1. Potera, Carol


The Joint Commission calls for eliminating 'disruptive behavior' in hospitals.


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Because intimidation and harassment among clinicians and other hospital staff can compromise the quality of care, the Joint Commission issued a Sentinel Event Alert to address such disruptive behavior. Effective January 1, 2009, the new leadership standard calls for hospitals and other organizations to establish a code of conduct that defines acceptable and unacceptable behavior and to create a process for managing disruptive behavior when it arises. The measure aims to eliminate intimidation and other disruptions not only between nurses and physicians but also among administrators, pharmacists, therapists, and support staff.

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The Joint Commission is an independent, nonprofit group that accredits and certifies 15,000 health care organizations in the United States. Research shows that disruptive behavior threatens patient safety, satisfaction, and care and contributes to medical error and lawsuits filed by workers and patients. Such behavior increases the cost of care and causes workers at all levels to seek employment elsewhere.


The new recommendations call for facilities to take the following actions:


* Educate all team members on a code of conduct emphasizing respect.


* Hold all staff responsible and enforce the code equitably.


* Devise policies addressing fear of retaliation and disciplinary action.


* Gather input from all employees on uncivil behavior.


* Train managers in conflict resolution.


* Develop reporting systems, as well as a way to assess risk to patients.


* Start with nonconfrontational strategies, then move to an action plan if needed.


* Make use of mediators.


* Encourage dialogue.


* Document all efforts at addressing disruptive behavior.



"There is a history of tolerance and indifference to intimidating and disruptive behaviors in health care. Organizations that fail to address unprofessional behavior through formal systems are indirectly promoting it," write the authors of the alert, which is available online at


Carol Potera