Pennsylvania Body Cites ‘Disruptive Behavior’ in Hospitals

July 20, 2010

A Pennsylvania state agency has released a report examining what it calls “disruptive behavior” by health care workers can pose a danger to patients.

The Pennsylvania Patient Safety Authority, which studies medical errors and “near-misses” at Pennsylvania health care facilities, said it found 177 incidents of disruptive behavior by health care workers during a 31-month period ending last October.

The incidents cited, which mostly involve doctors, include a surgeon storming out of the operating room, leaving others to finish the job, or dropping instruments on the floor and using the items on a patient, ignoring an offer of replacements. No names or places are revealed.

“I think the problem is real. I think any hospital or health system that says they don’t have a problem with disruptive physicians is probably not stating the truth,” said Dr. Nirmal Joshi, vice president of education and research at PinnacleHealth System.

Many of the incidents stemmed from conflicts between doctors and nurses, the physician often ignoring a concern raised by a nurse or was uncooperative when asked to clarify a written order, the report said.

“I think this type of human interaction happens in all workplaces,” said Mike Doering, the executive director of the authority. “Unfortunately, when it happens in a hospital environment, you have a patient who can suffer because of it.”

The authority said such incidents may result from a hospital hierarchy that allows high-ranking doctors and staff members to get away with disruptive and intimidating behavior, which can leave other employees feeling ignored or afraid to point out errors or raise concerns.

“There is a history of tolerance and indifference to intimidating and disruptive behaviors in health care, and organization leaders may fail to address health care clinicians’ disruptive behaviors for many reasons,” the report said.

The solution, the report said, is creating a culture in which employees at all levels are encouraged to express concerns, and all concerns are addressed _ and there is “zero-tolerance” for disruptive behavior.

The report refers to a survey of 2,100 doctors and nurses that found a “fundamental lack of respect” between the two groups. Another survey of nurses cited calls to doctors to clarify orders as the main trigger of disruptive behavior; surveys of doctors indicate frustration over orders not being carried out correctly or on time.

Pennsylvania health care facilities have since 2005 been required to report medical errors and near-misses to the authority, which looks for causes and ways to prevent them. The body cannot punish doctors or hospitals so people are not discouraged from reporting incidents.

Mishaps that harm patients, however, must also be reported to the Pennsylvania Department of Health, which can issue fines and penalties.

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