JCAHO requires “Zero Tolerance” For Disruptive Doctors And Administrators

Oriiginally published in Staying Well Within The

Law

Threatening, intimidating and otherwise disruptive behavior in

hospitals endangers patient safety, according to the Joint

Commission on Accreditation of Healthcare Organizations (JCAHO).

And it doesn't matter if the tantrum-thrower is a physician or

an administrator.

A new JCAHO leadership standard effective January 1, 2009,

requires hospitals and other accredited organizations to adopt and

implement a code of conduct that defines and manages disruptive or

inappropriate behavior by physicians and administrators. Leadership

Standard LD.03.01.01 was announced in Sentinel Event Alert 40

issued on July 9, 2008, entitled "Behaviors That Undermine A

Culture of Safety," posted at www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_40.htm.

Targeted behavior patterns include overt actions, such as verbal

outbursts and physical threats, as well as passive activities, such

as refusing to perform assigned tasks or quietly exhibiting

uncooperative attitudes during routine activities; reluctance or

refusal to answer questions, return phone calls or pages;

condescending language or voice intonation; and impatience with

questions.

Disruptive physician behavior has been the subject of medical

staff investigations and sanctions for decades, and has resulted in

considerable litigation over the years. The Physicians Health

Programs of the Pennsylvania Medical Society, which was established

to address substance abuse, also evaluates physicians with behavior

issues. In a departure from the historical focus on

"hothead" doctors, JCAHO noted:

While most formal research centers on intimidating and

disruptive behaviors among physicians and nurses, there is evidence

that these behaviors occur among other health care professionals,

such as pharmacists, therapists, and support staff, as well as

among administrators.

Factors contributing to disruptive behavior include increased

productivity demands, cost containment requirements, embedded

hierarchies, and fear of or stress from litigation, as well the

high-stakes health care workplace environment, fatigue, increasing

workloads and personality traits, such as self-centeredness,

immaturity or defensiveness. Of particular concern is the

widely-reported perception of a double standard that allows

high-volume physicians (and powerful administrators) more leeway to

engage in egregious conduct. Such perceived favoritism also may

result in allegations of...