Psychiatry Coding & Reimbursement Alert

Implement these tips today to put an end to disruptive behavior in your practice.

Rude behavior, unpleasant language, hostile attitudes, and other bad behaviors not only create an unpleasant environment but are detrimental to patient safety and quality of care. The Joint Commission requires healthcare organizations to create a code of conduct defining acceptable and unacceptable behaviors, as well as crafting a process for handling poor behavior.

Defining Disruptive Behavior

Intimidating and disruptive behaviors include overt actions, such as verbal outbursts and physical threats, as well as passive activities, such as refusing to perform assigned tasks or quietly exhibiting uncooperative attitudes during routine activities, according to the JC. Intimidating and disruptive behaviors are often exhibited by health care professionals in positions of power. Such behaviors include reluctance or refusal to answer questions, return phone calls or pages; condescending language or voice intonation; and impatience with questions. Overt and passive behaviors undermine team effectiveness and can compromise the safety of patients. They are unprofessional and should not be tolerated.

After surveying more than 100 hospitals, the JC came up with a list of 10 recommendations that facilities can implement now to address the issue of disruptive behavior:

1. Recognition and Awareness: Assess the frequency and significance of disruptive behaviors through a confidential survey.

2. Cultural Commitment/Leadership/Champions: Adopt a top-down, bottom-up approach where all staff and employees have a role and responsibility for their behavior. Commitment and endorsement needs to come from the board, administration, and clinical leadership.

3. Policies and Procedures: Develop a clear definition of acceptable behavioral standards. Establish a zero-tolerance policy for those people not in compliance. Policies need to be standardized.

4. Incident Reporting: Create a simple and standardized approach to reporting that enables the organization to avoid pitfalls. Make reporting confidential and safe, and follow up with action. Many organizations have set up a designated task force.

5. Structure and Process: Have a consistent methodology in place for addressing the issues. Again, assigning a core task force is a good idea. A task force should include a variety of people (i.e., administration, human resources, a physician, nurse, etc.)

6. Initiating Factors: To prevent future occurrences, understand why the disruptive behavior took place. This will lead to better future education and training to improve communication efficiency.

7. Education and Training: Education is multilevel and should include a focus on raising awareness about concerns and offer training for things like phone etiquette, stress management, diversity training, anger management, and more.

8. Communication Tools: There are many tools to improve communication. For instance, the Situation-Background-Assessment-Recommendation (SBAR) tool provides a scripted way to improve communication flow.

9. Discussion Forums: Get people together. This can be done formally or informally through patient rounds, joint conferences, or designated meetings.

10. Intervention Strategies: Minimize impact of disruptive behavior. Some organizations have put a “code white” policy in place where pre-selected individuals will respond to a call for assistance to help mediate during a disruptive event.

Create, Reinforce, and Follow Up

You need to put in place policies that address employee work conduct and disruptive behavior. These policies need to be implemented to ensure that employees are treated fairly, work in a safe environment, and continue to remain productive.

Create an ‘Employee Conduct and Work Rules’ to include a variety of examples of disruptive and inappropriate behaviors. The list of violations need not be all-inclusive. The policy should state how violation of one of these work rules, or any other disruptive or inappropriate behavior, may trigger the ‘Corrective Action’ process.

If you develop an ‘Employee Code of Ethics,’ it should outline behaviors that could be violations of therapeutic boundaries and/or professional conduct. With a ‘Productive Work Environment/Harassment’ policy, you could establish guidelines which prohibit harassment, including sexual harassment in the workplace. And finally, an ‘Impaired Physicians’ policy is needed to describe the process for identifying, intervening, and monitoring physicians with a substance use or mental disorder.

Go ahead and initiate corrective action procedures when employees violate your codes of conduct. It will serve as your primary mechanism for addressing disruptive behaviors and include steps for performance improvement and interventions, up to and including termination. One of the ways that you can reduce disruptive and inappropriate behaviors is to spend a great deal of time explaining how to prevent them during your new hire orientation. Ensure that key policies are reviewed annually with all employees. It is always helpful to have standards, because policies and procedures continue to evolve and improve.