Tolerating Bad Behavior May Impact Health Facilities Accreditation-August 2008

Mr. Lamb is a freelance pharmacy writer living in Virginia Beach and president of Thorough Cursor, Inc.

If you watch House and catch yourself thinking, “I work with that guy!” take heart. You should soon be experiencing less condescension, foul language, and abuse from bad-acting colleagues.

The latest revision and reorganization of the Joint Commission addresses standards for the accreditation of health care facilities to define and enforce professional behavior among physicians and all other providers and staff. The new Leadership standard (LD.03.01.01), which will take effect January 1, 2009, includes the following criteria:

• Element of Performance 4: The hospital/organization has a code of conduct that defines acceptable and disruptive and inappropriate behaviors
• Element of Performance 5: Leaders create and implement a process for managing disruptive and inappropriate behaviors

The Joint Commission noted in a July 9 Sentinel Alert that codes of conduct are necessary in the organizations it assesses because “intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators, and managers to seek new positions.” The commission also cautioned that “organizations that fail to address unprofessional behavior through formal systems are indirectly supporting it.”

Numerous studies have revealed that unprofessional behavior is both widespread among health care professionals and harmful for colleagues and patients. In 2005, for instance, nurses rated disruptive behavior as the primary reason they were dissatisfied with their workplace. An earlier survey of nurses, pharmacists, and other caregivers conducted by the Institute for Safe Medication Practices (ISMP)showed that “88% of respondents encountered condescending language or voice intonation (21% often); 87% encountered impatience with questions (19% often); and 79% encountered a reluctance or refusal to answer questions or phone calls (14% often).” Among pharmacists, 50% told the ISMP they had been strongly verbally abused by another provider.

In suggesting measures health care organizations can take to develop and enforce a code of professional conduct, the Joint Commission drew from an article Grena Porto, RN, MS, and Richard Lauve, MD, MBA, published in the July/August 2006 issue of Patient Safety and Quality Healthcare. According to Porto and Dr. Lauve, the code must be written with input from all the groups that will be covered by it, and the code must be accompanied with clear statements of potential interventions and disciplinary actions, according to Porto and Dr. Lauve. The authors also wrote that organizations should work to prevent unprofessionalism by implementing “known best strategies designed to improve relationships between members of the health care team.”