The Cost of Disruptive and Unprofessional Behaviors in Health Care

Rawson, James V.; Thompson, Norman L.; Sostre, Gilberto; Deitte, Lori A.

doi:10.1016/j.acra.2013.05.009

Cited by 51 publications

(35 citation statements)

References 10 publications

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“…This phenomenon is also not unique to physicians; the phrase "nurses eating their young" exemplified by passiveaggressive behavior is an example of "horizontal hostility." 43 Disruptive behavior also has wide-ranging impacts, both seen in terms of nurse satisfaction and retention, 44 health care costs, 45 and perceived impact on patient outcomes. 46 In surgical arenas, "harassment" and "intimidation" can be construed as having legitimate educational value, 47 demonstrating the power of socialization within health care circles.…”

Section: Factors That Impede Speaking Upmentioning

confidence: 99%

“Speaking Up” for Patient Safety in the Pediatric Emergency Department

Eppich

2015

Clinical Pediatric Emergency Medicine

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Section: Factors That Impede Speaking Upmentioning

confidence: 99%

“Speaking Up” for Patient Safety in the Pediatric Emergency Department

Eppich

2015

Clinical Pediatric Emergency Medicine

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“…18,[24][25][26] Intimidating and disruptive behaviors in health care organizations lead to medical errors, adverse preventable outcomes, and increased costs. [27][28][29] For most health care organizations there is a chasm between the official version of their aims, putting patients at the center of their endeavors, and the real culture of those institutions, which place medical hierarchy in the center. 8,30 This veiled conflict between explicit and implicit values sets the stage for distorted professionalism, cynicism, and arguably a degree of self-delusion.…”

Section: Discussionmentioning

confidence: 99%

Why Medical Schools Are Tolerant of Unethical Behavior

Vidal

Silva

Santos

et al. 2015

The Annals of Family Medicine

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The exposure to unethical and unprofessional behavior is thought to play a major role in the declining empathy experienced by medical students during their training. We reflect on the reasons why medical schools are tolerant of unethical behavior of faculty. First, there are barriers to reporting unprofessional behavior within medical schools including fear of retaliation and lack of mechanisms to ensure anonymity. Second, deans and directors do not want to look for unethical behavior in their colleagues. Third, most of us have learned to take disrespectful circumstances in health care institutions for granted. Fourth, the accreditation of medical schools around the world does not usually cover the processes or outcomes associated with fostering ethical behavior in students. Several initiatives promise to change that picture. THE ORATOR'S SPEECHR ecently, we attended the graduation ceremony of medical graduates at our medical school. It is satisfying to see the glowing faces of our students and their families, as these young men and women perform this last ritual towards becoming physicians. As the orator gave her speech, she thanked the professors and health care professionals who had taught her and fellow graduates important lessons of competent and humane care of sick patients, and also faculty who had provided them with examples of "pure unethical behavior." She justified her "gratitude" by saying that they had learned 2 eloquent lessons: how to behave professionally and how not to behave toward patients, their families, and colleagues.In the next few days after the ceremony, we asked other faculty members and other professionals who had attended the graduation ceremony about their thoughts on the speech. Surprisingly, no one seemed uneasy about the not-so-subtle allegation of unethical behavior of faculty in our medical school. In fact, no one had approached the orator or her fellow graduates to verify the claims of disrespectful and unethical behavior.We wondered what would have happened if that speech had been presented at another type of institution. Would the CEO respond by reaffirming the organization's commitment to ethical behavior? Would the orator and her fellow graduates be asked to substantiate the claims and assist with investigations to protect not only the organization's customers and employees, but also the organization's mission and reputation? We hope that the answer to those questions would be yes.Why then is unethical behavior tolerated in medical schools? This is not a local problem and unfortunately there are several examples in the medical literature describing how common such unprofessional situations are around the world.3-8 Most, if not all, medical schools confront harassment and discrimination as described by a recent systematic review. 9For the purposes of this essay we will define unethical behaviors as those that infringe any aspect of the medical code of ethics. We will also consider professionalism as a subset of health care ethics as proposed by Brody and Doukas 1 a...

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“…There are no data on dialysis practitioners. In the general medical community, one Midwestern hospital of 400 beds noted that they incurred a $1 million dollar loss due to physician disruptive behavior (i.e., medication errors and staffing turnover) (9,10,21). In another hospital, a poll of 840 physicians executives noted that 18.2% of the types of physician disruptive behavior described in Table 4 occur at least monthly (6).…”

Section: Disruptive Behavior By Physiciansmentioning

confidence: 99%

“…However, the general medical literature examines this source of aberrant behavior (5,6,8,9,11) and associates it with medical errors, poor patient satisfaction, preventable negative patient outcomes, increased staff turnover, higher costs, and malpractice claims (10,21). Consequently, The Joint Commission (JC) and the American Medical Association (AMA) have developed several recommendations and interventions concerning physicians exhibiting disruptive behavior (15,16,22).…”

Section: Disruptive Behavior By Physiciansmentioning

confidence: 99%

“…Nephrology can extrapolate from the general medical experience. The general medical literature associates disruptive behavior with medical errors, poor patient satisfaction, staff turnover, adverse outcomes, and excessive costs (5,9,10). Disruptive behavior, whether by a patient or nephrology clinician, creates an unsafe patient environment and impedes the delivery of high-quality care (11,12).…”

Section: Introductionmentioning

confidence: 99%

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Managing Disruptive Behavior by Patients and Physicians

Jones

Goldman

2015

Clinical Journal of the American Society of Nephrology

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The Centers for Medicare & Medicaid Services' Conditions for Coverage make the medical director of an ESRD facility responsible for all aspects of care, including high-quality health care delivery (e.g., safe, effective, timely, efficient, and patient centered). Because of the high-pressure environment of the dialysis facility, conflicts are common. Conflict frequently occurs when aberrant behaviors disrupt the dialysis facility. Patients, family members, friends, and, less commonly appreciated, nephrology clinicians (i.e., nephrologists and advanced care practitioners) may manifest disruptive behavior. Disruptive behavior in the dialysis facility impairs the ability to deliver high-quality care. Furthermore, disruptive behavior is the leading cause for involuntary discharge (IVD) or involuntary transfer (IVT) of a patient from a facility. IVD usually results in loss of continuity of care, increased emergency department visits, and increased unscheduled, acute dialysis treatments. A sufficient number of IVDs and IVTs also trigger an extensive review of the facility by the regional ESRD Networks, exposing the facility to possible Medicare-imposed sanctions. Medical directors must be equipped to recognize and correct disruptive behavior. Nephrology-based literature and tools exist to help dialysis facility medical directors successfully address and resolve disruptive behavior before medical directors must involuntarily discharge a patient or terminate an attending clinician.

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The Cost of Disruptive and Unprofessional Behaviors in Health Care

Cited by 51 publications

References 10 publications

“Speaking Up” for Patient Safety in the Pediatric Emergency Department

“Speaking Up” for Patient Safety in the Pediatric Emergency Department

Why Medical Schools Are Tolerant of Unethical Behavior

Managing Disruptive Behavior by Patients and Physicians

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