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What We Do and Say Matters—How Disrespectful Behaviors Increase Risk
January 6, 2022
A young pregnant woman called her OB in her last month of pregnancy with twins because she felt a decrease in movement of the babies. As advised, she reported to the hospital labor and delivery (L&D) unit for a non-stress test. An L&D nurse called the OB to report that the test was non-reassuring and requested he come in to see the woman. The OB accused the nurse of not knowing how to read a fetal monitoring strip and yelled at her for bothering him at the end of a busy day. He ordered the woman to be discharged with instructions to call back the next day with an update on fetal movement. The next morning the woman called the OB’s office and reported she felt no fetal movement. She was instructed to return to the hospital where an ultrasound showed fetal demise of both babies. The on-call OB induced labor and the woman gave birth to stillborn twins.
During the resultant malpractice claim against the OB and the hospital, the L&D nurse testified that this physician was well-known for yelling at nurses and for refusing to come in to the hospital when called about a patient concern. Nothing had been done by the organization to stop this behavior which was why the nurse did not invoke the chain of command when he refused to come in. The experts who reviewed the care, opined that the babies would likely have survived if a C-section had been done emergently following the non-reassuring test.
The prevalence of disrespectful, abusive and bullying behavior in health care
Disrespectful, abusive and bullying behaviors, like this case illustrates, are a contributing factor to harm events and have long been recognized as a problem in health care settings. Health care organizations have been identified as having the highest incidence of workplace bullying across American business sectors.1
The American Medical Association (AMA) defines bullying as “repeated, emotionally or physically abusive, disrespectful, disruptive, inappropriate, insulting, intimidating, and/or threatening behavior targeted at a specific individual or a group of individuals that manifests from a real or perceived power imbalance and is often, but not always, intended to control, embarrass, undermine, threaten, or otherwise harm the target.”
In 2003 and 2013, the Institute for Safe Medication Practices (ISMP) launched a survey on disrespectful behavior, which identified that this type of behavior was not an isolated event limited to a few difficult clinicians; it involved lateral and managerial staff (not just physicians).
In 2003, 88% of ISMP’s survey respondents reported that they had encountered condescending language or voice intonation; 87% encountered impatience with questions; and 79% encountered a reluctance or refusal to answer questions or phone calls. A decade later, little improvement was seen in their 2013 survey results.
In both 2003 and 2013, about half of the survey respondents reported more explicit forms of disrespectful behavior, such as being subjected to strong verbal abuse or threatening body language.
In October of 2021, ISMP invited health care professionals to take their survey again.
Implementing an easy to use, confidential reporting program that includes “no retribution” for reporting behaviors, fair investigation process and clear consequences for disrespectful behaviors regardless of role or position in the organization.
Find Best Practices and Tools in Constellation’s HEAL Prepare Toolkit. Unit 1: Culture. Sign in to ConstellationMutual.com to access the Toolkit found in Risk Resources.
The HEAL program provides healing benefits for care teams and their organizations because we truly believe that what’s good for care teams is good for business.
A review of our anesthesia malpractice claims reveals that most claims are related to improper patient management and involve technical skill issues, including known procedural risks. Learn strategies that can help reduce anesthesia-related harm.