When Tempers Flare
When jumbo jets collided in the Canary Islands on March 27, 1977, 583 passengers and crew died in the ensuing inferno; the worst aviation accident in history. Investigation revealed mis-communication between the tower and cockpit, and the fact that the first-officer was apparently too intimidated by the more experienced captain to question his actions.
The aviation industry responded by developing Crew Resource Management training, which focuses on the cognitive and interpersonal skills needed to manage a flight
Recently, there has been considerable interest in developing methods to prevent intimidation and mis-communication in the healthcare setting, as evidence mounts that disruptive behavior is a significant patient safety issue.
Historically, disruptive behavior among caregivers has been tolerated. Unless combatants resorted to fisticuffs (or scalpels), we tended to look the other way when tempers flared. ‘After all’ we thought, ‘patient care is a high-pressure job, it’s good to cut caregivers (and administrators, department heads, etc.) a little slack.’ In retrospect, that really wasn’t as magnanimous as it seemed. Bad behavior left unchallenged escalates; participants grow increasingly hostile and abusive, and communication grows more stilted. No one is happy; no one wins.
Disruptive behavior was reported in 177 events submitted to the Pennsylvania Patient Safety Authority from May 2007 to October 2009. In many of the events patient care was compromised, according to data published in a June 16, 2010 press release.
“Of the 177 events, 73 (41%) were due to conflicts between healthcare clinicians, 30 (17%) to procedures not followed, and 17 (10%) to absence of responses or delays.”
Every health system, including the military, faces this challenge. In response, the U.S. Department of Defense has published the Professional Conduct Tool Kit, which can be downloaded for free from their Patient Safety Program website. The DoD site sites, ”The (Professional Conduct) toolkit is designed for health professionals who may be serving in leadership roles or who are seeking resources for addressing behaviors that negatively impact patient safety and that disrupt the clinical work environment.”
None of us can afford to allow ourselves to be intimidated when it comes to addressing this vital patient safety issue.
George Anderson says:
June 23rd, 2010 at 11:40 am
It may be difficult to implement the tips made in this article. The JCAHO Sentinel Alert of January, 2009 relative to “disruptive physician” behavior mandates specific policy for all Health Care Organizations.
All intervention programs must begin with a comprehensive assessment followed by coaching or small group classes to address “disrutive behavior”. Post Tests are also mandated.