Dealing with Disruptive Behavior in the Health Care Workplace

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By Jennifer Larson, contributor 

April 12, 2013 - Disruptive behavior in a workplace can take many forms. It can be overt, or it can be more subtle and insidious. It can be outright bullying, or it can be a constant negative attitude that drags everyone down.

Regardless of the form it takes, disruptive behavior can be devastating to a workplace and individuals in the health care team, according to Jody Foster, MD, director of the professionalism program at Penn Medicine.

Unchecked, disruptive behavior can decrease morale and productivity, turn away patients, and even compel some people to quit and find other jobs. And that can be costly for health care systems that have to replace their employees.

“It’s costly financially and psychologically,” said Foster.

Health care professionals behaving badly 

The old hierarchical model with the physician at the top of the pyramid may be rarer than it used to be, but this set-up--and the accompanying power differential--does still exist in some health care settings. And lateral bullying among health care professionals, including nurses, is all too common, as well.

Of course, health care professionals are people; they are not perfect. They bring their personalities, flaws and all, with them to work. But when health systems and managers allow truly disruptive behavior to happen without being addressed, that sends a bad message.

Suzanne Gordon: disruptive behavior shouldn't be tolerated in the workplace
Author Suzanne Gordon said that nurse leaders should also pay attention to factors that may contribute to bad behavior, including fatigue.

“Why is the behavior of that bad apple being tolerated?” said Suzanne Gordon, an expert on communication issues in the health care setting and author of Beyond the Checklist: What Else Health Care Can Learn from Aviation Teamwork and Safety. “Why is that person not being coached? Why is that person not being talked to in a constructive way?”

A recent blog post by physician executive and consultant Jonathan Burroughs, MD, MBA, FACHE, for Health Impact, noted that rare or episodic offenders represent the vast majority of cases: 98 percent. Only 1.9 percent of staff have established a pattern of conduct problems, and only 0.1 percent could be considered truly “egregious” offenders.

Foster said she believes that whenever there is interpersonal conflict or disruption, it warrants some type of intervention. And don’t wait, she said; addressing disruptive behavior early on is critical.

“There’s an implicit approval of behavior if there aren’t interventions,” said Foster.

If ignoring a problem is an example of one bad strategy, moving a disruptive employee to another department, floor or unit is another.

“If you move chronic offenders to other locations, they will resume their bad behaviors and infest other parts of your organization,” warned Christine Porath, an associate professor at Georgetown University’s McDonough School of Business.

The price that’s paid 

In a recent Harvard Business Review article titled “The Price of Incivility,” Porath and Christine Pearson explored the price that everyone pays when incivility, rudeness or hostile behavior takes place at work.

The article includes the results of a survey of managers and employees from 17 industries, which found that nearly half of workers who have been on “the receiving end of incivility” decreased their effort at work. Not only that, but 80 percent lost valuable work time worrying about the incident, and two-thirds reported that their job performance declined. 

And 25 percent “admitted to taking their frustration out on customers.” That could have significant implications for health care, an industry where patient satisfaction has become increasingly important--to the point where Medicare reimbursement is now tied to some patient satisfaction benchmarks.

Even if you’re not the target of a bully or the focus of specific negative feedback, it can affect you in very profound ways.

“Even when people witness incivility, it can be extremely upsetting,” said Porath. “We’ve found that the primary reason is that people believe that it violates respectful treatment of others.”

Ramón Lavandero, MSN, RN, MA, senior director for AACN Critical Care for the American Association of Critical-Care Nurses (AACN), agreed.

“Disruptive behavior at work is a significant cause of moral distress among nurses,” he said, pointing to the example of nurses who recognize the appropriate ethical response to a situation but aren’t able to follow through. For that reason, he added, organizations need to have zero-tolerance policies toward abusive and disrespectful behavior--and nurses can work on their own communication and collaboration skills.

Experiencing incivility is also stressful on the body, which isn’t really designed to tolerate prolonged low-to-moderate stress. “When people experience average, run-of-the-mill stressors like incivility for too long or too often, their immune systems pay the price,” said Porath. “Over time, low-level stressors may lead to cardiovascular disease, ulcers, cancer and diabetes.”

Additionally, stress hinders our ability to learn and to effectively solve problems.

Health care team training programs, such as Team STEPPS, can be very useful, said Gordon, but it must be an ongoing effort. Managers need training on team building, too, particularly if they are working with an interdisciplinary team.

Educating the future nursing workforce 

Concordia College in New York is being proactive about preparing its nursing students to recognize bullying and other forms of disruptive behavior. Earlier this year, the college held a workshop on workplace incivility to help the students identify problem behavior and discuss possible strategies for dealing with it.

According to Susan Apold, PhD, the college’s dean of health and human services, it’s important to deliberately address this issue, rather than assuming that students will learn it on the job somehow.

“When someone behaves to you in a way that is not good, your inclination is to say, ‘What have I done to evoke this?’” she said. “So there is value in people being able to say, ‘Wow, that happened to you, too?’ These things can happen to you and have nothing to do with you.”

The college plans to continue offering opportunities to students to learn more about the issue and even participate in simulations and role-playing situations.

“I think we’ve made a very good start, and we’ll keep working on it,” said Apold.

Five tips for being civil to each other 

Porath and Pearson point out that civility in the workplace must be taken seriously. They offer the following suggestions for health care employers and staff:

1.  Create and add a statement about the importance of employee-to-employee civility to your mission.
2.  Don’t tolerate bad behavior from people in positions of power that you wouldn’t from others.
3.  Use good judgment when hiring new people. “Don’t let any uncivil people in your door,” Porath and Pearson wrote.
4.  Leaders must be aware of their own behavior and consciously try to set a good example.  “If other people see that those who have successfully climbed the corporate ladder are rude, embrace, or tolerate uncivil behavior, then people are likely to emulate that behavior,” they wrote in a 2010 article for Organizational Dynamics.
5.  Teach for civility. If you hire for civility, you should also give employees the opportunity to learn about it and practice it.

Related article:
ANA Aims at Stopping Workplace Bullying


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