Disruptive physician (provider) behaviors include inappropriate conduct in the hospital setting, resulting in conﬂict or confrontation. These behaviors can range from verbal and even physical abuse to sexual harassment. In recent years disruptive behavior in the hospital setting has become more evident, if not more common. One study showed that the vast majority of surveyed physicians, nurses, and administrators had witnessed disruptive behavior by physicians (53). Nurses and other hospital employees also commit disruptive behavior, but it is far less common than
Table 3.2 Examples of Dangerous Abbreviations and Dose Expressions
Modified from Reiter RC, Yielding L, Gluck PA. Clinical performance improvement: assessing the quality and safety of women health care. In: Hacker NF, Moore JG, Gambone JC, eds. Essentials of obstetrics and gynecology, 4th ed., Philadelphia: Elsevier/Saunders, 2004:52, with permission.
disruptive physician behavior. Disruptive behavior in the hospital setting can have adverse effects on patient safety and overall quality of care.
One recommendation for mitigating disruptive behavior among health care professionals when concise and clear communication is needed is the SBAR method, mentioned above. Having an accepted and agreed-upon verbal process to question or suggest changes in patient management improves communication. Team building that encourages collegial interaction and a sense that all members of the health care team are important and have something to offer can promote a culture that makes disruptive behavior less likely.
One of the better definitions of quality is “meeting a customer’s (patient’s and their families) expectations.” Clear and frequent communication between the team of health care professionals and the patient and the patient’s family is the most effective way to determine and meet appropriate expectations. The Joint Commission, in collaboration with the Centers for Medicare and Medicaid Services, introduced an initiative they called “Speak Up.” The program features brochures, posters, and buttons on a variety of patient safety topics. The program goal is designed to urge patients to take an active role in preventing health care errors by becoming involved and informed participants as members of the health care team. In 2008 a survey conducted by the Joint Commission indicated that campaigns like Speak Up add significant value to the accreditation process (54). Eighty percent of the more than1,900 organizations that responded rated the program as good or excellent.
Another initiative developed at Rand and the University of California–Los Angeles is the PREPARED checklist for informed, collaborative choice (Table 3.3) . Studies show that greater patient (and family) involvement in health care decision making results in improved satisfaction and better outcomes (55). The PREPARED checklist, using each letter in the word and a mnemonic, consists of a structured conversation that includes the Plan, Reason for the plan, Expectation of benefit, Preferences (e.g., prefer or avoid surgery), Alternatives, Risks, and Expenses, followed by an informed collaborative Decision to accept or reject the plan.
The use of either or both of these programs should improve overall safety by informing the patient and his or her family about what will happen, what is expected along with the known risks (complications and side effects), so that they can alert the health care team of any expected or unexpected adverse events. Patients and their families traditionally have low self-efficacy or confidence that they can understand and actively participate during their health care. Programs such as Speak Up and PREPARED are shown to increase patient and family member self-efficacy.
Organized medicine is increasing its focus on the prevention of medical error. A controversial issue involving medical error is the need to promptly disclose and apologize for any medical errors that occur. In the past many, if not most, health care organizations focused on managing the medical legal risk of medical error. The conventional wisdom was that any disclosure and apology for error would lead to litigation and bigger payouts. The Joint Commission and other professional organizations require or endorse active disclosure to the patient when adverse events occur, including those caused by error (56).