Red Flags for Disruptive Behavior in Healthcare Professionals
Laura M. Cascella, MA, CPHRM
Sadly, disruptive behavior among healthcare professionals and staff is common, and it poses a threat to patient safety and staff well-being. A bulletin from the American College of Surgeons states that the majority of healthcare professionals have encountered colleagues engaging in disruptive behaviors with coworkers, patients, relatives, and others.1 These behaviors can take a serious toll on members of the patient care team and can increase the risk of adverse events.
Disruptive behavior can manifest in various ways. Sometimes the behavior is manipulative; other times it might be threatening or intimidating. In some cases, disruptive behavior is passive, such as avoidance, failure to follow standard protocols or policies, and chronic tardiness. Regardless of how the behavior presents, it creates disorder and often ensnares the disruptive provider’s colleagues in turmoil and chaos.
Although disruptive behavior cannot always be prevented, healthcare leaders and providers can take proactive steps to identify colleagues who might be at risk for potentially toxic and harmful behaviors. Doing so may help address potential problems before they escalate and lead to safety issues. Early identification of disruptive behavior also might create opportunities to provide support and guidance for clinicians whose behaviors are reflective of burnout, mental or physical health problems, cognitive impairment, substance abuse or addiction, or other disorders.
Some potential red flags for disruptive behavior in healthcare professionals might be apparent during the hiring and credentialing process if, for example, the individual under review:
- Has a history of changing jobs frequently, often with geographic relocations and unexplained periods of unemployment.
- Has been employed in jobs that were inappropriate for his/her qualifications.
- Is reluctant to give permission to contact previous employers or organizations.
- Makes excuses for not being able to produce appropriate or adequate references. Letters of reference are “vague” and don’t really tell the story of the individual’s accomplishments and skills.
- Has a history of voluntary or involuntary relinquishment of licensure/registration or medical staff membership.
- Has a history of limitation, reduction, or loss of clinical privileges.
- Has an unusual pattern or excessive number of professional liability actions resulting in a final judgment against him/her.
- Has a history of board of medical examiner investigations or prior professional disciplinary actions.
- Has a history of poor performance evaluations.
In some cases, disruptive behavior develops over time as a result of personal or professional circumstances. A provider who was previously congenial might exhibit inappropriate or unprofessional actions that develop into a pattern of disruptive behavior. For example, in these situations, the individual might:
- Exhibit personality changes. Although everyone has “off” days, large-scale changes in a person’s overall demeanor and behavior might indicate a potential problem.
- Make inappropriate comments. He/she may become excessively sarcastic, negative, or antagonistic.
- Complain about being misunderstood or overworked.
- Have frequent absences or tardiness and become irritable when pressed to improve.
- Skip meetings and fail to meet deadlines; staff members might begin to double-check the provider’s work to prevent errors.
- Have a change in personal appearance or hygiene that is concerning (e.g., a disheveled appearance, body odor, dirty clothes, etc.).
- Seem shaky, nervous, jittery, or sweaty.
- Forget commitments, arrive late, be unprepared, or act unpredictably.
- Withdraw from activities that previously were of interest or behave inappropriately during such activities.
- Show signs of having a substance abuse disorder.
- Have legal concerns (e.g., arrests, impaired driving citations, divorce proceedings, etc.).
- Receive frequent complaints from patients.
It’s important to note that the indicators listed above do not necessarily imply that someone will become disruptive. Each person copes with life and work situations differently, and many people are able to maintain professional behavior even under stressful circumstances. Further, the Journal of Medical Regulation notes that, “A single episode of disruptive behavior does not render a physician a disruptive physician.”2 Rather, disruptive behavior is a pattern of actions that interferes with clinical performance, quality of care and safety, efficiency, and teamwork.
Awareness of potential red flags for disruptive behavior is an essential element of human resource management for healthcare organizations, both large and small. Healthcare leaders, providers, and staff members should understand their organizations’ codes of conduct and professional standards as well as the appropriate procedures and chain of command for reporting disruptive incidents.
Taking a proactive approach to managing disruptive behavior and supporting a nonpunitive environment in which employees feel empowered to report potential safety issues will help healthcare organizations reinforce a positive work environment and robust culture of safety.
To learn more about disruptive behavior, take MedPro’s free continuing medical education course titled Nip It in the Bud: Strategies for Addressing Disruptive Behavior in Healthcare.
The following MedPro resources also provide helpful information:
Endnotes
1 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/
2 Reynolds N. T. (2012). Disruptive physician behavior: Use and misuse of the label. Journal of Medical Regulation, 98(1), 8–19.
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