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Cases & Commentaries
- Web M&M
Bryan A. Liang, MD, PhD, JD; May 2004
Understanding that she may lose her life without it, a woman severely injured in a collision rejects a blood transfusion for religious reasons. However, her parents persuade the physicians otherwise, and the woman lives.
Journal Article > Study
Rosenstein AH, O'Daniel M. Jt Comm J Qual Patient Saf. 2008;34:464-471.
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.
Kowalczyk L. The Boston Globe. August 10, 2008;Metro section:1A.
This article describes how physician outbursts can affect patient safety and discusses a new Joint Commission policy that supports actions against providers who engage in disruptive behavior.
Thrall TH. Hosp Health Netw. 2008 December;82:42-4, 1.
Journal Article > Review
Tishler CL, Reiss NS. Gen Hosp Psychiatry. 2009;31:103-109.
Suicide attempts by inpatients are considered a never event, and, as such, are also considered reportable sentinel events by the Joint Commission. This article reviews the suicide rate in hospitals, related risk factors, methods of suicidal behavior, factors that contribute to the event, and suggestions for prevention and risk assessment.
Sandrick K. Trustee. November 2009.
This article discusses how physician disrespect, harassment, and physical intimidation affect staff morale, retention, and team communication. The piece also offers suggestions for board members and hospital leadership on how to address disruptive individuals.
Journal Article > Study
DuPree E, Anderson R, McEvoy MD, Brodman M. Jt Comm J Qual Patient Saf. 2011;37:447-455.
Disruptive and unprofessional behavior that goes unaddressed poses a threat to patient safety by hampering development of a culture of safety. This study reports on how one academic hospital addressed this issue by developing a multidisciplinary code of professionalism accompanied by a dedicated hotline for reporting unprofessional behavior. All reported incidents resulted in a combination of feedback, coaching, or disciplinary action for involved providers. Introduction of the code and the reporting system was associated with a significant improvement in teamwork and communication, as measured by the AHRQ Hospital Survey on Patient Safety Culture. This study provides an approach for health care organizations to address the disturbingly common problem of disrespectful and hostile behavior in the workplace. Other approaches are outlined in a PSNet perspective.
Gupta S. New York, NY: Grand Central Publishing; 2012. ISBN: 9780446583855.
To illustrate how physicians learn from mistakes, this novel (written by CNN medical correspondent Dr. Sanjay Gupta) explores the impact of a medical error on surgeons at one hospital.
Crane M. Medscape Medical News. December 11, 2010.
This news piece discusses one study's findings that clinician disruptive behavior affects an institution's bottom line.
Brown T. New York Times. March 17, 2013:SR5.
Journal Article > Commentary
Development of a professionalism committee approach to address unprofessional medical staff behavior at an academic medical center.
Speck RM, Foster JJ, Mulhern VA, Burke SV, Sullivan PG, Fleisher LA. Jt Comm J Qual Patient Saf. 2014;40:161-167.
Unprofessional behavior can hinder patient safety and create a disruptive work environment for other staff. The Joint Commission requires that organizations have clear processes for detecting and reporting unacceptable behaviors. This commentary describes the development and experience of a Professionalism Committee at the University of Pennsylvania Health System. The committee chair serves as the first point of contact for any behavioral concerns. In this system, the committee chair is a trained psychiatrist, which the authors argue is an important aspect of the program since it allows for early identification of behavioral health issues that could contribute to unprofessionalism. The article includes the specific problems addressed and the referral outcomes of 79 cases over 2 years, along with 3 illustrative case vignettes. A prior AHRQ WebM&M commentary focused on the importance of professionalism in patient safety, and an AHRQ WebM&M perspective reviewed strategies to identify and manage problem behaviors.
Lichtblau E. New York Times. June 15, 2014.
This newspaper article reports how a "culture of silence" at Veterans Affairs hospitals discouraged staff from speaking up about safety and quality concerns related to the use of inaccurate wait time data.