JosephP.Myers,MD,FACPProfessorofInternalMedicine

NortheastOhioMedicalUniversity

¡ Medicalerrors¡  Adverseoutcomes¡  Reducedstaffperformance¡  Reducedstaffinnovation¡  Increasedstaffturnover¡  Patientdissatisfaction¡  Lackofinformationsharing¡  Processingdelays

Any abusive conduct, including sexual orotherformsofharassment,orotherformsofverbalornonverbalconductthatharmsor intimidates others to the extent thatquality of care or patient safety could becompromised.

Reference.AmericanMedicalAssociation.2011AMACodeofMedicalEthics.Opinion9.045–Physicianswithdisruptivebehavior.Availableat:www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion9045.page.AccessedJanuary12,2015

Specificallymentionedarethefollowingactions:¡  Physicallythreateninganyone[inthehospital]¡  Makingthreateningorintimidatingphysicalcontactwithanotherperson

¡  Throwingthings¡  Threateningviolenceorretribution¡  Sexualorotherharassment¡  Persistentinappropriatebehavior,risingtothelevelofharassment.

Specificinappropriatebehaviorsoutlinedinthecodeinclude,butarenotlimitedto,thefollowing:¡  Makingbelittling,sarcasticorcondescendingstatements

¡  Callingpeoplenames¡  Usingprofanity¡  Blatantlyfailingtorespondtopatientcareneedsorstaffrequests

¡  Deliberatelyfailingtoreturncalls,pages,messages

Reference.RosensteinAH,O’DanielM.DisruptiveBehavior&ClinicalOutcomes.AJN2005;105(1):54-64.

Reference.RosensteinAH,O’DanielM.DisruptiveBehavior&ClinicalOutcomes.AJN2005;105(1):54-64.

Reference.RosensteinAH,O’DanielM.DisruptiveBehavior&ClinicalOutcomes.AJN2005;105(1):54-64.

Reference.RosensteinAH,O’DanielM.DisruptiveBehavior&ClinicalOutcomes.AJN2005;105(1):54-64.

Reference.RosensteinAH,O’DanielM.DisruptiveBehavior&ClinicalOutcomes.AJN2005;105(1):54-64.

Stress+Frustration+

LossofConcentration+Reducedteamcollaboration+Reducedinformationtransfer+

Reducedcommunication+ImpairedRN-MDrelationship=

UnsafeWorkEnvironment

¡  102participatingVHAhospitals¡  January2004–March2007¡  4,5030totalparticipants:

§  Nurses 2846§  Physicians 944§  Administration 40§  Other 700

Reference.JointCommissionJournalonQualityandPatientSafety2008;34(8):464-471.

Reference.JointCommissionJournalonQualityandPatientSafety2008;34(8):464-471.

¡  DBresultsinpatientdissatisfaction,errors,staffdissatisfaction,andlackofteamwork.Somenursesareafraidtocallsomephysicians...

¡  MostnursesareafraidtocallDr.Xwhentheyneedto,andfrequentlywon’tcall.Thepatient’ssafetyisalwaysinjeopardybecauseofthis.

¡  DBresultsinmedicationerrors,slowresponsetimes,andtreatmenterrors.¡  DBcausedincreasedstressandlackofconcentration,whichcausedanurseto

makeamistake.¡  Poorcommunicationpostopbecauseofadisruptivereputation,resultedin

delayedtreatment,aspiration,andthepatient’seventualdeath.¡  Myconcernisthatthenewnursesareafraidtocallaboutpatientproblems

andissuesthattrulyneedtobeaddressedinatimelymanner.¡  Physiciansbecomeclosemindedtosuggestionsbynursesfordifferent

treatment,andsoon,afterbecomingupsetwithstaffforotherreasonsorinsultedbynurses’ideas.

Reference.JointCommissionJournalonQualityandPatientSafety2008;34(8):464-471.

Whatexactlyis“DisruptiveBehavior”?§  JusticePotterStewartwrote(aboutpornography):"IshallnottodayattemptfurthertodefinethekindsofmaterialIunderstandtobeembracedwithinthatshorthanddescription;andperhapsIcouldneversucceedinintelligiblydoingso.ButIknowitwhenIseeit...“

§  Bullying§  Similartobeingan“Asshole”:theAsshole ...

1.  Allowshimselftoenjoyspecialadvantagesanddoessosystematically

2.  Doesthisoutofanentrenchedsenseofentitlement

3.  Isimmunizedbyhissenseofentitlementagainstthecomplaintsofotherpeople

Reference.JamesA.Assholes:ATheory.©2012;AnchorBooks;p.5.

§ Useoforal,writtenorgesturedlanguagethatmayincludedisparagingorderogatorytermsdirectedtoanotherperson.

§ Engaginginharassmentofanyemployee,patient,physician,visitor,volunteerorotherpersononthebasisoftheindividual’srace,sex,color,nationalorigin,religion,age,maritalstatus,sexualorientation,disabilitystatusorotherwise,includingverbalharassment,non-consensualorunwelcomephysicalcontact.

§ Non-constructivecriticismaddressedtoanindividualinsuchatoneorcontentsoastointimidate,undermineconfidence,belittle,orimplystupidityorincompetence,ordisparagethenameandreputationofaperson.

§  BlatantprofanityorsimilarlyoffensivelanguagewhileintheHospitalanddirectedatmedicalstaff,nurses,otherHospitalpersonnel,orpatientsandvisitors.

§  InappropriatemedicalrecordentriesconcerningthequalityofcarebeingprovidedbytheHospitaloranyotherindividualorotherwisecriticaloftheHospital,otherMedicalStaffmembersorpersonnel

1.  RecognitionandAwareness2.  CulturalCommitment/Leadership/Champions3.  PoliciesandProcedures4.  StandardizedIncidentReporting5.  ConsistentUniformStructureand

Methodology6.  UnderstandInitiatingFactors7.  ImplementEducationandTraining8.  ImplementCommunicationTools9.  InitiateDiscussionForums10.  InterventionStrategies

https://www.docsmb.org/rounds-february-2016/the-5-fundamentals-of-civility-for-physicians