Medical Staff

Renaming disruptive behavior: Help or hindrance?

Medical Staff Leader Insider, December 8, 2011

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Over the last ten years, I have observed significant progress by medical staff leaders in addressing the issue of disruptive physician behavior.  Although this behavior has not been eradicated or managed with equal skill across all medical staffs, it is no longer blatantly ignored by physician leaders. Medical staff leaders have implemented better policies, improved leadership training efforts, and possess a greater moral resolve to address these events. Also gone are the days when physicians confidently felt they could just go somewhere else with their patients; they know that a similar commitment to managing disruptive behavior is likely to be in place at the neighboring hospital.

I mention the strides medical staffs have taken in managing disruptive behavior because The Joint Commission recently announced that is removing the term “disruptive behavior” from its elements of performance in regard to physician behavior (LD.03.01.01, EPs 4 and 5) after physicians raised concerns about the ambiguity of the term. The language will be replaced with “behavior or behaviors that undermine a culture of safety.”

I wonder if this change will help physician leaders continue to address inappropriate behaviors or if this is simply a move to a more politically correct term? Personally, I don’t particularly care for the term “disruptive behavior” when it appears in the title of a medical staff policy. Instead, I often suggest that medical staffs use the title “Code of Conduct,” which can cover both positive and negative behaviors.

The Joint Commission’s actions raise the question: Is the term “disruptive behavior” more ambiguous than “undermining a culture of safety?” Does this change help physician leaders identify and decrease these negative behaviors? In some ways, the new term is more ambiguous because it could apply to compliance with other policies that one would not associate with disruptive behavior. For example, forgetting to wash your hands could be construed as undermining the culture of safety. Clearly, not practicing safe infection precautions is a behavior that should be addressed by physician leaders. However, it is not the type of interpersonal behavior that physician leaders have tried to eradicate in an effort to bring physicians’ standards up to the same level of human resource standards expected of any employee in the organization.

I applaud the idea that we should not undermine the safety culture. However, if the real intent of The Joint Commission’s standard change is to reduce ambiguity regarding the inappropriate behaviors that have plagued our profession rather than to be politically correct, I believe it would have been better to define disruptive behavior more explicitly than to change to a term that will take much more time to understand and even longer to explain. 

Robert J. Marder, MD, CMSL, vice president of The Greeley Company, a division of HCPro, Inc. in Danvers, MA.

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