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A decade later, unresolved disrespectful behavior continues to impact patient safety

Premier Communications

Brought to you by the Premier Safety Institute®
October 29, 2013

Gina Pugliese, RN, MS, editor


A decade later, unresolved disrespectful behavior continues to impact patient safety

The Institute for Safe Medication Practices (ISMP) recently released the results of its 2013 national survey on intimidation in the workplace. The survey showed that disrespectful behaviors
– such as negative comments about colleagues or leaders, reluctance to work collaboratively, refusal to return phone calls, condescending language, verbal threats, yelling, and even physical abuse
– continue to plague the health care workplace. Many of the same disrespectful behaviors were encountered as frequently as they were in a similar ISMP survey conducted a decade ago.

“The survey results demonstrate the pressing need for action. Disrespectful behavior erodes the professional communication necessary for patient safety
and quality, and increases the risk of medication errors. These are not isolated events limited to a few difficult practitioners-bullying and
intimidation is widespread, involving both genders equally and more healthcare professionals than just physicians. There is an urgent need for
hospitals to develop a greater culture of respect in order to protect patients and staff.”

Michael R. Cohen, RPh, MS, ScD, FASHP
President, ISMP

*Disrespectful behaviors reported to have occurred at least once or more in past year

  • Reluctance/refusal to answer questions
  • Negative comments about colleagues
  • Impatience with questions, hanging up the phone
  • Reporting to manager (threats or actual)
  • Yelling, cursing, verbal threats
  • Condescending or demeaning comments, insults
  • Constant fault finding
  • Inappropriate joking
  • Reluctance to follow safety practices
  • Physical abuse/assault
  • Shaming, humiliation
  • Insults/slighted due to race/religion/gender/appearance
  • Throwing objects

*ISMP Survey 2013

Practitioners report a variety of disrespectful behaviors.

A variety of disrespectful behaviors were reported by the more than 4,800 health care practitioners responding to the survey (Table). Practitioners
included physicians, nurses, pharmacists, and quality/risk management staff.

The most frequently reported behaviors were reluctance or refusal to answer questions or return calls and negative comments about colleagues or leaders,
both of which were encountered once or more in the past year by about three quarters of respondents.

More than one third of respondents reported that they experienced disrespectful behaviors from three to five individuals in the past year and about one
fifth reported disrespectful behaviors from more than five individuals.

About 18 percent of respondents reported objects being thrown and seven percent reported physical abuse or assault at least once in the past year.

Health care professionals from a variety of disciplines engage in disrespectful behaviors.

More than 50 percent of respondents reported that both physicians and other healthcare professionals were involved in disrespectful behaviors, including
hanging up the phone, threats to report them to the manager, condescending comments and insults, and reluctance to work collaboratively.

Disrespectful behaviors affect patient safety.

Almost half (44 percent) of respondents had changed the way they handled order clarifications or questions about medication orders because of past
intimidation. For example, 63 percent of pharmacists and 30 percent of nurses reported that within the past year they had assumed a medication was correct
to avoid interacting with a specific prescriber. Teamwork, which is essential for patient safety, is built on mutual trust and respect among team members.
A disrespectful environment prevents effective teamwork.

Decline in the organizational support in dealing with disrespectful behavior

Compared with 2003, a smaller proportion of respondents in the recent survey reported that they felt their organization dealt effectively with
disrespectful behavior-39 percent in 2003 versus 25 percent in 2013. Similarly, 70 percent of respondents in 2003 felt their organization or manager would
support them if they reported disrespectful behavior, compared to only 52 percent in 2013.

Disrespectful behavior is learned and reinforced by the culture of an organization

Disrespect is often a learned behavior that is supported and reinforced by the authoritarian, status-based culture found in most hospitals. In addition to
the disrespectful behaviors identified in this survey, other types of disrespect such as unduly long work hours, burdensome high work-loads, and physical
hazards, are common, potentially harmful, and often accepted as the norm.

ISMP plans to release a second report with specific recommendations for addressing disrespectful behaviors in the workplace.



Safety Institute




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