Joint Commission Standards on Disruptive Behavior Require Leaders to Act

Recognizing that unprofessional, disruptive workplace behavior can adversely affect patient care and safety, JCAHO (the Joint Commission on Accreditation of Healthcare Organizations) announced new accreditation standards this month for healthcare organizations and their leadership. The new standards, effective January 1, 2009, require organizations to implement practices and systems to reign in such conduct and create a culture of safety. This is notable, though long-in-coming, and a topic we have written about for many years.

The issue is of particular concern in healthcare due to the risk of patient harm, and the stance taken by JCAHO is garnering significant interest. The blogosphere has taken notice, where nurses are providing their take on it ("it's about time") and sharing horror stories from inside hospital corridors; I also commented on this topic in the Wall Street Journal's blog, which has attracted its share of opinions on the subject. JCAHO notes that addressing the behavior and culture requires a systemic, comprehensive approach that includes training, standards, reinforcement, communication and measurement. I agree. But what’s most important is leadership. The rest is ancillary – necessary, but not sufficient.

Years ago, I defended a client, a textile manufacturer with a large plant in the North Carolina countryside, against a secretary's charges that her boss had harassed her. He was the Vice President of Sales, a powerful, dynamic and successful executive, six feet two and imposing. The charge enraged him and he wanted to get even. We faced a major government investigation and he needed to behave. I was a young, newly minted lawyer, and I could not get him to understand how serious a situation he faced.

The division president understood. He was a half a foot or so shorter, soft spoken, a Boston Brahmin type who said little, still amazed, I think, that  he’d made his life in the South. He walked up to the VP – just about a half foot away from him, nose to chest – and said, “Look at me and listen very closely. You are to say and do nothing to this employee except to treat her properly, as if this charge had never been filed. I will fire you if you don’t. Do you understand?”

The VP got the message. And he behaved. Since then, I’ve seen doctors, lawyers, and professionals at all levels dealing with similar situations. Those who confront the issue and are willing to act and get results. Those who won’t, don’t.

This commitment by leaders to take action in the face of outrageous and inappropriate conduct – from disruptive physician behavior to bullying in the workplace – is what the accreditation standards are ultimately all about. Absent this commitment, the processes will fail. With it, they will flourish and we’ll see a quick, dramatic and “cultural” change in behavior – and improved team performance and patient results.