A Survey of the Impact of Disruptive Behaviors and Communication Defects on Patient Safety

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Article-at-a-Glance

Background

A recent survey was conducted to assess the significance of disruptive behaviors and their effect on communication and collaboration and impact on patient care.

Survey

VHA West Coast administered a 22-question survey instrument—Nurse-Physician: Impact of Disruptive Behavior on Patient Care—to a convenience sample. Of the 388 member hospitals (in four VHA regions) invited, 102 hospitals participated in the survey (26% response rate). Results from surveys received from January 2004 though March 2007 are represented. Of the 4,530 participants, 2,846 listed their titles as nurses, 944 as physicians, 40 as administrative executives, and 700 as “other.”

Results

A total of 77% of the respondents reported that they had witnessed disruptive behavior in physicians—88% of the nurses and 51% of the physicians. Sixty-five percent of the respondents reported witnessing disruptive behavior in nurses at their hospitals—73% of the nurses and 48% of the physicians. Sixty-seven percent of the respondents agreed that disruptive behaviors were linked with adverse events; the result for medical errors was 71%, and patient mortality, 27%.

Discussion

The results from the survey show that disruptive behaviors lead to potentially preventable adverse events, errors, compromises in safety and quality, and patient mortality. Strategies to address disruptive behaviors should (1) prevent disruptive events from occurring, (2) deal with events in real time to prevent staff or patient harm, and (3) initiate postevent review, actions, and follow-up.

Recommendations

Twelve recommendations—including recognition and awareness, policies and procedures, incident reporting, education and training, communication tools, discussion forums, and intervention strategies—address what hospitals and other organizations can do now to address disruptive behaviors.

Section snippets

Development

The convenience sample survey was conducted by VHA West Coast, one of 17 regional offices of VHA Inc., a national alliance of more than 1,400 not-for-profit hospitals across the United States. In the absence of any prototype surveys addressing issues around the frequency, seriousness, or impact of disruptive behaviors, the investigators developed the 22-question survey instrument—Nurse-Physician Relationships: Impact of Disruptive Behavior on Patient Care*

Physicians’ Disruptive Behavior

A total of 77% of the respondents reported that they had witnessed disruptive behavior in physicians at their hospitals. Of interest, 88% of the nurses reported witnessing disruptive behavior in physicians, and 51% of the physicians reported witnessing disruptive behavior in their peers (Figure 1a, page 466). When asked about which specialties were most likely to exhibit disruptive behaviors, respondents rated general surgery highest at 28%, and obstetrics/gynecology lowest (6%); all other

Discussion

The results from the survey show that disruptive behaviors can cause significant psychologic and behavioral disturbances that can have a critical effect on focus and concentration, collaboration, communication, and information transfer, which in turn can lead to potentially preventable adverse events, errors, compromises in safety and quality, and patient mortality.

The current survey focused predominantly on disruptive behavior between physicians and nurses, but our research has shown that

Recommendations

We offer the following recommendations on the basis of what we have observed in our experiences with information gathered apart from the survey process from more than 100 hospitals, which organizations can implement right now to address the issue of disruptive behavior.

Conclusion

Although disruptive behavior is a sensitive subject that may involve prominent physicians or employee staff, the issue must be addressed to ensure best patient care. The organization needs to be committed to a culture of zero tolerance and to develop policies and procedures that define appropriate behavior standards that hold staff accountable for their actions. Offering education programs that provide a better understanding of background issues that influence thoughts and behaviors and

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