A number of recent studies have come to similar conclusions – disruptive physician behavior is not only an employee relations problem, but also can impair quality and contribute to adverse events and medical errors. The American Medical Association (AMA) and other professional groups have recognized that outbursts of anger, belittling comments, suppression of opinions of other members of a health care team by belittling or intimidating language or behavior that weakens self-confidence in patient care decisions, and retaliation against a health care team member who reports or speaks out about such behavior are all examples of disruptive behavior. 

Such behavior has become a serious problem for healthcare institutions. According to a study of more than 840 physicians and physician leaders released in May by QuantiaMD and the American College of Physician Executives (ACPE), more than 70% said that disruptive physician behavior occurs at least once a month at their organizations, and more than 10% said that such incidents occur on a daily basis. 99% believe that disruptive behavior ultimately affects patient care. It can also adversely affect physician/patient relationships. 60% of physicians surveyed said their organizations have received written complaints from patients or their families, and 50% have seen patients actually change physicians or leave a practice due to such behavior.

Because of the potential for harm to patients as well as to the cohesiveness of health care team work, the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) adopted new standards that require hospitals and other accredited organizations to adopt and implement codes of conduct that define and manage disruptive or inappropriate behavior by physicians and administrators. Among other elements of an effective code of conduct, the Joint Commission suggests a "zero tolerance" policy for disruptive physicians and administrators.

The AMA has also adopted a policy that calls for medical staffs to develop and implement a code of conduct that focuses on disruptive behavior, and has developed a model code.

Healthcare institutions should take these messages to heart and employ effective strategies to detect disruptive behavior and enforce processes and procedures to improve behavior and implement appropriate discipline for physicians, administrators, and staff members when necessary. Such strategies should include the following elements:

• Implement clear and consistent policies and procedures: Implement a policy or code of conduct that incorporates the elements regarding disruptive conduct recommended by the Joint Commission and the AMA. Consider a procedure that allows anonymous reporting and that encourages physicians, administrators, staff members, patients, and visitors to report disruptive, intimidating, or unprofessional behavior without fear of adverse repercussions.
• Prohibit retaliation: Policies should include a provision that prohibits retaliation against anyone who reports or cooperates in the investigation of intimidating, disruptive or other unprofessional behavior.
• Create awareness: At every opportunity reinforce the message that disruptive behavior is not accepted by the institution. Employees should be periodically reminded of the institution's policies and procedures, and that disruptive behavior is a violation of those policies.
• Education and Training: Develop and implement a regular course of training tailored to physicians and employees at all levels, providing instruction about the characteristics of disruptive and unacceptable behavior, the relationship of such behaviors to patient outcomes and safety, and the institution's policies and procedures regarding disruptive and unacceptable behavior.
• Apply Policies and Procedures Consistently: One key to success is consistency in implementing policies and procedures for reporting, investigating, correcting and – if appropriate – disciplining disruptive and unacceptable behavior.
• Documentation: It is wise to document all efforts to address intimidating and disruptive behavior.
• If disciplinary action becomes necessary: Make sure the process and procedure for disciplinary action complies with applicable law.