Joint Commission Alert: Stop Bad Behavior among Health Care Professionals

Rude language, hostile behavior threaten safety, quality.

Media Contact:   
Ken Powers
Media Relations Manager
630-792-5175
kpowers@jointcommission.org

(OAKBROOK TERRACE, Ill. – July 9, 2008 ) Health care is a high-stakes, pressure-packed environment that can test the limits of civility in the workplace. A new alert issued today by The Joint Commission warns that rude language and hostile behavior among health care professionals goes beyond being unpleasant and poses a serious threat to patient safety and the overall quality of care.

Intimidating and disruptive behaviors are such a serious issue that, in addition to addressing it in the new Sentinel Event Alert, The Joint Commission is introducing new standards requiring more than 15,000 accredited health care organizations to create a code of conduct that defines acceptable and unacceptable behaviors and to establish a formal process for managing unacceptable behavior. The new standards take effect January 1, 2009 for hospitals, nursing homes, home health agencies, laboratories, ambulatory care facilities, and behavioral health care facilities across the United States.

Health care leaders and caregivers have known for years that intimidating and disruptive behaviors are a serious problem. Verbal outbursts, condescending attitudes, refusing to take part in assigned duties and physical threats all create breakdowns in the teamwork, communication and collaboration necessary to deliver patient care. The Institute for Safe Medication Practices found that 40 percent of clinicians have kept quiet or remained passive during patient care events rather than question a known intimidator. To help put an end to once-accepted behaviors that put patients at risk, The Joint Commission Sentinel Event Alert urges health care organizations to take action.

“Most health care workers do their jobs with care, compassion and professionalism,” says Mark R. Chassin, M.D., M.P.P, M.P.H., president, The Joint Commission. “But sometimes professionalism breaks down and caregivers engage in behaviors that threaten patient safety. It is important for organizations to take a stand by clearly identifying such behaviors and refusing to tolerate them.”

To help put an end to intimidating and disruptive behaviors among physicians, nurses, pharmacists, therapists, support staff and administrators, the Sentinel Event Alert recommends that health care organizations take 11 specific steps, including the following:

• Educate all health care team members about professional behavior, including training in basics such as being courteous during telephone interactions, business etiquette and general people skills;

• Hold all team members accountable for modeling desirable behaviors, and enforce the code of conduct consistently and equitably;

• Establish a comprehensive approach to addressing intimidating and disruptive behaviors that includes a zero tolerance policy; strong involvement and support from physician leadership; reducing fears of retribution against those who report intimidating and disruptive behaviors; empathizing with and apologizing to patients and families who are involved in or witness intimidating or disruptive behaviors;

• Determine how and when disciplinary actions should begin; and

• Develop a system to detect and receive reports of unprofessional behavior, and use non-confrontational interaction strategies to address intimidating and disruptive behaviors within the context of an organizational commitment to the health and well-being of all staff and patients.

Addressing unprofessional behavior among health care professionals is part of a series of Alerts issued by the Joint Commission. Previous Alerts have addressed pediatric medication errors, wrong-site surgery, medication mix-ups, health care-associated infections and patient suicides, among others. The complete list and text of past issues of Sentinel Event Alert can be found on The Joint Commission’s website: http://www.jointcommission.org/SentinelEvents/SentinelEventAlert

Anger Management Institute of Texas is a certified Anderson & Anderson ® provider.

Anger Management Classes and Executive Coaching available in Houston, Texas.

Gregory A. Kyles, M.A., LPC, CEAP, CAMF
Director, Anger Management Institute of Texas
Diplomate, President of Texas Chapter
American Association of Anger Management Providers
http://www.ami-tx.com
http://www.ami-tx.org
https://gregorykyles.wordpress.com
http://www.linkedin.com/in/gregorykyles
http://www.myspace.com/anger_management_expert

Psychiatric Assessments for Disruptive Physicians, A Risk for Non-Impaired Doctors

JCAHO standards for physicians make a clear distinction between “disruptive physicians”, psychiatrically impaired physicians, substance abusers and/or sexual abusers. Unfortunately, some resources for “disruptive physicians” demand that all participants undergo a formal psychiatric examination whixh includes projective tests.

While assessments for all of the above issues may be necessary, the mental health assessment should be limited to suspected cases of nervous or mental disorders rather than anger management. Anger is not listed as a DSM-IV Diagnostic Disorder. According to the American Psychiatric Association, anger is a lifestyle issue and is therefore not responsive to psychotherapy or psychiatric intervention.

A mandated psychiatric assessment places inappropriately referred physicians at risk of being entered into the National Practitioner Data Bank. Once a physician is listed in this data bank, it is almost impossible to get any information removed.

Unfortunately, the stigma against mental illness continues to exist and can damage the career of any physicians. Physicians ordered to attend Coaching for Anger Management should insist on a program that is not psychiatrically bases.

By George Anderson, MSW, BCD, CAMF, CEAP http://www.andersonservices.com

Anger Management Institute of Texas is a Certified Anderson & Anderson® Provider

Anger Management Classes and Executive Coaching available in Houston, Texas.

Gregory A. Kyles, M.A., LPC, CEAP, CAMF
Director, Anger Management Institute of Texas
Diplomate, President of Texas Chapter
American Association of Anger Management Providers
http://www.ami-tx.com
http://www.ami-tx.org
https://gregorykyles.wordpress.com
http://www.linkedin.com/in/gregorykyles
http://www.myspace.com/anger_management_expert

The Negative Effects of Anger On Your Health

There are many serious and very dangerous side effects associated with constantly being angry. Anger puts extra stress on all of your body’s systems. Long, frequent periods of anger have been associated with problems such as heart disease, high blood pressure, and even strokes. Chronic anger goes hand and hand with insomnia, depression, anxiety disorders and substance abuse; all of which have the possibility of taking devastating tolls on an individual’s mind and body.

