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Joint Commission issues alert about behavior, safety

Oakbrook Terrace, Ill.—Bad behavior by health care professionals is more than just unprofessional, according to The Joint Commission—it poses a serious threat to patient safety and the overall quality of care.

The Joint Commission issued a new alert July 9 on "Behaviors That Undermine a Culture of Safety," and is introducing new standards that take effect Jan. 1, 2009, for hospitals, nursing homes, home health agencies, laboratories, ambulatory care facilities and behavioral health care facilities nationwide.

More than 15,000 accredited health care organizations will be required to create a code of conduct that defines acceptable and unacceptable behaviors and to establish a formal process for managing unacceptable behavior.

The alert identifies intimidating and disruptive behaviors, including "overt actions such as verbal outbursts and physical threats, as well as passive activities such as refusing to perform assigned tasks or quietly exhibiting uncooperative attitudes during routine activities. Intimidating and disruptive behaviors are often manifested by health care professionals in positions of power. Such behaviors include reluctance or refusal to answer questions, return phone calls or pages; condescending language or voice intonation; and impatience with questions. Overt and passive behaviors undermine team effectiveness and can compromise the safety of patients. All intimidating and disruptive behaviors are unprofessional and should not be tolerated."

"As a sponsoring organization of The Joint Commission (along with the American Hospital Association, the American Medical Association, the American College of Surgeons and the American College of Physicians) the ADA is certainly committed to supporting these changes that are ultimately designed to increase patient safety in all areas of health care," said Dr. David Whiston, vice chair of The Joint Commission Board of Commissioners. Dr. Whiston, an oral and maxillofacial surgeon in Falls Church, Va., is a past ADA president (1997-98) and trustee (1992-1996).

"Most health care workers do their jobs with care, compassion and professionalism," said Mark R. Chassin, M.D., Joint Commission president. "But sometimes professionalism breaks down and caregivers engage in behaviors that threaten patient safety. It is important for organizations to take a stand by clearly identifying such behaviors and refusing to tolerate them."

The Joint Commission addresses disruptive and inappropriate behaviors in two of its elements of performance and also offers 11 additional suggested actions for health care organizations, including:

  • Educate all health care team members about professional behavior, including training in basics such as being courteous during telephone interactions, business etiquette and general people skills;
  • Hold all team members accountable for modeling desirable behaviors, and enforce the code of conduct consistently and equitably;
  • Establish a comprehensive approach to addressing intimidating and disruptive behaviors that includes a zero tolerance policy, strong involvement and support from physician leadership, reducing fears of retribution against those who report intimidating and disruptive behaviors, empathizing with and apologizing to patients and families who are involved in or witness intimidating or disruptive behaviors;
  • Determine how and when disciplinary actions should begin;
  • Develop a system to detect and receive reports of unprofessional behavior, and use non-confrontational interaction strategies to address intimidating and disruptive behaviors within the context of an organizational commitment to the health and well-being of all staff and patients.

To download the complete text of the alert or a podcast, log on to The Joint Commission Web site: