Come Jan. 1, 2009, medical personnel are not allowed to have a bad day. That’s when new standards introduced by The Joint Commission for the Accreditation of Health Organizations (JCAHO) in a July 9 sentinel event alert are slated to go into effect.

“Intimidating and disruptive behaviors include overt actions such as 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,” the commission said. “All intimidating and disruptive behaviors are unprofessional and should not be tolerated.”

The new standards will require more than 15,000 accredited health care organizations to create a code of conduct defining acceptable and unacceptable behaviors, and to establish a formal process for managing unacceptable behavior.

But the commission’s broad definition of unacceptable behavior has the American Medical Association’s (AMA) House of Delegates up in arms.

Dissension Among the Ranks

Delegates have expressed their concern to the AMA that The Joint Commission’s definition of unacceptable behavior is too general and would allow more “arbitrary and capricious enforcement” against physicians.

The AMA said it will seek a one-year moratorium to allow medical staff to change the bylaws to comply with the rule and develop an appeals process for physicians who are accused of bad behavior.

To learn more about the AMA’s effort, read the AMNews report.

12 Responses to “JCAHO: New Behavior Standards Announced”

1. Nancy Buchanan Says:
   December 3rd, 2008 at 12:10 pm

   I have a friend who is an MD who this directly affected. He was teasing an employe who was histerical because her dog died 10 days before. He was fired because she claimed he was abusive and created a hostile work environment. What about her disruption? Her histerical outburst was in a busy emergency room in front of patients. He apologized, even offering to financially compensate her for his slight of her emotions, but was fired anyway. There needs to be a set of levels of corrective action set and it should apply to all staff from unit clerk to physician. Offer behavior modification classes and/or psychological counseling.

   With levels of importance set the Administrator could decide if the doctor laying in the floor kicking his feet rises to the same level as the doctor who tosses a scalple at an employee. I have experienced both and nothing happened to either physician because they were Medical Directors. We need to treat improper behavior for all no matter what their title.

2. Kathie Riebling Says:
   December 3rd, 2008 at 12:44 pm

   I have concerns about patient safety that may be adversly affected. Recently in hospital not in my state, a resident instructed a “senior” nurse (my firend) on care to provide for an ill and laboring patient. The nurse refused to cooperate as the care was not appropriate without more qualifying lab factors. There was a loud arguement and the on-call physician eventually was called and it was settled, siding with the senior nurse. Is that then improper behavior? Seems if that is deemed as such, we may have even more of a nursing shortage soon!

3. Pat Kennedy Says:
   December 4th, 2008 at 4:36 pm

   I am currently an Instructor at a local College and have been for almost 10 years. I am constantly telling students that the practice of Medicine is a large portion of common sense. I think this law is about as ridiculous and the little kindergartener( a boy) being suspended for kissing a classmate (a girl). Do we not have common sense left?
   Isn’t there a reason that we call it, “Health CARE”? I also spent 20+ years in the Military and the easiest people to work with are the ones who show mutual respect for their co-workers and thier patients as well. You can’t teach common sense or manners, courtesy or compassion.Wouldn’t it be terrific if we all just kept pondering, as simplistic as it sounds, “the Golden Rule”.
   We, in class, often discuss the rude health care “professional”, whether it is a Physician, Nurse, Physician’s Assistant or Medical Assistant, or the people we cannot do without, the CNA’s and Custodial Staff. I hope to be able to impart the kinder and gentler reply that it all starts with one kind word. Even if you don’t feel like giving it, it has to start somewhere. And to all those who think that the very popular show “House” is terrific, I want to ask, would you want him to “care for” you or your loved ones? When did it become the norm to be sarcastic and mean? Does his uncanny ability to be right, justify his arrogance?
   When someone is sick and tired of taking care of people, also known as our patients, then it is quite possible to consider a career change. Once again, there is a reason that we are in the “Health Care” business.

4. Jason Says:
   December 5th, 2008 at 12:20 pm

   I think that it is important to recongize correctly that there is no longer the JCAHO it is just The Joint Commission. I may be picky but I think if you are to publish professionaly one should make sure they are respecting all aspects. Great article but for the forgetfullness of a name change that is important to a few.

   In the second quarter of 2007 around February The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) changed thier name to “The Joint Commission.” The rebranding includes the name, logo, and tag line change to “Helping Health Care Organizations Help Patients.”

