INTIMIDATING OR DISRUPTIVE BEHAVIOR

To affirm the professional responsibility of the pharmacist to ensure patient and workplace safety by communicating with other healthcare personnel to clarify and improve medication management; further,

To advocate that hospitals and health systems adopt zero-tolerance policies for intimidating or disruptive behaviors in their institutions; further,

To encourage hospitals and health systems to develop and implement education and training programs for all healthcare personnel to encourage effective communication, set expectations for standards of conduct, promote use of de-escalation techniques, and discourage intimidating or disruptive behaviors; further,

To encourage colleges of pharmacy and residency training programs to incorporate training in communications and managing intimidating or disruptive behaviors; further,

To collaborate with other organizations to advocate codes of conduct that do not allow intimidating or disruptive behavior in hospitals and health systems; further,

To encourage hospitals and health systems to adopt processes for identification and reporting of intimidating or disruptive behaviors to evaluate and mitigate unacceptable behaviors in a timely and effective manner.

Rationale

Intimidating or disruptive behaviors can lead to medical errors, contribute to poor patient satisfaction, increase costs, and cause staff turnover. Such behaviors range from passive behaviors such as providers refusing to answer questions or return pages to use of condescending language to overt actions such as verbal outbursts or physical threats. The Institute for Safe Medication Practices conducted a national survey regarding intimidation in the workplace in 2003 and conducted a follow-up survey in 2013 for comparison. Based on recent events involving healthcare practitioners along with the results of this survey, disrespectful behaviors continue to erode professional communication, which is essential to employee and patient safety.

In addition, healthcare workers face an increased risk of work-related assaults resulting primarily from intimidating or disruptive behavior of patients and their caregivers or family members. Disruptive behavior, including interference with treatment plans, vulgar language, and threatening statements, can impede a healthcare worker’s ability to provide safe and effective care. Another common form of unprofessional behavior may be inappropriate judgement of peers and breaching confidentiality behind peers. While such behavior is often overlooked, underreported, or considered to be part of the job, it can also lead to more serious confrontations. Unfortunately, there is no clear way to identify patients or family members who will be disruptive to healthcare personnel, so every patient and family member must be treated with the same level of caution.

According to the U.S. Bureau of Labor Statistics (BLS), healthcare workers accounted for 73% of all nonfatal workplace injuries and illnesses due to violence in 2018. BLS data also show that the highest rates of injuries caused by workplace violence occur in the healthcare and social service industries, and that healthcare workers are five times as likely to suffer a workplace violence injury as workers overall. Further, it has been demonstrated that workplace violence can harm a person’s intrinsic sense of self-worth and confidence, which can result in physical symptoms, such as headaches, anxiety, and depression. The American Nurses Association and the American Medical Association have taken positions concerning violence against healthcare workers and actively promote solutions to address the issue.

ASHP believes organizations should develop training programs to discourage disruptive behaviors and to train employees in handling disruptive situations, including de-escalation techniques, and colleges of pharmacy and residency training programs should also provide such training. Organizations should outline a proposed risk management plan in addition to informing the workforce of the legal ramifications that come with workplace bullying. Education of all team members on appropriate professional behavior, including reporting workplace concerns (as defined by the organization’s code of conduct), instruction in basic business etiquette (e.g., phone, email, and social media interactions), and training in interpersonal skills are a leadership responsibility. These organizational efforts will help with compliance with The Joint Commission workplace violence standards to guide organizations in developing workplace violence prevention systems and post-incident strategies to decrease workplace violence.