Start Intimidating and disruptive behaviors

Intimidating and disruptive behaviors

Chain of command may fail because the next person up the hierarchy “blinks,” refuses to act, has not been trained to act, fears retaliation, or falls back on enabling behaviors.

Chain of command provides healthcare staff with a formal process to use when attempting to get satisfactory resolution or to report concerns about questionable patient conditions or care delivery.

When hierarchical differences exist between healthcare clinicians, people lower in the hierarchy tend to be uncomfortable communicating problems or concerns.

The Joint Commission instituted a new leadership standard effective January 1, 2009, that requires accredited hospitals to address healthcare clinician disruptive and inappropriate behaviors.

This standard expands the Joint Commission National Patient Safety Goal 2, which requires accredited organizations to improve the effectiveness of communication among caregivers to reduce risk, improve patient safety, and recommends standardization of communication whenever possible.

Individuals at the top of the hierarchy that exhibit disruptive or unapproachable behaviors may further hinder communication between healthcare clinicians.

Delays, inappropriate care, or lack of patient care may be the byproducts of these hierarchical differences, particularly if the organization’s chain of command fails to outline a structured communication method to address disruptive behaviors or concerns about a patient’s condition or the care they are receiving.

Use a discerning eye when pinpointing the culprits. Initiate a private discussion with the menacing staff member.

Sometimes employees may be aware of company policy, but are unaware of the fact that they are in violation of it.

Covertly keep an eye on his attitude in the workplace. If the disruptive behavior persists and proves to cause a decrease in productivity and company morale, it's time to take definitive action.

Take note of any changes, improvements or reoccurring insubordination. Explicitly follow each of the disciplinary procedures outlined in your company policy while administering formal procedures regarding employee adherence.

An effective chain of command in healthcare organizations facilitates, rather than impedes, communication, teamwork, and collaboration between the decision maker and the frontline clinician.