Joint Commission issues staff behavior standard
Link drawn to patient safety and quality of care
Citing scientific research that shows a direct link between "intimidating and disruptive behaviors" on the part of health care providers and adverse outcomes, The Joint Commission has both issued a Sentinel Event Alert and unveiled a new leadership standard effective Jan. 1, 2009, to encourage hospitals to identify and deal with such behaviors.
The new leadership standard (LD.03.01.01) has two key elements of performance:
- EP 4: "The hospital/organization has a code of conduct that defines acceptable and disruptive and inappropriate behaviors."
- EP 5: "Leaders create and implement a process for managing disruptive and inappropriate behaviors."
Laying the foundation
The Joint Commission underscored the importance of such a step in a Sentinel Event Alert issued July 9, 2008, entitled, "Behaviors that undermine a culture of safety."
The alert begins with the following framing statement: "Intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators and managers to seek new positions in more professional environments." The statement is supported by no fewer than eight footnoted scientific articles.
"There is good evidence from a number of studies," notes Peter Angood, MD, vice president and chief patient safety officer for The Joint Commission.
In fact, he adds, such behaviors can undermine other Joint Commission standards, such as the Universal Protocol for avoiding wrong-site surgeries.
"You may, for example, have a domineering surgeon who intimidates all the team members in the room — to the point where they do not want to point out [a potential error]," Angood says. "In effect, that surgeon will prevent others from alerting him that they are about to do a wrong-site procedure, because they won't speak up."
What was so important about this issue that The Joint Commission was compelled to put out an alert? "Our standards are one method in which to create change, and in an effort to make sure they are met, we try to get good measurement," Angood explains. "Our National Patient Safety Goals focus on other topics and note the need for change and analysis of processes. The alerts provide a third venue in which we can profile issues that may not fall into performance measure or patient safety goals."
The Joint Commission, he continues, tries not to push too many issues in this fashion. "We have a listing of topic areas we think are important," he notes.
What The Joint Commission wants
So in terms of this new leadership standard, what is The Joint Commission looking for? "The types of things we are looking for include the organization having created a code of conduct — which is important — but then also setting minimal expectations for how the medical staff and leaders should behave, both with each other and with the patients," Angood says. "There needs to be within that code a delineation of what these expectations are, and mention of what the ramifications are if an individual does not follow the code."
These ramifications, which would likely involve disciplinary action, should be based on different levels of behaviors and different frequencies, Angood says. "There will be a relative minority of staff who exhibit this type of behavior on a consistent, routine basis," he notes. "Just because someone has had a bad day and grumps at somebody, that does not necessarily mean they should be penalized. But if you do it every day, that's a different case."
One of the leading organizations in this area, as noted in the alert, is Vanderbilt University in Nashville, TN. "They have utilized reporting of patient complaints and staff complaints, which are anonymous," says Angood. "With this method, they can track how many [complaints] come in on different staff members, and can see when they need to start moving into an 'advising' mode."
[For more information, contact:
Peter Angood, MD, Vice President and Chief Patient Safety Officer, The Joint Commission, One Renaissance Blvd., Oakbrook Terrace, IL 60181. Phone: (630) 792-5000.]
Citing scientific research that shows a direct link between "intimidating and disruptive behaviors" on the part of health care providers and adverse outcomes, The Joint Commission has both issued a Sentinel Event Alert and unveiled a new leadership standard effective Jan. 1, 2009, to encourage hospitals to identify and deal with such behaviors.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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