Disruptive
Behavior
A Process for Preventing and Containing
Unacceptable Behavior1,2,3
A Presentation for Pomerene Hospital Leaders
Kendall L. Stewart, MD, MBA, DFAPA
January 11, 2010
to the SOMC Code of Conduct.
intend to offer practical suggestions that you can use at work tomorrow.
3Please let me know whether I have succeeded on your evaluation form.
1Refer
2I
Why is this important?
• Unfortunately, disruptive
behavior happens.1,2,3
• When it does, it negatively
impacts our organizational
performance around
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Safety,
Quality,
Service,
Relationships, and
Performance.
• This presentation focuses on the
SOMC process as an example
for preventing and managing
disruptive behavior.
1And
• After mastering the information
in this presentation, you will be
able to
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Define disruptive behavior,
Describe three disruptive behaviors,
Summarize a process for preventing
disruptive behavior,
Identify three steps in a model
process for managing disruptive
behavior when it occurs.
• The Joint Commission now
requires that hospitals “address
disruptive behavior of
individuals working at all
levels.”2
physicians are not the only offenders.
creates an opportunity to enhance and document our current processes around these issues.
3Drunks often behaved disruptively in my father’s church.
2This
What disruptive behaviors have we
observed at SOMC?1
•
•
•
•
•
Berating colleagues publicly
Using profanity
Yelling
Refusing to answer pages
Making suggestive sexual
comments
Throwing things in frustration
Disagreeing in front of patients
Arguing with colleagues in
public
Refusing to accept responsibility
for one’s patient
Putting colleagues in the middle
Belittling others behinds their
backs2
•
•
•
•
•
•
1This
2My
• Physically moving colleagues
out of one’s way
• Using harsh, aggressive
language and behavior
• Refusing to follow SOMC
processes
• Lying
• Engaging in a repetitive pattern
of tardiness
• Having temper tantrums
• Conducting inappropriate
conversations in the presence of
patients and families
• Bullying colleagues
list is not comprehensive.
patient once quoted the criticisms of a hospital administrator and a colleague; the administrator came to see me.
What is disruptive behavior?1,2,3
1See
2
Porto and Lauve (2006) and Neff (2000) in the reference section of this presentation.
SOMC Code of Conduct
3These
behaviors are not always disruptive. Take eye rolling for example.
Not that it matters, but why do
disruptive people behave that way?
• It makes them feel special.
• They think they can get away with
it.
• They have observed others behave
that way and get away with it.
• They are spoiled and emotionally
immature.
• They think their outbursts are
justified because of their position or
rank in the organization.1,2,3
• They believe that their colleagues
exist primarily to meet their needs–
to keep them happy and content.
• Disruptive people are ordinarily not
psychiatrically impaired; they are
just garden-variety bullies.
1Bullying
does not end on the playground.
in any position of power are always tempted to abuse that power.
3A nurse manager refused to permit her employee to come to see me.
2People
What should you do if you are a
victim?
•
•
•
•
•
•
•
•
•
1Captain
Calm yourself.1,2
Don’t blame yourself.
Remove yourself.
Express yourself.
Document what happened quickly
and dispassionately.
Ask other witnesses to document
what they observed.
Ask your manager to investigate.
Participate fully in the
investigation.
Develop realistic expectations.
Chesley Sullenberger, III, reported that he first had to calm himself.
breathing, note taking and mental distractions are the best approaches.
2Controlled
What is the SOMC process for
preventing disruptive behavior?
• We will clarify our behavioral
expectations as a part of every
job offer.
• We will specifically inquire
about a past pattern of
disruptive behavior in our
referencing process.
• If a significant past history of
disruptive behavior in the
workplace is confirmed, we will
not hire that applicant.
• We will provide each applicant
with a copy of SOMC’s Code of
Conduct.
• We will require our applicants
to confirm in writing that they
understand they understand
and will comply with the SOMC
Code of Conduct.
• We will make it clear in our
orientation programs that a
pattern of disruptive behavior
will result in administrative
action up to and including
dismissal.
What is the SOMC process for dealing
with disruptive behavior?
• An incident of perceived
disruptive behavior occurs.
• The people who directly observe
that behavior will document it
promptly and completely.
• The documentation will focus on
observable behaviors, not
suspected motives.
• The incident documentation will
be submitted promptly to the
appropriate manager.
• The documentation will be revised
if necessary.1
• The manager will contact all
parties directly involved in the
allegation and complete an
investigation promptly.
1Emotional
• If the issue is resolved
satisfactorily and this incident is
not a pattern of disruptive
behavior, the process will end at
this point.
• If there is a pattern or if the issue
cannot be promptly and
satisfactorily resolved, the
manager will refer the issue and
all documentation to the
appropriate executive.
• The executive will take the
appropriate administrative
action.
and judgmental language will be excluded; additional clarifying behavioral detail may be needed.
What is the SOMC process for dealing
with disruptive behavior?
Alleged disruptive behavior occurs
Appropriate leader investigates
promptly
Investigator reaches a conclusion
Involves
Physician(s)
Involves
Employee(s)
HR
Complaint dismissed
1Our
2If
No
Review
Violation
occurred?
process is to follow our process.
there is no process, our process is to design and deploy a process.
CMO
Yes
Appropriate action taken
and documented in
Quantros ™
What administrative outcomes may
occur?
• The complaint may be found to be
without merit.1
• An informal counseling may occur.2
• The organizational corrective action
process may be initiated or continued.
• A referral for anger management may
be made.
• A behavioral contract may be required.
• Dismissal or loss of privileges may
occur.
1Inappropriate
2I
complaints have infrequently been lodged in the past.
spoke to a physician and he followed my advice to take roses to the offended nurse.
Where can you learn more?1
•
•
•
•
1Please
APAOnline, “Is Your Hospital Safe? Disruptive Behavior and
Workplace Bullying,” Psychology in the News, September 12,
2008
The Joint Commission, “Behaviors That Undermine a Culture
of Safety,” Sentinel Event Alert, Issue 40, July 9, 2008
Porto, Grena and Lauve, Richard, “Disruptive Clinician
Behavior: A Persistent Threat to Patient Safety,” Patient Safety
& Quality Healthcare, July/August 2006
Neff, KE, “Understanding and Managing Physicians with
Disruptive Behavior,” In Ransom, et. al., Enhancing Physician
Performance: Advanced Principles of Medical Management,
American College of Healthcare Executives, 2000: 45-72
visit www.KendallLStewartMD.com to download related white papers and presentations.
Are there other questions?
www.somc.org
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