Along with the damage it can cause to your body, it can also take a toll on your home life and your family’s home life. When you are constantly angry, you tend to take it out on those that are at your disposal. A family that has to walk on eggshells around one of its members can not be a happy and peacefully functioning unit.

The person feeling angry is not the only person that has to worry about stress. The friends and family of an angry individual may also be dealing with a tremendous amount of unhealthy stress. These individuals are also at risk for stress related illnesses and depression.

Try to think about the people you work with and the people you live with the next time that you feel an outburst coming on. They may be the source of your anger or they may not be. Your internal and external conflict may be causing bad side effects on you and your peers. Take a deep breath, step back from the situation, and allow yourself to come down before you overreact. You will find that not only are you happier but so is everyone around you.

By Carlos Todd, LPC http://www.masteringanger.com

Anger Management Institute of Texas is a certified Anderson & Anderson ® provider.

Anger Management Classes available 7 days a week in Houston, Texas.

Gregory A. Kyles, M.A., LPC, CEAP, CAMF
Director, Anger Management Institute of Texas
Diplomate, President of Texas Chapter
American Association of Anger Management Providers
http://www.ami-tx.com
http://www.ami-tx.org
https://gregorykyles.wordpress.com
http://www.linkedin.com/in/gregorykyles
http://www.myspace.com/anger_management_expert

Handling Workplace Anger Issues

We often see people getting mad at work, and the ripple-effects are never very good. Anger as a reaction to bad news is a common scene, and anger as an intimidator is often used to get results.
Since coworkers lose a lot of respect for those who vent on a regular basis, what can be done about it?

By Dan Bobinski www.management-issues.com

First we need to find out what causes people to get mad.

Anger most often occurs when what we want to happen is not happening. It manifests itself in various forms, from mild frustration to all out rage. Essentially, we choose anger because we don’t know what else to do to get the results we want, and anger often manipulates others into doing what we want.

Sadly, this view is rather short-sighted.

Additionally, and contrary to popular belief, no one ever “makes” someone else angry. Anger is always a choice one makes.

Whether you are the aggressor or are on the receiving end of outbursts, one of the best ways to combat workplace anger is to have alternative choices.

If you’re one of those who tends to vent, think about when you’ve gotten angry. Don’t blame others, look seriously within. What was it that you didn’t do that you could have done? What didn’t you plan for? Or, were you trying to control something beyond your control?

If you’re truly honest with yourself, you may be surprised at your answers, and realize that other, better choices were at your disposal.

“Better choices” usually means asking better questions. One way is to ask yourself how you could have planned better to prevent a problem from occurring. Another way is to ask forward-thinking, solutions-oriented questions to find a resolution to a problem. These normally start with the words “what” or “how” and incorporate “I” or “we,” not “you.” Examples include “what can we do from here?” or “how can I solve this problem?”

Questions asking “why” or using the word “you” are dangerous because they put people on the defensive and usually try to assign blame. An example could be, “why didn’t you think of this ahead of time?”

Beyond asking better questions, a person who tends toward anger can also choose better actions. Instead of slamming a fist on a desk and raising one’s voice, it’s better to sit back in the chair, breathe deeply, and focus on the next step for resolution. The purpose? A move toward resolution leads to a better sense of control.

Essentially, there is no excuse for relying on anger or intimidation as a way to get things done.

For anyone who must deal with those who choose anger, remember that anger is simply a tactic for trying to gain or regain control. Anyone who works with angry people should memorize this fact.

Therefore, one of the worst things you can say to an angry person is “calm down.” Think about it. An angry person already feels out of control. If they’re being told to calm down, it is telling them to acquiesce to someone else’s command, taking them further out of a feeling of control. This is why many angry people get even madder when told to calm down!

My best recommendation is simply acknowledging why the angry person is upset. One of the best ways to do this is by paraphrasing. A standard line might be “You sound pretty upset about ‘x’”. By acknowledging the reason for a person’s anger, you validate their concern. This gives them a sense of control, and once people feel in control again, their anger starts to subside.

Might I add that it’s usually not a good idea to match a person’s anger. Such action only escalates the other person’s anger, because they continue to feel out of control.

If a person refuses to calm down, simply state that you’d be happy to continue the conversation when emotions have subsided, and then respectfully but quietly disengage. It may even require walking away.

Anymore, continued threats and yelling constitute a hostile work environment, and life is too short to be putting up with such nonsense.

Obviously there are more situations about workplace anger than can be listed here, but this is a start.

Nevertheless, the bottom line is that people with anger habits need to find alternative ways to stay in control, and those who endure antagonistic behavior can set healthy boundaries so they don’t have to put up with it anymore.

Anger Management Institute of Texas is a Certified Anderson & Anderson® Provider

Anger Management Classes available 7 days a week in Houston, Texas.

Gregory A. Kyles, M.A., LPC, CEAP, CAMF
Director, Anger Management Institute of Texas
Diplomate, President of Texas Chapter
American Association of Anger Management Providers
http://www.ami-tx.com
http://www.ami-tx.org
https://gregorykyles.wordpress.com
http://www.linkedin.com/in/gregorykyles
http://www.myspace.com/anger_management_expert