American Medical Association Stalls on Standards for Disruptive Behaviors
Monday January 12, 2009
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The new standards include mandating health organizations develop a code of conduct that defines disruptive and inappropriate behaviors for all employees as well as an enforcement process.
According to a Dec. 1, 2008, article on the organization's amednews.com., the AMA's House of Delegates at their 2008 Interim Meeting took issue with potentially "broad definitions" of disruptive behavior. Delegates are concerned The Joint Commission standards "…could lead to 'arbitrary and capricious enforcement' against physicians."
The AMA is seeking the one-year freeze to give medical staffs time to update bylaws to comply with the standards and is encouraging them to develop their own conduct codes and investigation and appeal plans. The organization also will update its own policy on disruptive behavior.
The AMA declined to be interviewed, but gave a statement to Nursing Spectrum that says the organization passed a directive to partner with the commission and interested parties to develop a definition of disruptive behavior. This definition will include actions that are "true disruptive abusive behavior." The AMA also will work to create a fair appeals process for accused physicians.
The commission is reviewing a letter from the AMA containing the one-year moratorium request, according to Ken Powers, spokesperson for the commission.
The trigger for the focus on disruptive behaviors comes from data compiled by the commission in its July 9 Sentinel Event Alert. The alert found intimidating and disruptive behaviors pose a serious threat to patient safety and the overall quality of care. In addition, 40% of clinicians have kept quiet or remained passive during patient care events rather than question a known intimidator, according to the Institute for Safe Medication Practices.
Cases of physician misbehavior directed at nurses have been spotlighted recently in the lay press, including a Dec. 1 New York Times article, "Arrogant, Abusive, and Disruptive — and a Doctor."
The article focuses on dramatic consequences of physician misbehavior. This included a surgeon who refused to comply with the proper process to verify a surgical site and shouted for the nurse to do it herself. He ended up operating on the wrong site.
Another story told of a resident who refused to heed the assessment of a nurse who noted signs of a serious increase in a patient's intracranial pressure. She had to go over the doctor's head in the physician hierarchy to get the patient the surgery he needed.
Other articles in the Los Angeles Times and Chicago Tribune also have focused on the intimidation and disruptive behavior of physicians. Despite this, nurses and other healthcare employees also are guilty of disruptive behavior.
A survey published in the August 2008 issue of The Joint Commission Journal on Quality and Patient Safety revealed 65% of healthcare employees reported witnessing disruptive behavior in nurses. The Joint Commission Sentinel Event Alert says intimidating and disruptive behaviors are not limited to one gender, one profession, or a small number of perpetrators.
The complete text of the new standards can be found at www.jointcommission.com.
Catherine Spader, RN, is a contributing writer for Nursing Spectrum and NurseWeek. To comment, e-mail editorNTL@gannetthg.com.
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