Editorial

I recently visited a good friend who had just lost her husband. The funeral had been a few days before. Her daughter was still in town, and the three of us sat in the light-drenched sunroom, sharing memories and mourning. All of us are healthcare careerists, and eventually the conversation turned to our field. The daughter (I’ll call her Camille), told us about her best friend. The friend works in a hospital-based medical office and is frequently in tears. The doctor for whom she works is a productive researcher and surgeon–and an abuser. She yells, slams doors, and “communicates” condescendingly. With a shortage of other jobs, Camille cannot just walk away from this one, and her supervisors will not acknowledge the abuse, much less address it.

Camille’s story is not unique. Leadership is failing her and her co-workers miserably–they are left to be demeaned, fearful, angry, and struggling to be productive. It’s not a good environment for either morale or quality, or for the patients.

Until a decade ago, we did not acknowledge how many people were dying in our hospitals due to preventable medical errors. We had to own up when the IOM presented irrefutable evidence. Similarly, many of us have turned a blind eye to the abusers in our midst. How can we confront the tyrannical nurse who is central to patient care, or the demeaning physician, on whose admissions, tests, and procedures our billing revenues depend?

When the Joint Commission announced its standard requiring hospitals to address disruptive behavior last summer, denial was no longer an option. We had to at least acknowledge that the problem exists. Of course, some of us are saying “It doesn’t happen here,” or “It’s really not that bad,” but that thinking will only prolong the crisis. Others among us fear the process and outcome of dealing with the bully. This makes us co-conspirators in the abuse. The situation is especially uncomfortable when the abuser is a colleague, co-worker, or even a good friend.

Many healthcare administrators, however, have already faced this problem head on. They have recognized the terrible toll that abuse takes on patient care, on families, and on other staff. They know abusers can exist anywhere within the workforce. Several of those who have taken action tell their stories and share their insight in this issue of Frontiers.

William Swiggert and the team at the Center for Professional Health at Vanderbilt University Medical Center have developed a leading edge program to address the issue of disruptive behavior, particularly among physicians. They explain their work through the story of Dr. Jane Doe. Unlike the physician abusing Camille’s friend, the doctor in this story came to grips with her bullying behavior and found resolution through the skill, persistence, and caring of professionals who would not let her behavior slide.

Dianne Felblinger from the University of Cincinnati describes the scenarios in which disruptive behavior tends to arise and how it manifests itself. She discusses the need for policies and clearly explains the impact on ROI. Dr. Felblinger helps us understand that the organizational costs and the loss in patient safety are compelling reasons to set aside our reluctance, denial, and malaise, and finally address bullying and disruptive behavior.

The commentators in this issue contribute to the debate, from Pamela Brier’s story of building respect among employees at Maimonides Medical Center in Brooklyn to David Yamada’s persuasive argument that we need to help abusers’ victims heal.

Bullying and disruption can be eliminated in the work place if we have the will, the sense of responsibility, and the caring to do so. If we succeed, our patients will be safer and our staff happier and more productive.