Disruptive behaviors can have a significant negative impact on staff relationships, communication flow, task responsibility, and team collaboration, all of which can adversely impact patient outcomes of care. Addressing disruptive behaviors in a positive manner by emphasizing the benefits of mutual understanding, shared goals and priorities, and adherence to accepted standards of care will enhance communication flow and improve the process and outcomes of care. This is particularly relevant in the obstetrics setting, where care is delivered over a continuum of time, with multiple different members of the health care team playing a vital role as the patient progresses from labor to delivery. Critical strategies for success include having strong organizational commitment and leadership support, raising provider insight and awareness, implementing appropriate policies and procedures, providing appropriate educational and training programs, and facilitating action-oriented interventional support.
Disruptive behaviors in the health care setting can have a significant negative impact on staff relationships, team collaboration, and communication flow, all of which can impact patient outcomes of care adversely. It is not that anyone starts out the day planning to be disruptive, it is just that the stress and pressures of the day may trigger an inappropriate or disruptive response, which may result in behaviors that affect coworkers’ thoughts and actions that can interfere with process flow and task responsibilities. In most cases, individuals are unaware of the clinical consequences of their behaviors and the downstream effect on patient care. With a primary goal of providing the best quality of care in a safe medical environment, we must address the issue head on. Raising levels of awareness about the seriousness of the issue, holding individuals accountable for their behaviors, and providing strategies not only to reduce the incidence and consequences of disruptive events but also to improve efficiency of communication and team collaboration are the crucial steps that are needed to support these organizational objectives.
Background
Disruptive behaviors in health care have been around for years but, until recently, were never really addressed in a consistent effective manner. Reasons for the reluctance to address the issue included a history of organizational tolerance that was related to the fear of antagonizing a physician who might threaten to take his or her patients elsewhere, the hierarchal medical structure that propagated physician autonomy and authority, the unwritten code of silence, concerns about conflicts of interest, and the lack of willingness, initiative, skill set, and organizational structure needed to address one’s peers on behavioral rather than clinical matters. With the perception of no harm done, organizations were content to look the other way.
However, things have changed. First was the concern about the growing nursing shortage and the relationship of disruptive behaviors to nurse satisfaction, retention, recruitment, and turnover. Second was the growing research that documented the impact of disruptive behaviors on medical errors, adverse events, and patient safety. Third was the requirement to have a disruptive behavior policy in place as part of the Joint Commission Accreditation standard. Fourth was the relationship of disruptive behaviors to patient satisfaction, patient complaints, and malpractice proceedings. The culmination of these factors can affect the organization’s reputation as a workplace of choice and quality provider, which has both staffing and financial implications.
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