Preventing and Addressing Workplace Abuse: Inappropriate and Disruptive Behavior
November 1999 (revised)
November 2002 (revised)
November 2005 (reaffirmed)
November 2010 (revised)
Statement of the Issue
Healthcare executives have a professional responsibility to create and maintain an organizational culture that promotes quality patient care and a healthy work environment that protects staff from inappropriate and disruptive behavior. Such behavior, including aggression, harassment and intimidation, can adversely affect the ability of the healthcare team to work together and can negatively impact the quality of patient care. Countering the adverse effects of inappropriate and disruptive behavior requires that healthcare executives establish an organizational code of conduct defining such behaviors, provide staff with relevant education, and implement enforceable polices and processes to identify and prevent such behaviors.
An organizational culture that clearly conveys zero tolerance for inappropriate and disruptive behaviors while providing the necessary resources and mechanisms to safeguard against such behaviors can improve teamwork, foster a sense of mutual respect, and improve communication. Not only can quality of care and patient safety be enhanced, but there is a concomitant reduction in the legal, physical and emotional repercussions of inappropriate and disruptive behavior such as loss of productivity, absenteeism, turnover, low morale, lack of trust, communication breakdowns, and long-term career and psychological damage.
The American College of Healthcare Executives believes that all healthcare executives have a professional and ethical responsibility to promote a healthy workplace that is free of aggression, harassment and intimidation. Healthcare executives should demonstrate zero tolerance for inappropriate and disruptive behavior, including harassment on the basis of gender, sexual orientation, age, race, ethnicity, religion, national origin, disability, or any other personal characteristic. On behalf of their employing organizations, healthcare executives must further realize that they are responsible for implementing policy and monitoring compliance among their managers. To this end, healthcare executives should model desired behaviors and promote multifaceted programs in their organizations to prevent inappropriate and disruptive behaviors. Sample program components include, but are not limited to, the following:
Clearly articulated code of conduct and policy against inappropriate and disruptive behavior. The organization should have a code of conduct that defines acceptable, disruptive and inappropriate behavior. The related policy also should define specific terms such as "harassment" (preferably as defined by the Equal Employment Opportunity Commission–EEOC) and "aggression," and reference intimidation (both verbal and non-verbal), violence (both physical and verbal) and passive aggressive behaviors. In addition, the policy should explicitly state that these behaviors are not tolerated in the organization. The policy might include examples of prohibited conduct, delineate methods for making and investigating complaints, state that retaliation is prohibited and no reprisals will be taken against any employee filing a complaint under this policy, and provide that appropriate corrective action will be taken. The code of conduct and policy should be revised on a periodic basis and incorporated into the employee handbook as well as discussed in new employee orientation.
Employee training on inappropriate and disruptive behavior and its prevention. Human resources staff or other individuals who have a technical and legal understanding of the issues, in addition to demonstrated ability to stimulate discussion about this sensitive topic should conduct training. Training should be conducted on an ongoing and regular basis with the goals of: raising awareness of harassment, intimidation and aggression; clarifying misconceptions about what constitutes these behaviors; explaining the manager’s role and responsibility in providing a safe and supportive work environment; and finally, sharing the specifics of the organization’s policy prohibiting inappropriate and disruptive behavior.
Procedure for reporting allegations of inappropriate and disruptive behavior. The procedure should provide as much confidentiality as possible for both the complaining employee and the person accused of these behaviors. The procedure should take into account the need of the individual accused to be presented with the specific charges so as to be able to form a defense. Employees should be protected from retaliation for filing a complaint or appearing as a witness in an investigation. Further, if the procedure requires employees to make initial complaints to their supervisors, an alternate person should be designated to handle complaints when lodged against the supervisor. Supervisors should be required to report all complaints and be made aware of liability for failing to do so.
Procedure for expeditiously investigating complaints of inappropriate and disruptive behavior. According to EEOC guidelines, once an employee complains, employers should promptly investigate and take "immediate and appropriate corrective action" based upon the results of their investigation. The organization should, therefore, have a process in place for investigating complaints quickly, discreetly and completely. An objective party should conduct an investigation, and the results of the investigation should be reported to both the complaining employee and the person accused. Other staff should be informed on a "need to know" basis.
Standards for corrective action. Standards for corrective action are an essential part of any plan to prevent inappropriate and disruptive behavior. Disciplinary action should be proportionate to the severity of any behavior found. The organization’s policy, as it relates to corrective action, should avoid providing specific punishments for specific actions and instead be broad enough to give the freedom to exercise appropriate action. For example, the policy might state that such behaviors may result in discipline, up to and including discharge.
In addition to the program components mentioned above, legal counsel should review policies and procedures related to inappropriate and disruptive behavior because of the potential exposure to liability.
Workplace safety and quality of patient care is dependent on teamwork, communication and a collaborative work environment. To assure quality and to promote a culture of safety, healthcare executives must address the continuum of inappropriate behaviors that threaten overall performance and patient outcomes.
Approved by the Board of Governors of the American College of Healthcare Executives on November 8, 2010.
American Medical Association’s Opinion E-9.045
The Joint Commission Standard L.D. 03.01.01
The Joint Commission, Sentinel Event Alert, Issue 40
American College of Physician Executives, “Special Report: 2009 Doctor-Nurse Behavior Survey,” The Physician Executive, November/December 2009, Vol. 35, Issue 6