If you have run an Event Type summary report in our ECRI
database, you have noticed that the largest category by volume is
“Other” for the CHPSO aggregate. As we have been reviewing events
classified as “other” we have noticed some common themes:
non-team promoting behavior (physician), poor coordination of
care, and delay in care related to insufficient staffing. Over
the next few months, we will look closer at each of these issues.
Disruptive and non-team promoting behavior
Here are a couple of examples of the types of reports we are
receiving about behavior that is disruptive for the health care
team, as well as for the patient.
A physician attempted unsuccessfully 9 times to place a
nasogastric tube. He refused assistance from nursing staff. The
patient experienced a vagal response and a code blue was
During rounds a pharmacist asked if the patient should be on
GI prophylaxis because he had a nasogastric tube in place and had
recent abdominal surgery. The physician’s response was to draw up
his fingers like a gun and “shoot” the pharmacist for asking the
Suggested strategies to address this problem
In 2008, the Joint Commission identified disruptive behavior as a
problem and issued the Sentinel Event Alert “Behaviors
that undermine a culture of safety”. The following year, they
added a new Leadership standard for all accreditation programs
that addressed disruptive and inappropriate behaviors in two of
its elements of performance (EP):
EP 4: The hospital/organization has a code of conduct that
defines acceptable and disruptive and inappropriate behaviors
EP 5: Leaders create and implement a process for managing
disruptive and inappropriate behaviors.
In addition, six core competencies are to be addressed in the
credentialing process under the Medical Staff chapter, including
interpersonal skills and professionalism.
Additional suggested actions
Educate all team members –both physician and non-physician-
on appropriate professional behavior defined by the
organization’s code of conduct. The code and education should
emphasize respect and include training on basic business
etiquette (particularly phone skills) and people skills.
Hold all team members accountable for modeling desirable
behaviors, and enforce the code consistently and equitably among
all staff –regardless of seniority or clinical discipline– in a
positive fashion through reinforcement as well as punishment.
Make use of mediators and conflict coaches when professional
dispute resolution skills are needed
Determine what steps your organization has taken to implement
these Joint Commission recommendations and whether or not they
are reinforced when addressing disruptive and inappropriate