Intimidation in health care settings can negatively affect patient safety. Following an adverse event in 2006 at Spectrum Health, a 7-hospital health care system in Grand Rapids, Michigan, leadership of the Grand Rapids perioperative services department led an initiative to evaluate and reduce the incidence of intimidation in the department. Physicians were surveyed to ascertain their beliefs about behaviors that constitute intimidation and to correlate those findings with definitions of intimidation identified by several national professional organizations. Our findings suggest that a majority of physicians in perioperative services agree that behaviors identified as intimidating by national organizations actually constitute intimidation in only 4 of 9 instances and that, for even the most egregious behaviors, there is lack of complete agreement that the behavior constitutes intimidation.These findings suggest reasons why traditional means of addressing intimidating behavior may not be effective and also suggest alternative means of handling behaviors that disrupt the care environment.

The Centers for Medicare and Medicaid Services and the Centers for Disease Control and Prevention launched the Surgical Infection Prevention Project in 2002. The groups developed performance measures regarding perioperative antibiotic use to prevent surgical site infections. Other organizations have since adopted these measures. Spectrum Health, a not-for-profit health system in western Michigan with seven hospitals, more than 140 service sites, and a 565,000-member health insurance plan, formed an interdisciplinary quality improvement team to meet a goal of 100% adherence at two of its acute care hospitals in the city of Grand Rapids. Eighteen months later, process shifts had been achieved, demonstrating that a comprehensive, interdisciplinary approach can result in consistent perioperative antibiotic utilization.

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