5. Patty Says:
   December 10th, 2008 at 8:10 am

   All I have to say is, that is about time that physicians are held accountable for their “unacceptable” behaviors . They need to lose the ego. I have worked with physicians for twenty years and some of their actions are unbelievable to say the least. I have witnessed charts being thrown at employees. Employees cursed at and on and on, too much to mention. All the staff should be held accountable and act professional, including physicians. After all healthcare professionals are there to take care of the patients. I have said it so many times that most of these people are in the wrong profession. Compassion barely exist anymore. Maybe now things will change for the common good. Good for JCAHO.

6. Donna Nelosn Says:
   December 10th, 2008 at 1:51 pm

   Don’t you think that the work place is regulated enough, now they are going to tell us, or the “Phycisians” how to act. Yes, I agree there are Physicians out their that are real JURKS, I have worked for a few, but there are alot more out there that truely care for their patient’s and staff, so why should the good ones be punished for a bad day, becaue the new rule, believe me, will not change the bad one..

7. Sandy Says:
   December 11th, 2008 at 1:11 pm

   I think this is a good idea. You can not teach someone common scence or manners but, you can certainly enforce it through the workplace. I have worked in the Medical Field for 30 years, from what I have witnessed , the Physicians need to be included in this. I have noticed alot of staff simply do not care, are lazy, it is not my job, blame it on someone else, are afraid to do something for fear some one else will accuse them of taking their job, and are rude and worthless to people because they can and no one approaches them about their behaviour. Healthcare means you care. I feel alot of people do not care.

8. George Anderson Says:
   December 14th, 2008 at 4:40 pm

   Disruptive behavior is a lot more serious than “haviing a bad day”. Rather, it is a lack of self-control, lack of social awareness,and a lack of emotional intelligence. It is a factor in patient safety, staff retention and creates a hostile work environment.

9. Lavanna Says:
   December 15th, 2008 at 7:51 pm

   Number 4 on the Test Yourself on line has the answer to the question as A: Technology adoption and staffing. In my reading, it seems the answer should be D: Code of conduct. Please explain. Thanks.

10. Faye Says:
    January 8th, 2009 at 8:51 am

    I can understand what the JC is getting at. Some people are just here for the paycheck and forget what healthcare is for and what it entails. There are rules, codes, and ethics that we live by. We are surrounded by other employees that are not afraid to act like a fool because there are no concrete do’s and dont’s for behavior. Clinical and administrative alike, we have a debt to those patients and co-workers that surround us everyday. Without patients, we have no reason to be where we are and without co-workers we have to do it all alone.

    It’s too bad that this sort of “disruptive and unacceptable” behavior can extend outside of the work place. I think that every healthcare worker should remember to conduct themselves and their workplace in public places also. I went on a bus trip and overheard a nurse from a local hospital mouthing off to her buddies about ICU patients that had MRSA. She actually said that it was the patients fault for not being clean and that she was tired of taking care of them. She broadcast what hospital she worked for and seemed so smug. She did not realize that the six women sitting behind her had just lost a loved one at that same hospitals ICU because of MRSA. He contracted it in that hospital. The family caught hospital employees not using gloves while taking care of him, and dropping iv lines on the floor and trying to still use them on this patient. That in my book is refusing to follow proper precaution and that is basic clinical practice. Those employees should have been fired in my opinion. Maybe this will be a good thing after all.

11. Susan Waremburg Says:
    January 14th, 2009 at 11:17 am

    This article states unacceptable workplace behavior is “refuse to return phone calls and pages”, but I had to choose “sneeze on patient” for Question #3; the article addresses and specifically states “code of conduct” but I had to choose “technical adoption/staffing” for Question #4. What gives with these online exams? Can someone look into this for future tests and CEUs? Thank you. It is easier to learn when the test questions match the content of the articles. I have found “problem” test questions in the Coding Edge also.

12. Paul Macdonald Says:
    February 14th, 2009 at 9:27 pm

    Doctors and staff who daily carry the responsibility of a patients life are going to have bad days. More harmful are those in support roles who (in order to survive), blame their incompetance on subordinates and others to cover for their mistakes, poor judgement and lack of skill. Abuse of authority is a problem I see everyday, and when someone speaks up, they are labeled the problem. Therefore most are terrified to do so for fear of retribution. And so, it goes on. If the JC can weed out that kind of abuse, all patients benefit.

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