PRO

Iapplaud the efforts of The Joint Commission for including disruptive and inappropriate behavior as a new leadership standard effective January 1, 2009. This new standard requires that institutions "have a code of conduct that defines acceptable and disruptive and inappropriate behaviors"; and that "leaders create and implement a process for managing disruptive and inappropriate behaviors." (The Joint Commission, 2008).

There is a growing focus on the role of prevailing hospital culture as a contributing factor in medical errors, and the healthcare industry has begun to realize that human interaction is an important source of error. While we know that most healthcare workers perform their duties with care, compassion, and professionalism, there are times when professionalism breaks down and can devolve into unprofessional behaviors. This can threaten patient safety, and therefore it is imperative that healthcare organizations take a stand by clearly identifying such behaviors and refusing to tolerate them. It is well known that safety and quality of patient care is dependent on teamwork, communication, and a collaborative work environment (The Joint Commission, 2008). Disruptive behaviors include yelling and screaming, intimidating gestures, profane language, condescending comments, outbursts of anger, threats, retribution, and other such behaviors. These disruptive behaviors create an unhealthy and potentially hostile work environment and are toxic to the nursing profession, the patients, and healthcare team. In addition, they have a negative impact on retention of quality staff. Disruptive behaviors often increase the risk for errors by breaking down communication, which can result in delays in contacting healthcare providers who are known to behave badly, and in errors in critical medical decisions.

Inappropriate and disruptive behaviors are often manifested by healthcare professionals in positions of power. It has been shown that when disruptive behaviors among physicians, nurses, and other members of the healthcare team are ignored, collaboration and information exchange are affected, as are team dynamics and patient outcomes (Rosenstein & O'Daniel, 2005). Research published in 2002 by the same authors documented the negative impact of physician disruptive behavior on nurse satisfaction and retention. We also know that patient care is affected; the Institute for Safe Medication Practices (2003) found that 40% of clinicians have kept quiet or remained passive even in the face of deleterious patient care events rather than question a known intimidator. Disruptive behavior does not cultivate a culture of safety, which is an atmosphere characterized by open and respectful communication among all members of the healthcare team aimed at inspiring and providing safe patient care.

Healthcare organizations have an obligation to protect patients from harm. One of the ways they can do this is to address disruptive and inappropriate behavior and hold all team members accountable for modeling desirable behaviors, thus enforcing a code of professionalism consistently and equitably. In addition, in my opinion, each institution must establish strong policies and systems to protect those who report or cooperate in the investigation of disruptive behavior. Critical decisions regarding patients' lives are entrusted to us everyday. Disruptive behavior in our healthcare culture is a toxic factor and must be vigorously eliminated.

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