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Press Start: Lead an Empowered Life as a Clinical Laboratorian

Combating Bad Behavior

Published August 11, 2008 11:49 AM by Glen McDaniel

The Joint Commission has issues a statement that rude, hostile and obnoxious behavior in the workplace is not simply unpleasant and inappropriate, but can be considered a patient safety or quality of care issue as well.

Anyone who has been in healthcare for a while is aware of a physician, nurse or laboratorian who is known for flying off the handle frequently or using foul, abusive or threatening language on a frequent basis. Very often such legendary behavior has been tolerated with excuses, especially if there is a perceived imbalance of power, such as from a physician directed at a nurse or laboratorian; or from a lab supervisor to a subordinate.

Excuses I have heard frequently often go like this: "he is very rude but otherwise he is an excellent physician," or "she is a real patient advocate and is only concerned about her patient," or "he always cools down and apologizes anyway." The Joint Commission has taken a second look at such behavior and interpreted it as serious enough to issue a sentinel event alert. Sentinel events are those which are serious enough to have caused harm or potential harm to a patient.

Alerts are sent out when The Joint Commission regards a sentinel event as serious enough or frequent enough that organizations need to develop a plan of action to avoid or minimize such events. This particular sentinel event alert comes with 11 specific recommendations. Additionally, The Joint Commission is adding new standards requiring healthcare organizations, including hospitals and clinical laboratories, to develop and document conduct codes designed to define acceptable behavior, minimize abusive behavior and address it when it occurs. Expect to see these standards in place in January 2009.


I recently received some literature  summarizing the highlights of  The Medical Group Management Association annual meeting in San Diego. It was attended by physicians, executives and  physician office staff.

One workshop (conducted by a physician) focused on disruptive behavior by physicians.

I immediately thought of your comments, Kare, when I saw the list of behaviors that attendees mentioned they had personallyexperienced- from yelling, swearing, threats, and sexual harassment to sabotage and destruction of property.  One of the  most bizzare was that of a physician who would get mad and turn off power at the main fuse box!

The consensus was that physicians very often do not see -or will not admit to-  the negative effects of their behavior on others. They trivialize their own behavor and seek to justify it.

Psychologists say that those who perform an action will describe it in terms of the effect they want- you yank a child so they dont rush into traffic, you ground a kid to teach them a lesson, you yell to get someone to correct bad behavior.

On the other hand, those who are on the receiving end of an action see the behavior in terms of how it makes them feel. That is why in seeking to change behavior it is important to point out to the perpetrator  how the behavior affects others and makes them feel.

Given the fact that there are always several alternative ways of acting, disrupters must be made to 1. understand the effect of their bad behavior and 2. the negative consequences they will encounter if they choose disruptive over more acceptable, appropriate behavior.

Glen McDaniel November 24, 2008 7:04 PM

During my first job as a MT/CLS four years ago in the blood bank of a level I trauma center in Winston Salem, NC, I would dread hearing the name of a particular anesthesiologist in any incoming calls because she always rudely demanded to know where the h*ll her blood was. :P

More recently, in my current position at a busy 210-bed Texas hospital, a CCU nurse took exception to my JCAHO-compliant request that she "read back and affirm" a critical CK-MB value, commenting that "this is the 1st time anyone has questioned her hearing."  Being stressed out from the morning run during my last few hours of a 10-hour night shift, I e-mailed the lab director about how the nurse who made this "snide remark" (and possibly others) should recognize the RBA requirement as "an integral part of patient safety - NOT a matter of anyone questioning an individual's hearing abilities!"

My supervisor pointed out that most of us can get discombobulated from the stress of a busy morning in our occupation, regardless of whether we're nurses, in the lab, or elsewhere in the hospital - and it is very easy for anyone to sound "snide" or "short" over the phone (or be interpreted as such by the person with whom he/she is speaking).  Also, however, the nursing supervisor AND the laboratory director "commended me for doing the right thing" and ensuring patient safety in subsequent e-mails after that morning. :)

Stephanie Mathis, MT(ASCP), Generalist - Clinical Laboratory Scientist, Aureus Medical Group September 6, 2008 7:34 PM
College Station TX

I hope the standards are sufficiently specific that people can picture the actual behavior in their mind's eye.  

When the stakes are high and the rule-crafting group is large, well-educated and smart, the standards are principles whether than concrete rules.  

As a fan of Advance and a journalist-turned speaker in the medical/health care world I recognize how vital these standards can be.  Kudos to you Glen, for this post.  Kare Anderson, movingfrommetowe, sayitbetter

Kare Anderson, author/speaker - co-founder, Say it Better Center LLC September 2, 2008 1:57 PM
Sausalito CA

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