This article discusses strategies to manage disruptive behaviors in the obstetric setting.

Nearly 20% of emergency department personnel reported witnessing unprofessional behavior that directly affected patient safety. This article also presents a structured approach for organizations to identify and address disruptive behavior by clinicians.

This commentary discusses disruptive behavior along with how to reduce the incidence of disruptive events and improve care outcomes.

This news piece discusses one study's findings that clinician disruptive behavior affects an institution's bottom line.

This survey of clinicians and managers from more than 100 hospitals revealed that unprofessional behavior is common among both physicians and nurses. Respondents strongly agreed that disruptive behavior adversely affects patient safety and the quality of care, and the authors recommend various approaches that hospitals can implement to address communication and behavioral problems. A prior commentary discussed system-level solutions to addressing unprofessional behavior, and guidelines have been formulated to identify and address such issues. The concept of just culture has been proposed in order to maintain individual accountability for unsafe behaviors, while acknowledging that most errors occur as a result of system flaws.

Unprofessional behavior by physicians has been linked to adverse events. This survey of staff, nurses, and physicians found that disruptive behavior—including using disrespectful language or berating staff—was common among nurses and physicians. Respondents agreed that unprofessional behaviors adversely affected the quality of care. The authors provide a framework for organizations to use in addressing disruptive behavior. Prior research in this area has investigated predictors of unprofessional actions and system-level solutions to the problem. A case of disruptive behavior affecting patient care was discussed in a prior AHRQ WebM&M commentary.

The investigators surveyed nearly 250 providers of perioperative care (eg, physicians, nurses, anesthetists, and others) at a single academic medical center to study the negative impact of disruptive behavior. The authors report that the stated behaviors affected communication, teamwork, staff relationships, and also the perception of threats to patient safety and quality of care. The authors conclude that organizations must acknowledge the presence and effect of disruptive behaviors and institute policies and processes to address the issue. A past survey study by the same authors examined the impact of work relationships on clinical outcomes. Dr. Lucian Leape also discussed the issue of problem doctors and disruptive behavior from a systems standpoint.

This study examined the impact of work relationships on clinical outcomes. Investigators surveyed more than 1500 nurses, physicians, and administrators to elicit their perceptions on disruptive behavior and its consequences. Most providers perceived a negative effect of such behavior on adverse events, medical errors, and the overall quality of care provided. The authors suggest greater emphasis on improving working relationships and offer a number of strategies to consider.