The Patient Safety and Financial Implications of Disruptive Behavior
Disruptive behavior among healthcare providers and staff is widespread in healthcare settings, from large health systems to small healthcare practices. In a survey of more than 800 physicians and physician leaders, more than 70 percent of participants said that disruptive physician behavior occurs at least once a month at their organizations, and more than 10 percent of participants said that such incidents occur on a daily basis.1
The negative consequences of disruptive behavior are far reaching. These behaviors can affect staff morale, focus/concentration, collaboration, communication, and information transfer.2 Thus, from a broad perspective, disruptive behavior can have both patient safety and financial implications.
Patient Safety Implications
An Institute for Safe Medication Practices (ISMP) survey of healthcare providers regarding intimidation and disruptive behavior found that almost half of respondents changed how they addressed medication order clarifications or questions because of a disruptive provider.3 Additionally, 40 percent of respondents who had concerns about a medication order either kept quiet or asked another practitioner rather than confront the intimidating doctor. Not surprisingly, 7 percent of respondents said that they had been involved in a medication error in which the intimidating actions of another member of the healthcare team played a role.4
ISMP's study is one example of how disruptive behavior can influence staff interactions and compromise patient safety. Healthcare providers and staff members who are forced to deal with disruptive behavior might learn to cope by avoidance; as a result, they may fail to provide timely communication about concerns and patient problems.
Other studies that have examined disruptive behavior show similar findings. For example, an American College of Surgeons article on disruptive behavior cites a survey conducted at 102 Veterans Affairs hospitals with 4,530 participants. Two-thirds of the survey's respondents said they felt that disruptive behavior was linked to adverse events. Further, 71 percent saw a link to errors, and 27 percent saw a link to patient mortality.5
Another example of how disruptive behavior affects patient safety occurs when providers fail to follow established rules and protocols. For example, a surgeon who refuses to participate in a preoperative timeout and surgical site marking requirements may unnecessarily put a patient at risk for an adverse outcome. If the surgeon is intimidating or belligerent, other members of the surgical team might hesitate to voice concerns.
The Pennsylvania Patient Safety Authority also identified absence of or delayed response as a type of disruptive behavior that can lead to substandard care or patient harm.6 Examples include not addressing a patient's deteriorating clinical condition or failing to respond in a timely manner to a patient's pain. Absence of, delayed, or inadequate response also can occur in communication among healthcare providers. A survey of healthcare workers in relation to six specific disruptive behaviors noted the following two: individuals who turn their backs before a conversation is over, and individuals who hang up the phone before a conversation is over. The former was noted as the most prevalent behavior experienced by survey respondents.7
In general, a healthcare provider's or staff member's behavior can be viewed as disruptive if it compromises an organization's culture of safety; affects the morale of other workers; and increases the risk of adverse events, suboptimal care, and poor patient outcomes.
Financial Implications
In addition to jeopardizing patient safety, disruptive behavior can have serious financial implications. In a survey of 2,500 physicians, nurses, and senior level administrators from acute care hospitals, more than one-third of participants said that they were aware of at least one nurse who had left a job because of disruptive behavior.8
Newly licensed nurses might be particularly vulnerable because they lack the experience and strategies to cope with toxic cultures.9 An article from the Healthy Workforce Institute notes that 60 percent of nurses who quit their first jobs within 6 months cite bad behavior from their colleagues as their reason for leaving.10
Staff turnover is a multilayered loss to healthcare organizations. Direct costs are incurred when the organization must pay overtime to remaining employees or obtain the services of temporary staff. Also, the organization must factor in replacement costs such as advertising, recruitment fees, credentialing and hiring processes, orientation, and work-start monitoring. Shortages of healthcare workers further complicate these issues.
Indirect costs include the loss of employee expertise that might not be recouped for several years. Productivity suffers as administrative time is required for "damage control" and remaining staff figure out workarounds. Rescheduling of patient appointments, procedures, and treatments; patient transfers; and complaints all take a financial toll.
Further, because disruptive behavior can directly and indirectly affect patient safety and satisfaction, it also can potentially threaten reimbursement and increase the risk of liability and costly malpractice claims.
Unfortunately, the costs associated with staff turnover, poor patient outcomes, and medical errors have a significant financial impact not only for the provider involved, but also for the organizations and business entities with whom they are affiliated.
In Summary
Disruptive behavior undermines the relationships, communication, and teamwork needed to provide high-quality patient care; it can precipitate clinical errors; and it can lead to dissatisfaction for both patients and staff. Further, disruptive behavior can be costly as a result of costs associated with employee attrition, coverage duplication, administrative costs, suboptimal care, and liability exposure.
To learn more about how to address issues related to disruptive behavior, see Risk Tips: Addressing Disruptive Behavior and take MedPro's free continuing education program The Impact of Disruptive Behavior: Strategies to Minimize Risk.
Endnotes
1 MacDonald, O. (2011, May). Disruptive physician behavior. Quantia MD and the American College of Physician Executives. Retrieved from www.quantiamd.com/q-qcp/Disruptive_Physician_Behavior.pdf
2 Paramo, J. C., Welsh, D. J., Kirby, J., Andreone, P., Ducoin, C., Smith, J. A., Butsch, D. W. (2019, May 1). 2018 ACS Governors Survey: The disruptive and impaired surgeon. Bulletin of the American College of Surgeons. Retrieved from https://bulletin.facs.org/2019/05/2018-acs-governors-survey-the-disruptive-and-impaired-surgeon/
3 Institute for Safe Medication Practices. (2004, March). Intimidation: Practitioners speak up about this unresolved problem (Part I). Retrieved from www.ismp.org/resources/intimidation-practitioners-speak-about-unresolved-problem-part-i
4 Ibid.
5 Santin, B. J., & Kaups, K. L. (2015, February). The disruptive physician: Addressing the issues. Bulletin of the American College of Surgeons. Retrieved from http://bulletin.facs.org/2015/02/the-disruptive-physician-addressing-the-issues/
6 Pennsylvania Patient Safety Authority. (2010, June). Chain of command: When disruptive behavior affects communication and teamwork. Pennsylvania Patient Safety Advisory, 7(2), 4–13.
7 Rehder, K. J., Adair, K. C., Hadley, A., McKittrick, A., Frankel, A., Leonard, M. . . . Sexton, J. B. (2020). Associations between a new disruptive behaviors scale and teamwork, patient safety, work-life balance, burnout, and depression. The Joint Commission Journal on Quality and Patient Safety, 46(1), 18-26. doi: https://doi.org/10.1016/j.jcjq.2019.09.004
8 Rosenstein, H. A. (2009). Managing disruptive behaviors in the health care setting: Process, policy, prevention and intervention. In A. M. Columbus (Ed.), Advances in Psychology Research (Volume 7, Chapter 7). New York: Nova Science Publishers. Retrieved from www.physiciandisruptivebehavior.com/admin/articles/22.pdf
9 Sanner-Stiehr, E. (2020). Responding to disruptive behaviors in nursing: One-year follow-up of quasi-experimental research measuring links to turnover, intent to leave, and patient care quality. Journal of Nursing Education and Practice, 10(7), 9-17. doi: 10.5430/jnep.v10n7p9
10 Healthy Workforce Institute. (2018, June 15). How to improve nurse retention by building a business case to address bullying and incivility. Retrieved from https://healthyworkforceinstitute.com/improve-nurse-retention/
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