Joint Commission Leadership Standard Addressing Disruptive and Inappropriate Behavior Becomes Effective January 1, 2009

December 10, 2008

Effective January 1, 2009, together with a general renumbering and reorganization of all accreditation standards, The Joint Commission (TJC) will implement new Leadership Standard LD.03.01.01 requiring all accredited health care facilities to have a code of conduct defining disruptive and inappropriate behaviors. This Standard also requires health care facilities to implement a process for managing disruptive and inappropriate behaviors. The Standard has developed from TJC’s historical concern that intimidating and disruptive physician behaviors foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care, and cause attrition of qualified health care professionals. It is important to note, however, that the new Standard targets the behavior of all physicians and non-physician staff members.

TJC issued a Sentinel Event Alert on July 9, 2008, addressing the problem of intimidating and disruptive behaviors. The Alert stated that such problematic behaviors include, among others, “verbal outbursts and physical threats, as well as passive activities such as refusing to perform assigned tasks or quietly exhibiting uncooperative attitudes during routine activities . . . reluctance or refusal to answer questions, return phone calls or pages; condescending language or voice intonation; and impatience with questions.”

The Alert attributes such behavior to multiple systemic and individual factors, including a history of tolerance and indifference to intimidating and disruptive behaviors; indirect promotion of such behavior by organizations that fail to correct unprofessional behavior through formal disciplinary systems; the inherent stresses of dealing with life-or-death situations; fatigue; productivity demands; cost containment requirements; the fear of, or stress from, litigation; and individual personality traits such as self-centeredness, immaturity, and defensiveness.

The new Leadership Standard promotes three courses of action:

  • education regarding both acceptable and inappropriate behaviors;
  • development of policies and procedures promoting a culture of teamwork, safety, and quality; and
  • monitoring all individuals and activities covered by the policy.

TJC recommends educating all team members, both physicians and non-physician staff, on appropriate professional behaviors defined by the organization’s code of conduct and holding all team members accountable for modeling desirable behaviors. TJC also encourages organizations to develop a “zero tolerance” policy for intimidating and/or disruptive behaviors. Organizations are encouraged by TJC to incorporate the zero tolerance policy into their medical staff bylaws, employment agreements, and administrative policies. Leaders are also required to monitor individuals for compliance with its disruptive behavior policy and to consistently and equitably enforce the policy among all physicians and non-physician staff members, regardless of seniority or clinical discipline.

McGuireWoods is experienced in developing disruptive behavior policies and is happy to help hospitals ensure compliance with this, and other new TJC standards. Please contact the authors if you have any questions.