August 2008 Volume 34 Number 8
The Joint Commission Journal on Quality and Patient Safety
A Survey of the Impact of Disruptive Behaviors and
Communication Defects on Patient Safety
Ever since the publication of the Institute of Medicine
Report To Err Is Human, health care organizations have
received the wake-up call that they need to address the
growing concern about patient safety1; several follow-up reports have documented moderate improvement, but there are still
large, disconcerting gaps between what we have been able to
achieve and where we need to go.2–5 To advance further we need to improve our processes, systems, and technology, and at the same time address the human factor issues that affect bedside care.
We originally reported on the impact of disruptive physician behavior on nurse satisfaction and retention in 2002. The
results of this research showed a significant relationship
between disruptive physician behavior, poor nurse satisfaction and morale, and an increase in nurse turnover.6,7 As part of the research for this study, we searched for information on a relationship between disruptive behaviors and negative outcomes
of care, but other than a few anecdotal stories, we could find no documented studies directly linking disruptive behavior to negative clinical outcomes.
In an effort to address the relationship of disruptive behaviors to potential compromises in patient outcomes of care, we
extended the scope of the survey to include assessment of disruptive behaviors in nurses and other health care disciplines
and evaluated their perceptions and experiences as to the
impact of disruptive behaviors on patient care. These studies showed a significant relationship between both physician and nurse disruptive behaviors and worrisome psychological and
behavioral traits, which led to impaired working relationships hampered by intimidation, hostility, stress, frustration, loss of focus, poor communication, and reduced transfer of necessary information, all of which adversely affected patient outcomes.8,9 The Joint Commission reports in its root cause analysis of
sentinel events that nearly 70% of the events can be traced back to a problem with communication.10 Effective January 1, 2009, The Joint Commission will require that the hospital (organization) “has a code of conduct that defines acceptable, disruptive, Article-at-a-Glance
Background: A recent survey was conducted to assess the
significance of disruptive behaviors and their effect on communication and collaboration and impact on patient care.
Survey: VHA West Coast administered a 22-question survey
instrument—Nurse-Physician: Impact of Disruptive
Behavior on Patient Care—to a convenience sample. Of
the 388 member hospitals (in four VHA regions) invited,
102 hospitals participated in the survey (26% response
rate). Results from surveys received from January 2004
though March 2007 are represented. Of the 4,530 participants, 2,846 listed their titles as nurses, 944 as physicians,
40 as administrative executives, and 700 as “other.”
Results: A total of 77% of the respondents reported that
they had witnessed disruptive behavior in physicians—
88% of the nurses and 51% of the physicians. Sixty-five
percent of the respondents reported witnessing disruptive
behavior in nurses at their hospitals—73% of the nurses
and 48% of the physicians. Sixty-seven percent of the
respondents agreed that disruptive behaviors were linked
with adverse events; the result for medical errors was 71%,
and patient mortality, 27%.
Discussion: The results from the survey show that disruptive behaviors lead to potentially preventable adverse events,
errors, compromises in safety and quality, and patient mortality. Strategies to address disruptive behaviors should (1)
prevent disruptive events from occurring, (2) deal with
events in real time to prevent staff or patient harm, and (3) initiate postevent review, actions, and follow-up....
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and Safety, 2007
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