Disruptive Behavior: Understanding Factors that Cultivate a Code of Silence

Abstract

(41st Biennial Convention) Healthy practice environments and organizational cultures of shared respect among healthcare providers are prerequisites for patient safety and quality care. There is substantial evidence that disruptive behavior, prevalent in all settings where health care is delivered, reduces clinician teamwork and communication, threatens patient safety, and negatively impacts staff recruitment and retention. Our study used an investigator-developed psychometrically tested tool to measure the phenomenon of disruptive behavior (DB) among professionals in the acute care setting. We used a mixed method design that included a 59-item survey and one open-ended question for participants to share personal experiences with DB. We administered the Disruptive Clinician Behavior Survey for Hospital Settings to all levels of registered nurses, physicians, nurse practitioners, and physician assistants (N= 5710) in a 1000 bed academic medical center in northeast US during 2010. Our overall response rate was 27%. We found an 85% prevalence rate of disruptive behavior. As a result of DB, 30% of respondents were considering transfer to another unit or leaving the organization (27%), and 8% planned to resign within the next year. We will report both the quantitative and qualitative results based on our conceptualization of disruptive behavior--- triggers (intrapersonal, interpersonal, organization), type of disruptive behavior (incivility, psychological aggression, physical violence), responses, and impacts (patients, staff, work environment). We will illustrate how clinicians and leaders can use the results to plan and implement strategies to break the code of silence and address this behavior. Our work underscores the complexities of disruptive behavior and identifies distinct contextual variables that are targets for safety interventions and quality monitoring.