Intimidating and disruptive behaviors

This workplace violence website provides information on the extent of violence in the workplace, assessing the hazards in different settings and developing workplace violence prevention plans for individual worksites.Workplace violence is any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site.

Almost half (49 percent) of all respondents indicated that their past experiences with intimidation had altered the way they handle order clarifications or questions about medication orders.

We now accept that most errors are committed by “good, hardworking people trying to do the right thing,” and that to improve patient safety we should focus on designing systems which ensure a safe culture rather than trying to identify who is at fault. Individuals who have a history of disruptive behavior also pose the highest litigation risk for American hospitals, and many would argue that such behavior is inconsistent with the highest professional standards.

Several groups have described approaches for dealing with disruptive and intimidating behavior; the ones which seem most adaptable are those from the College of Physicians and Surgeons of Ontario and the Vanderbilt group.

Such behaviors include reluctance or refusal to answer questions, return phone calls or pages, condescending language or voice intonation and impatience with questions.” All definitions recognize that disruptive and intimidating behavior occurs along a spectrum of intensity and frequency and that recurrent disruption by a small number of individuals is the most common pattern.

The 1999 Institute of Medicine (IOM) report “To Err is Human” – widely regarded as the document which launched the modern patient safety movement – recognized that although most efforts to improve safety should focus on reducing system failures, individual professionals’ “dangerous, reckless or impaired” behavior can also sometimes harm patients (page 169).

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