The Joint Commission Compels Recognition of Bullying
The Joint Commission wisely named its July 9, 2008 Issue 40 Sentinel Event Alert "Behaviors that undermine a culture of safety." It is abundantly clear that through the undermining of employee safety, disruptive individuals threaten patient safety, the core mission of every JCAHO-accredited hospital or organization.
In response to this safety threat, effective January 1, 2009, The Joint Commission promulgated a new Leadership Standard (LD.03.01.01) to address intimidating, disruptive and inappropriate behaviors. JCAHO cited research demonstrating that negative interpersonal conduct by physicians and others can lead to medical errors, preventable adverse patient outcomes, poor patient satisfaction, increased cost of care, increased malpractice risk, and turnover among professionals who have to deal with the abusive actors.
The phenomenon of Workplace Bullying most accurately describes the set of overt actions that JCAHO is proactively addressing in this new leadership standard.
Healthcare is institutionally prone to bullying because of its unique mix of highly-skilled and educated individuals interacting in an environment charged by internal hierarchical and external challenges. The survey conducted by the Institute for Safe Medication Practices found that 61% of respondents said their organization dealt ineffectively with intimidators and 93% reported a medication error attributable to a professional's intimidating behavior. Research by the American College of Physician Executives reported that 38.9% of high revenue generating physicians seem to bully with impunity.
Current Procedures Are Inadequate
Existing Disruptive Physician policies are not effective. The problem is that fear of retaliation leads to serious under-reporting and accusations of employer negligence. Anti-harassment policies, compliant with state and federal laws, do little good unless the alleged offender is not a member of a protected status group. Sexual harassment and racial discrimination rarely apply in situations of status-blind cruelty. Organizational Value Statements declaring "Respect for all individuals" ring hollow without the power of enforcement.
If these policies and declarations had worked, there would be no broad-based evidence to compel JCAHO to take this extraordinary step to require attention to the work environment in healthcare organizations.
Some Work Doctor Healthcare Clients
- Central Peninsula Hospital
- Northeast Kingdom Human Services
- Centre for Addictions & Mental Health
- University of California, Davis Medical Center
- Kaiser Permanente
- John Muir Medical Center
- Oregon Health & Science University, Portland
- Clarian Health Partners, Indianapolis
- National Occupational Injury Research Symposium NIOSH
- Work, Stress and Health - NIOSH Conferences
- American Public Health Association Occupational Safety & Health Research Symposium
- National Conference on Workplace Safety & Health Training
Meet our Consultants,
Work Doctor Services Ensure Compliance with JCAHO Required & Suggested Elements
EP 4: The hospital/organization has a code of conduct that defines acceptable and disruptive and inappropriate behaviors. We lead a collaborative policy-writing process.
EP 5: Leaders create and implement a process for managing disruptive and inappropriate behaviors. We help with two services: (1) We create formal enforcement procedures that make the policy a credible prevention tool and (2) informal resolution procedures are created for situations when formal complaints aren't required.
The Joint Commission's #5 suggested action: Deliver leader and manager training in skills relevant to mitigating negative conduct and conflict resolution. We deliver on-site manager training AND clients may purchase our DVD - Workplace Bullying: A Primer for Managers.
The Joint Commission's #1 suggested action: Educate all team members – physicians and non-physician staff – on the new code of conduct and its definitions of appropriate professional behavior. We deliver on-site all-hands training. We also train an internal team of peer experts who train colleagues to understand the policy and internal resources available to them.
The Joint Commission's #5 suggested action: Use assessment tools to measure whether or not changes in leadership behaviors occur over time. We provide online survey technology to assess the prevalence of bullying and various aspects of the phenomenon. Ongoing measurement determines changes over time.
The Joint Commission's #6 suggested action: Survey staff perceptions of the prevalence, nature, and consequences of unprofessional conduct addressed by the new code of conduct. Our online survey service.
The Joint Commission's #4 and #10 suggested actions: Develop a process that addresses intimidating and disruptive behaviors that incorporates substantial input from an interdisciplinary team – medical staff, nursing, administration and other employees. Encourage inter-professional dialogues to address conflicts and to improve collaboration and communication. We train an internal team of peer experts, required to be interdisciplinary with members representing various ranks within the organization, who devise bullying incident resolution procedures specific to their workplace. The team provides a number of services for colleagues of their own choosing. Some team members will intervene, some will facilitate dialogue, others will educate.
The Joint Commission's #7 suggested action: Develop and implement a reporting/surveillance system for detecting unacceptable behavior as per the code. Include ombuds services and patient advocates. We consider this role critical for the internal peer experts team that we train.
The Joint Commission's #2 suggested action: Model desirable behaviors. Enforce the code equitably regardless of seniority or discipline using both positive reinforcement and punishment. The internal peer experts team become the ambassadors for the anti-bullying initiative and will model desirable behaviors and teach others to emulate them.
The Joint Commission's #9 suggested action: Conduct interventions given a commitment to the health and well-being of all staff with adequate resources to support individuals whose behavior is caused or influenced by physical or mental health pathologies. We also assign top priority to employee health. Bullying is a health-harming phenomenon. All individuals involved with the anti-bullying initiative implemented by Work Doctor are taught to consider employee health implications of all practices and to make harmed individuals whole after incidents are resolved.
The Joint Commission's #8 suggested action: Interventions should be non-adversarial with the focus on building trust, placing accountability on and rehabilitating the offending individual and protecting patient safety. We train the internal peer experts team to intervene in ways that preserve the dignity of all involved parties.