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Perspectives on Safety > Interview
High-Risk Physicians and Disruptive Behaviors, December 2009
Gerald B. Hickson, MD, is one of the world's leading experts on physician behavior and its connection to clinical outcomes and medical malpractice. He is a Professor at the Vanderbilt University School of Medicine, where he is also the Joseph C. Ross Chair in Medical Education and Administration, Associate Dean for Clinical Affairs, Director of the Vanderbilt Center for Patient and Professional Advocacy, and Director of Clinical Risk and Loss Prevention. We asked him to speak with us about high-risk physicians and malpractice.
Journal Article > Commentary
Porto G, Lauve R. Patient Safety Qual Healthc. July/August 2006;3:16-24.
The authors describe disruptive clinician behavior, contributing factors, and the impact on the workplace and patient safety. They suggest ways that organizations can deal with this issue.
Legislation/Regulation > Sentinel Event Alerts
Sentinel Event Alert. July 9, 2008;(40):1-3.
The Joint Commission issues sentinel event alerts one to two times yearly to highlight areas of high risk and to promote the rapid adoption of risk reduction strategies. Adherence to these strategies is then assessed on Joint Commission site visits at health care organizations nationwide. This newly released sentinel event alert focuses on intimidating and disruptive behaviors and the role they play in the costs, quality, safety, and satisfaction of care delivered. The alert outlines existing Joint Commission requirements and provides a series of suggested actions that include educational programs, "zero tolerance" policies, and clear processes for detecting, reporting, and documenting all instances of such unacceptable behavior.
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.
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.