Disruptive Behavior Among Staff: Now What Do We Do?

Lela Holden, Ph.D., RN, CPPS Patient Safety Officer May 20, 2013

Let’s begin with a story....

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   Behaviors that Undermine a Culture of Safety Overt actions  Verbal outbursts and physical threats Passive activities  Refusal to perform assigned tasks, or unacceptable attitudes.. Including reluctance or refusal to answer questions, return calls or page, condescending language, voice intonation and impatience with questions Intermittently disruptive behaviors can:       Foster medical errors Decrease satisfaction and outcomes Increase cost Decrease retention Degrade teamwork Occur across all disciplines and among all staff Joint Commission, Sentinel Event Alert -- July 9, 2008 - Issue # 40: Behaviors that Undermine a Culture of Safety 3

Current Process at MGH

3-Stages:  SURVEILLANCE: Encourage reporting of these events in electronic safety reporting system. Surveillance method is essential  ANALYSIS: Investigation by Quality Assessment Chairs in the respective departments; collaborate across departments; involve HR as determined by leaders  INTERVENTION: Encourage and facilitate the interaction of individuals involved: come to the table 4

140 120 100 80 60 40 20 0

Reports of Unprofessional Conduct Summary Data FY 2011-2012

127 32 70 FY 2009-2010 FY 2010-2011 FY 2011-2012 5

Evaluation of the model

 Touched a nerve---number of reports steadily increased  Staff Satisfaction with Model 356 individuals surveyed using REDCAP* 145 responses – 41% response rate * Harris PA et al, 2009 6

Staff perceptions of the model

How willing would you be to recommend this process to others?

80 70 60 50 40 30 20 10 0 Willing Very Somewhat Neutral Unwilling 7

What have we learned?

   We are making progress… The model is useful in:    Advancing a culture of patient safety Building relationships across disciplines/departments/QA Chairs Focusing attention on the impact of teamwork in the delivery of quality care A policy is needed for those involved with repeated professional conduct issues . . .under development in collaboration with senior leaders 8