JCAHO To Require Healthcare Organizations to Stop Workplace Bullying

On July 9, 2008, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) issued a Sentinel Event Alert amending its Leadership Standards and requiring accredited healthcare organizations beginning on January 1, 2009 to (1) create codes of conduct which define acceptable and disruptive and inappropriate workplace behaviors and (2) create and implement a process for managing disruptive and inappropriate behaviors. The JCAHO also amended the Medical Staff standards to incorporate six core competencies to be addressed in “the credentialing process including interpersonal skills and professionalism.”

The JCAHO explained that it was taking this action because “intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse consequences, increase the cost of care and cause qualified clinicians, administrators and mangers to seek new positions in more professional environments. Safety and quality of patient care is dependent on teamwork, communication, and a collaborative work environment.”

While recognizing that workplace bullies have contributed much to this endemic problem, not all “such behaviors [are] confined to the small number of individuals who habitually exhibit them . . . It is important that organizations recognize that it is the behaviors that threaten patient safety, irrespective of who engages in them.”

“Organizations that fail to address unprofessional behavior through formal systems are indirectly promoting” a culture “of tolerance and indifference to intimidating and disruptive behaviors in health care.” Granted, the recurrence of dealing with highly emotional and stressful situations “can contribute to occasional intimidating or disruptive behavior, particularly in the presence of factors, such as fatigue. Individual care providers who exhibit characteristics such as self-centeredness, immaturity or defensiveness can be more prone to unprofessional behavior” and lack interpersonal, coping or conflict management skills.

In addition to the mandatory standards for addressing this problem, the JCAHO recommends that organizations take an additional thirteen steps, including:

* Educate all staff on appropriate professional behavior defined by the organization’s code of conduct with an emphasis on mutual respect. The training should include basic business etiquette, telephone skills, customer service and other basic people skills.
* Hold all staff accountable for modeling desirable behaviors and enforce the code consistently and fairly among all staff, regardless of seniority or clinical discipline. This should include both positive and negative reinforcement where appropriate.
* Develop and implement policies and procedures which address zero tolerance for egregious instances of disruptive behavior (such as assault, threats and other criminal acts). These standards should be incorporated into bylaws and employment agreements as well. Physicians and staff should be held to the complementary standards. Staff should be encouraged to report and cooperate in investigations of disruptive behavior by including non-retaliation statements into all policy statements.
* “Provide skills-based training and coaching for all leaders and managers in relationship-building and collaborative practice, including skills for giving feedback on unprofessional behavior and conflict resolution. Cultural assessment tools can also be used to measure whether or not attitudes change over time.”
* “Develop and implement a reporting/surveillance system (possibly anonymous) for detecting unprofessional behavior. Include ombuds services and patient advocates.”
* “Support surveillance with tiered, non-confrontational interventional strategies, starting with informal “cup of coffee” conversations directly addressing the problem and moving toward detailed action plans and progressive discipline, if patterns persist. These interventions should initially be non-adversarial in nature, with the focus on building trust, placing accountability on and rehabilitating the offending individual, and protecting patient safety. Make use of mediators, and conflict coaches when professional dispute resolution skills are needed.”

Insomniacs can read the Alert in full at http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_40.htm. The Alert does not address what will happen to Dr. Greg House when these standards become effective.:)

NOTICE: This summary is designed merely to inform and alert you of recent legal developments. It does not constitute legal advice and does not apply to any particular situation because different facts could lead to different results. Information here can change or be amended without notice. Readers should not act upon this information without legal advice. If you have any questions about anything you have read, you should consult with or retain an employment attorney.