Patient Code of Conduct Aimed at Protecting Staff
February 1, 2023
EXECUTIVE SUMMARY
A prominent Boston hospital implemented a patient code of conduct. It is meant to protect staff from offensive and disruptive patients.
- The policy says patients may be turned away for violations.
- The hospital expects refusing to care for a disruptive patient will be rare.
- Patient codes of conduct are increasingly common.
Mass General Brigham hospital in Boston recently implemented a patient code of conduct designed to protect clinicians and other staff from verbal abuse or disrespect. Such policies are becoming more common in response to harassment in healthcare workplaces.
“Words or actions that are disrespectful, racist, discriminatory, hostile, or harassing are not welcome,” according to the code.1
The hospital provided these examples:
- “Offensive comments about others’ race, accent, religion, gender, sexual orientation, or other personal traits;”
- “Refusal to see a clinician or other staff member based on these personal traits;”
- “Physical or verbal threats and assaults;”
- “Sexual or vulgar words or actions;”
- “Disrupting another patient’s care or experience.”
“If we believe you have violated the code with unwelcome words or actions, you will be given the chance to explain your point of view. We will always carefully consider your response before we make any decisions about future care at Mass General Brigham,” the authors wrote. “Some violations of this code may lead to patients being asked to make other plans for their care, and future non-emergency care at Mass General Brigham may require review, though we expect this to be rare.”
The policy also encourages those who witness or are the target of such violations to report it to a member of their care team.
Hospitals Responding to Abuse
Such policies are increasingly common among hospitals, says Mark R. Ustin, JD, partner with Farrell Fritz in Albany, NY. Growing concern about verbal abuse and violence in healthcare settings is prompting hospital leaders to tell patients they must act responsibly if they are to receive non-emergent care.
Hospitals across the nation have experienced a growing threat of violence and abusive behavior by patients or visitors on hospital campuses, says Stacey L. Goldstein, JD, an attorney with Farrell Fritz in Albany.
In 2022, the American Hospital Association noted 44% of nurses reported physical violence and 68% reported verbal abuse during the pandemic. The consensus seems to be these numbers are increasing.2
“These numbers are concerning, not only because of the violence they represent, but also in terms of the impact they are having on an already overworked and overstressed workforce,” Goldstein says. “Unless hospitals are able to get these numbers under control, continuing acts of violence against hospital workers will only continue to contribute to caregiver burnout and further exacerbate existing staffing shortages.”
Difficult to Control Patient Behavior
Hospitals have little ability to control patient behavior, Ustin says. They routinely adopt codes of conduct that set forth compliance expectations for themselves and their employees, including their commitment to comply with applicable federal and state laws and their efforts to prevent fraud, waste, and abuse.
Hospitals also are required by law to adopt a patients’ bill of rights, Ustin says. In New York, it identifies 21 separate rights governing the way treatment is delivered. In EDs, EMTALA prevents hospitals from turning away emergent patients.
But there has been little effort to require patients to act appropriately. That may be changing.
Mass General Brigham’s Patient Code of Conduct is an attempt to modify patient and visitor behavior, reduce verbal or physical threats to hospital employees, and establish a safer and more civil workplace. It may serve as a model for other hospital systems interested in establishing similar codes of conduct.
“Of course, the devil is in the details,” Ustin notes. “Hospitals interested in adopting such a code of conduct need to review that code carefully to ensure it is consistent with applicable law. They need to think carefully about what behavior is being regulated and provide examples so that both staff and patients understand.”
‘Offensive’ Can Be Hard to Define
Goldstein notes it can be difficult to define offensive, vulgar, or disruptive words or actions.
“You do not want a policy that penalizes behavior that is not truly aggressive or threatening,” she explains. “The hospital will also want to make sure that the policy includes fair and consistent enforcement methodologies. For example, will the patient be excluded for a certain length of time, or a lifetime ban?”
The hospital also must ensure a distinction between minor infractions and more serious ones, or first infractions vs. repeated violations, Goldstein says.
Because there are so many potential legal pitfalls, hospitals will need to invest in staff training to ensure everyone understands how the code should be implemented. Patients also should be given notice of the code through appropriate signage or as part of the standing package of consent forms every patient signs.
Good recordkeeping also is important to ensure there is clear proof of what led to the denial if the person sues the hospital, which Ustin says inevitably will occur in some cases.
“If implemented carefully and consistently, patient codes of conduct can provide a level of protection for hospitals and staff against physical and verbal assault,” Ustin says. “For this reason, we can expect them to grow in popularity. However, we will not know the true impact until they are tested in court. The ultimate effect they will have remains to be seen.”
REFERENCES
- Mass Brigham General. Patient code of conduct. 2023.
- American Hospital Association. Fact sheet: Health care workplace violence and intimidation, and the need for a federal legislative response. June 2022.
SOURCES
- Mark R. Ustin, JD, Partner, Farrell Fritz, Albany, NY. Phone: (518) 313-1403. Email: [email protected].
- Stacey L. Goldstein, JD, Farrell Fritz, Albany, NY. Phone: (518) 313-1359. Email: [email protected].
Mass General Brigham hospital in Boston recently implemented a patient code of conduct designed to protect clinicians and other staff from verbal abuse or disrespect. Such policies are becoming more common in response to harassment in healthcare workplaces.
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