Invited Article: Managing disruptive physician behavior Impact on staff relationships and patient care Alan H. Rosenstein, MD, MBA Michelle O’Daniel, MHA, MSG ABSTRACT Disruptive behavior can have a significant impact on care delivery, which can adversely affect patient safety and quality outcomes of care. Disruptive behavior occurs across all disciplines but is of particular concern when it involves physicians and nurses who have primary respon- sibility for patient care. There is a higher frequency of disruptive behavior in neurologists compared to most other nonsurgical specialties. Disruptive behavior causes stress, anxiety, frustration, and anger, which can impede communication and collaboration, which can result in avoidable medical errors, adverse events, and other compromises in quality care. Health care organizations need to be aware of the significance of disruptive behaviors and develop appropriate policies, standards, and procedures to effectively deal with this serious issue and reinforce appropriate standards of behavior. Having a better understanding of what contrib- utes to, incites, or provokes disruptive behaviors will help organizations provide appropriate educational and training programs that can lessen the likelihood of occurrence and improve the overall effectiveness of communication among the health care team. Neurology ® 2008;70:1–1 Physicians have the ultimate responsibility for providing appropriate, safe, efficient, and effective patient care. As part of this process physicians are not only expected to be knowledgeable and competent in their craft, but must also take primary responsi- bility for directing and communicating with their patients and all members of the health care team who have a role and re- sponsibility in the health care delivery pro- cess. Given the complexities of today’s health care environment, clinical and tech- nical expertise is not enough. Successful health care outcomes are dependent upon effective communication, team collabora- tion, and coordination, which ensure role clarity, mutually understood objectives, and expected actions. When this process is disturbed, there is a significant risk of gaps in care where critical tasks or functions are not completed and vital information is not transferred, which can adversely affect pa- tient outcomes of care. BACKGROUND Disruptive physician behavior is defined as any inappropriate behavior, confronta- tion, or conflict, ranging from verbal abuse to physical or sexual harassment. 1 Disruptive behav- ior stirs up strong psychological and emotional feelings, which can affect attitudes and actions, which can adversely impact patient care (A. Rosenstein and M. O’Daniel, unpublished). 2,3 Disruptive behavior is not a new concept—it is not unique to physicians and it is not unique to healthcare. However, for the health care sector, disruptive behavior is taking on a new meaning. In the past, hospitals were reluctant to deal with disruptive physicians, as they were not hos- pital employees, they voluntarily admitted their patients to the hospital, and they were the major source of hospital revenue. The issue was also masked by a hierarchal system which placed the physician on a pedestal because of training and clinical expertise. Many organizations tolerated this type of behavior as a way of doing business, shrugging off the problem as a minor occurrence with no ill effects to patients or staff. There were two major issues which brought the situation more into focus. First was the 1999 Address correspondence and reprint requests to Dr. Alan H. Rosenstein, Vice President and Medical Director, VHA West Coast, 4900 Hopyard Road #320, Pleasanton, CA 94588 arosenst@vha.com From VHA West Coast, Pleasanton, CA. Disclosure: The authors report no conflicts of interest. SPECIAL ARTICLE: PROFESSIONALISM balt4/znl-neurol/znl-neurol/znl01708/znl5385-08a bockovec S5 3/7/08 15:17 Art: WNL189052 Input-nlm Copyright © 2008 by AAN Enterprises, Inc. 1 Fn1 AQ: 1 <article article-typeresearch-article> • <article-id pub-id-typedoi>10.1212/01.wnl.0000310641.26223.82</article-id>