Healthcare clinicians' disruptive behaviors negatively affect patient care: Data

Pennsylvania Patient Safety AuthorityJun 17 2010

Pennsylvania Patient Safety Authority data shows that healthcare clinicians' disruptive behaviors negatively affected patient care while a Pennsylvania hospital works to reduce the number of adverse events in its facility by improving teamwork

Disruptive behavior was reported in 177 events submitted to the Pennsylvania Patient Safety Authority from May 2007 to October 2009. In many of the events patient care was compromised, according to data released today by the Pennsylvania Patient Safety Authority and published in the June Supplementary Pennsylvania Patient Safety Advisory. 

Of the 177 events, 73 (41%) were due to conflicts between healthcare clinicians, 30 (17%) to procedures not followed, 17 (10%) to absence of responses or delays, 22 (12%) were listed as other, and behaviors for the remaining 35 events (20%) were not given.

Some of these reported events listed disruptive behaviors that may have contributed to delays in pain control, increased risk of healthcare-associated infections or increased risk of burns.

"The Authority's analysis shows patient care can be compromised when healthcare clinicians display disruptive behavior in a healthcare setting," Mike Doering, executive director of the Pennsylvania Patient Safety Authority said. "Healthcare facilities should examine their policies on disruptive behavior so patient safety is not compromised due to a healthcare clinician's unprofessional behavior."

Doering added that the Authority provides guidance in the Advisory to help facilities adopt chain-of-command policies. Chain of command in healthcare refers to an authoritative structure established to resolve administrative, clinical or other patient safety issues by allowing healthcare clinicians to present an issue of concern through the lines of authority until a resolution is reached. 

"An effective chain of command in healthcare organizations encourages, rather than prevents communication, teamwork and collaboration between the decision maker and the frontline clinician," Doering said. 

Examples of reports describing conflicts between healthcare clinicians, refusals to adhere to procedures and absences or delayed responses that resulted in patient care delays and increased risks for healthcare-associated infections or burns are listed in the Advisory. They include:

Report 1:[Conflict]

The primary surgeon walked out of the OR [operating room] suite, and the assistant surgeon completed the surgery. The event was a result of an altercation between surgeon, assistant surgeon and anesthesiologist.

Report 2:[Refusals to adhere to procedures]

Staff were about to apply [a topical anesthetic] cream to a baby's penis when the baby's physician entered the room and stated that he was ready to do the circumcision. The physician was told that he would have to wait 30 minutes until after the cream was applied. He stated he would not wait 30 minutes and that it would be done now. Baby had a pain score of 4/7 [after the procedure].

Report 3:[Absences or Delayed Reponses]

A patient in active labor was complaining of severe pain. The anesthesiologist was notified of request to re-bolus [the patient's] epidural. Physician stated that someone could not come to [labor and delivery department] for an hour to medicate the patient. After one and a half hours, the nurse called again and was told that lunch breaks were being given and to call a different physician. When called, physician stated that she was not on call for obstetrics, and no one was available to help patient. Patient was finally injected two hours after the initial request.

In the disruptive behavior events reported to the Authority, the care areas where the behaviors most frequently occurred were in operating rooms (24%), medical/surgical units (24%), intensive care units (16%), EDs (8%), outpatient departments (7%), labor and delivery units (4%), behavioral health units (3%), laboratories (1%) and others (8%).

To see more reports and more strategies to prevent patient harm due to disruptive behavior go to the Supplementary Advisory article, "Chain of Command: When Disruptive Behavior Affects Communication and Teamwork," at the Authority's website www.patientsafetyauthority.org.

The Authority's supplementary 2010 June Advisory contains other articles that focus on the importance of teamwork particularly in a healthcare setting to improve patient safety. Highlights include:

• Pennsylvania Hospital Focuses on Operating Room (OR) Safety: York Hospital in York, Pennsylvania, has been using a group of techniques known as Crew Resource Management (CRM) to train employees on how to reduce human performance errors such as wrong-site surgeries and retained foreign objects (RFOs). As a result of the training program, the facility has seen steady increases in staff using the techniques that confirm the widespread adoption of CRM in the York Hospital OR.
• Column: Patient Safety is Enhanced by Teamwork: The Authority's Patient Safety Liaison located in the South Central region discusses the importance of teamwork and how facilities in her region have adopted programs such as Team STEPPS™ (Team Strategies and Tools to Enhance Performance and Patient Safety™) to improve patient safety in their facilities.

Coincidentally, the teamwork articles were released during the American Society for Healthcare Risk Management's (ASHRM) national Healthcare Risk Management Week (June 14-18). The week highlights the risks associated with disruptive behavior with the theme, "RMPower! Take Charge for Patient Safety."