Mind Your Manners
Beginning January 1, 2009, your on-the-job behavior—and that of other healthcare providers—will be held to a new standard. New Joint Commission standards include a requirement for healthcare organizations to create a code of conduct outlining acceptable and unacceptable behaviors for healthcare professionals, and to implement a process for managing problematic behavior. The reason for this unusual step is the belief that disruptive or intimidating behavior by physicians, nurses, and other healthcare workers has a negative impact on the quality of care.
“I think the standard shows that the Joint Commission is interested in behaviors within hospitals and other healthcare organizations, and how that affects quality of care, safety and the patient experience,” says Russell L. Holman, MD, immediate past president of SHM and chief operating officer for Cogent Healthcare, Nashville, Tenn. “By highlighting this as an area to be included in reviews and standards, it causes organizations to look for their own policies on disruptive behaviors.”
Here is a closer look at the new standard and how it might impact hospital medicine.
Not Physicians Only
The Joint Commission standard addresses “the problem of behaviors that threaten the performance of the healthcare team,” mentioning unprofessional behavior, specifically “intimidating and disruptive behaviors.” To many, this seems to target physicians. “In a hospital, there is an unwritten hierarchy, with physicians at the top,” Dr. Holman points out. “As such, some feel that different standards are applied to physician behaviors. For example, if a nurse or a pharmacist uses obscene language, they may be terminated. If a physician does this, they may receive feedback that the language was inappropriate.”
However, the Sentinel Event Alert released by the Joint Commission in July states, “While most formal research centers on intimidating and disruptive behaviors among physicians and nurses, there is evidence that these behaviors occur among other healthcare professionals, such as pharmacists, therapists, and support staff, as well as among administrators.” The alert does not single out physicians or any other healthcare profession regarding bad behaviors.
“I think the Joint Commission has been very clear in its intent that the standard applies equally to physicians and non-physicians,” Dr. Holman says.
When Hospitalists Cross the Line
How will this code of conduct standard affect hospitalists? Because of the nature of their work, they will be held to the standards of any hospital they work in. In the case of hospitalists who are directly employed by a hospital, the response should be straightforward. However, independent hospital medicine groups will have to work with their hospitals on behavior issues. First, these groups will need to decide whether they should have their own policies and procedures for code of conduct. “Hospital medicine groups need appropriate systems of identifying disruptive behavior, monitoring it, and taking any necessary actions to make sure the behavior is not continued,” Dr. Holman stresses.
