Introduction
Definitions
Organization | Definition | Germane examples | Excluded behaviours |
---|---|---|---|
Canadian Medical Protective Association | Can interfere with communication between team member or with patients, and may negatively affect patient care and patient satisfaction109
| • Dismissive comments | • Good faith patient advocacy |
• Derogatory comments | • Professionally written alerts | ||
• Insensitive, uncaring, callous attitudes | • Complaining to an outside agency | ||
• Inappropriate language | • Testifying against colleagues | ||
• Profanity | |||
• Bullying | |||
• Threats | |||
• Angry outbursts | |||
• Demeaning conduct | |||
• Condescending conduct | |||
• Aggressive conduct | |||
• Boundary issues | |||
Council on Ethical and Judicial Affairs, American Medical Association | Verbal or physical conduct, that does, or may, negatively affect patient care110
| • Foul language | • Good faith criticism |
• Threatening language | |||
• Aggressiveness | |||
• Hyperactivity | |||
• Intrusiveness | |||
• Irritability | |||
• Argumentativeness | |||
Joint Commission on Accreditation of Hospital Organizations (JCAHO) | Conduct that intimidates others to the extent that quality and safety are compromised 111
| • Verbal outbursts | None provided |
• Physical threats | |||
• Refusing to perform assigned tasks | |||
• Quietly exhibiting uncooperative attitudes | |||
• Reluctance to answer questions | |||
• Condescending language26
|
Frequency
The antecedents
Intrapersonal51
Organizational51
Interpersonal51
Who is disruptive?
The consequences
The cognitive appraisal of the victims and witnesses
The behavioural responses of the victims and witnesses
Category |
Subcategory
| Definition | |
---|---|---|---|
Strength of opposition to disruptive behaviour | Aggressive opposition |
Coercing
| Clinician uses threats, physical violence |
Competing
| Clinician uses aggressive verbal confrontation | ||
Assertive opposition |
Collaborating
| Clinician works with the instigator to find solutions that benefit all | |
Compromising
| Clinician bargains with the instigator in order to find solutions that are at least marginally acceptable to all | ||
Passive opposition |
Ingratiating
| Clinician attempts to gain favour with the offender or makes them feel guilty | |
Manipulative
| Clinician manipulates the offending party into stopping | ||
Inaction |
Avoiding
| Clinician ignores or downplays situation, or avoids interacting with others | |
Reluctant support |
Acquiescing
| Clinician placates to the instigator | |
Willing support |
Promoting
| Clinician knowingly supports the behaviour |
The effect on patient care
Decreased patient care due to reduced communication and teamwork
Decreased patient care due to undermined clinical decision-making
Decreased patient care due to reduced technical performance
The effect on clinicians
The effect on students
The effect on institutions
Prevention and management of disruptive behaviour
Set the expected standards for behaviour
Equip and educate clinicians to meet the standards
Monitor compliance with the standards
Enforce standards and provide staged remediation when required
The responsibility of individual clinicians
John Hopkins Rules of Civility that are applicable to the operating room112
| The Ontario Medical Association’s fundamentals of civility113
|
---|---|
• Acknowledge others: their presence, worth and effort | • Respect others and yourself |
• Respect others’ opinions, time, space (physical & emotional) | • Be aware |
• Speak kindly | • Communicate effectively |
• Respectfully assert yourself | • Take good care of yourself |
• Don’t blame | • Be responsible |
• Keep it down |