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Ask the Expert: Staff intimidation and verbal abuse can trigger errors

Accreditation Connection, May 9, 2005

How can you prevent medication errors when abusive and intimidating behavior is so widespread and tolerated?

Judy Smetzer, RN, BSN, who conducted a survey of 3,000 hospital employees for the Institute of Safe Medication Practice (ISMP), was shocked to discover the relationship between intimidation/verbal abuse and medical errors.

Smetzer found that 49% of survey respondents who had experiences with intimidation or verbal abuse were negatively affected in the way they handled order clarifications or questions about medication orders.

"There are no easy remedies for this longstanding cultural problem," says Smetzer. But her report on the ISMP survey offers direction toward a solution, which includes the following:

• Establish a steering committee. Include representatives from all departments and staff at all levels. Define workplace intimidation and list examples of the forms it can take. Develop a mission statement and an action plan to reduce intimidation.
• Create a code of conduct. Specify blatantly unacceptable behavior as well as behavior that is more subtly undermining. Have all staff sign a code of conduct upon hire/appointment and annually thereafter.
• Establish a standard, assertive communication process. Provide alternatives to intimidation. Establish a verbal code, such as "red light," that staff could use to immediately halt the behavior. Or require staff to use first names when communicating important information as a way of breaking down artificial barriers.
• Establish a conflict resolution process. Create an avenue for resolution outside the typical chain of command if the conflict involves a supervisor and subordinate.
• Encourage confidential reporting of intimidating behavior.
• Provide ongoing education that reinforces your organization's commitment to a caring culture.
• Reward outstanding examples of collaborative teamwork.

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