Disruptive Behavior Between Physicians and Nurses: Building the Interdisciplinary Toolkit for Change

Purpose: Healthcare organizations face the challenge of disruptive behavior every day. Addressing these behaviors involves more than talking with the individuals involved. Acknowledging the power gradient as an underpinning of disruptive behavior, the lack of infrastructure to address the issue, the lack of policies and procedures and inconsistent support from leadership to resolve the issues in a meaningful way are essential to developing a zero tolerance culture.   

Methods: Using results from IRB approved surveys about disruptive behavior from two healthcare organizations and other evidence, behavioral issues and patterns related to disruptive behavior were identified and used as the basis to develop an interdisciplinary toolkit. The intent was to provide comprehensive strategies to deal collaboratively with the power gradient and to identify the required structures and processes needed to resolve this organizational challenge.

Results: Survey results were similar between the two healthcare systems and with the 2009 American College of Physician Executive Survey. Disruptive behavior still exists within healthcare organizations, and a comprehensive approach is critical to finally resolve this enduring issue.

Conclusion: Developing an evidence based toolkit is an important first step in addressing disruptive behavior. Recognition of the factors influencing disruptive behavior, from the power gradient to the lack of organizational supports, informs the strategies included. Developing policies and procedures and educating all involved about behavioral expectations are approaches to demonstrating the organizational commitment to zero tolerance.