Managing Disruptive Behavior in the Healthcare Workplace

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• What is disruptive behavior?

  • An enduring pattern of unacceptable behavior that disrupts the healthcare workplace or a single serious incident e.g. sexual assault.
  • It can be passive or aggressive. Examples include:
    • Passive - repeated refusal to comply with known and accepted practice standards, chronic refusal to work with colleagues, staff and patients, failure to respond to calls for assistance (when on-call or expected to be available) and persistent lateness.
    • Aggressive - objectionable language, uncontrolled anger and verbal and physical threats.

• Why is it significant?

  • One disruptive individual can cause a negative impact on patient care and safety, colleagues and co-workers and the organization itself.
  • Organizations with a disruptive individual may suffer from staff recruitment being impeded, high staff turnover, requests for transfers and additional sick time from staff.

• What causes disruptive behavior?

  • Several factors may contribute to the cause of disruptive behavior including:
    • Systemic/environmental factors, such as a lack of resources in the workplace, heavy demands on the physician
    • Personal factors including stress, illness, dependency, family or economic tensions
    • Personal character traits
    • Lack of recognition for, and management of, incidents of disruptive behavior

• What is being done to address the issue?

  • The guidance document and toolkit provide users with a fair and consistent process for resolving incidents of disruptive behavior. To successfully reduce incidents of disruptive behavior in the healthcare workplace however, the following changes also need to occur:
    • Workplace cultures need to shift toward non-tolerance of disruptive behavior
    • Healthcare staff need to feel safe and empowered to report disruptive behavior without fear of retaliation
    • Healthcare staff need to know reports will be investigated and resolved in a timely manner

• What percentage of physicians act in a disruptive manner?

  • Estimates from the United States show approximately 3 – 5 per cent of physicians are disruptive. Although specific statistics are not available, the same percentage is estimated for Alberta physicians.

• If there is such a small percentage of physicians acting disruptively, why is this an issue?

  • Even one physician exhibiting disruptive behavior can have a negative impact on the workplace, colleagues and co-workers and ultimately patient safety.
  • By dealing with and creating tools to help address this issue, a safer workplace and better patient care will ensue.
  • Complex issues may result in time and resource intensive investigations.

• What happens if a physician occasionally loses his/her temper or yells at someone? Is that considered disruptive behavior?

  • It is recognized that occasional lapses can occur in even the most professional physician.
  • If a report is submitted, considerations will be made for the following:
    • systemic/environmental factors, including a lack of resources in the workplace, heavy demands on the physician
    • personal factors.

• What are the consequences for a physician who acts in a disruptive manner?

  • Depending on the severity of the incident(s), the guidance document offers recommendations regarding what course of action to take.
  • The recommendations range from a collegial conversation with clear expectations to more serious interventions, temporary practice permit suspension and/or continuing care or remediation contracts.
  • The local administrator (or equivalent) determines how the incident is handled, based on the organization’s policies and bylaws.

• I believe my physician is behaving in a disruptive manner. Whom do I report this to?

  Alberta Health Services – Patient Concerns and Feedback

  Alberta – Red Deer and North
  Toll-free: 1-877-753-2170
  Telephone: 780-342-8080
  Fax: 1-877-871-4340

  Mailing Address:
  Patient Feedback
  Mail Slot 57
  11111 Jasper Avenue
  Edmonton, Alberta T5K 0L4

  Alberta – South of Red Deer
  Toll-free: 1-877-957-9771
  Telephone: 403-944-8616
  Fax: 1-877-243-9103

  Mailing Address:
  Patient Feedback
  10101 Southport Rd. SW
  Calgary, Alberta T2W 3N2

  The Complaints department of the College of Physicians & Surgeons of Alberta (CPSA)
  Phone: 780-423-4764
  Toll free: 1-800-661-4689 (in Canada)
  Email: complaints_department@cpsa.ab.ca 

Guidance Document & Toolkit

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• What is the guidance document and toolkit?

  • A resource that offers physicians and healthcare administrators a fair and consistent process for resolving incidents of disruptive behavior.
  • The guidance document provides recommended processes for reporting, investigating and resolving issues of disruptive behavior, a sample bylaw, the CPSA Code of Conduct and other resources.
  • The toolkit includes template forms for reporting, investigating and resolving disruptive behavior that correspond with the processes described in the guidance document.

• How will the document and toolkit be used? Is this a policy document?

  • The information provided is offered as a reference to help manage disruptive behavior in the healthcare workplace. It is not intended as legal advice or advice regarding human rights or labor legislation, nor is it a policy document.
    • Note: Offenses not covered by the document should be dealt with under the relevant legislation, Standard of Practice, policy, bylaw or code of conduct.

• Why was this document created?

  • To help address the issue of disruptive behavior by physicians in Alberta’s healthcare workplaces because:
    • Incidents are small in number, but can be time consuming to investigate and resolve.
    • A lack of a consistent and fair process has meant incidents are ignored or tolerated, or handled on an ad-hoc basis.

• Who was involved in developing the document?

  • The College, in collaboration with a group of related organizations including:
    • Alberta Health & Wellness
    • Alberta Health Services (Formerly Regional Health Authorities)
    • Alberta Medical Association - Professional Affairs and Physician Family Support Program (PFSP)
    • Canadian Medical Protection Association & other legal representatives
    • Members of the public
    • Other professional associations and colleges
    • University of Alberta, University of Calgary

• Were physicians consulted through the development of the document?

  • Yes, feedback from physicians and other key groups was gathered through a comprehensive consultation process.

• Who will use the document?

  • Alberta physicians and healthcare administrators.
  • It may also be adapted for use by other healthcare providers.