care. Journal of Communication in Healthcare, 2(4), 328.
• Weber, D. O. (2004). Poll results: Doctors’ disruptive behavior disturbs physician leaders. The Physician Executive, 30, 4, 6-14. 

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