Better Hospital Manners by Mandate

Posted by Theo Francis

Coming soon to a hospital near you: Rules for good behavior — for doctors, nurses, pharmacists and others.

Even well-run hospitals are fraught with tensions beyond the life-and-death concerns of treating the sick and wounded. Doctors yell at underlings. Nurses can be passive aggressive. Surgeons have even been known to hit subordinates for making mistakes in the OR. And that’s just what we’ve seen on soap operas.

In real life, bad behavior can’t be good for care. Intimidated nurses may balk at warning doctors of mistakes, residents may hesitate to speak up, pharmacists may not raise quality concerns with bullying administrators. So the Joint Commission, the biggest hospital-accrediting body in the land, is going to do something about it. Sort of. Starting Jan. 1, hospitals must have in place a policy outlining “unacceptable behavior” and how the institution intends to deal with it. (You may remember the Joint Commission as the tongue-twisting JCAHO, the Joint Commission on Accreditation of Healthcare Organizations.)

The JC hasn’t quantified just how often bad behavior by medical professionals contributes to sentinel events–serious injuries or deaths that trip the quality alarm. But poor communication of one sort or another underlies roughly 70% of sentinel events, and bad behavior seems to be a bigger component than previously thought. An alert issued today goes into more detail.

Still, it’s not clear just how much the new rule will change things. Hospitals that fail to follow their behavior policies aren’t likely to have their accreditation yanked or lose their state licenses. The JC isn’t even specifying what’s unacceptable behavior, or how hospitals should deal with it, leaving the organization open to familiar criticism that it’s toothless.

Certainly, good communication encourages better care, Kevin Pho, a New Hampshire internist and blogger, tells Health Blog. So any policy that cuts down on intimidation and abuse is well-intended, “in concept,” he says. “The question is, how will it be enforced?”

Bad habits may prove be hard to change. Grena Porto, an R.N. and senior vice-president at consulting firm Marsh Inc., all but acknowledged as much in the Joint Commission’s Q & A with reporters this afternoon. She recounted seeing a doctor become “very vocal, angry” with hospital staff, in a way that disturbed her, while working in a clinical setting some years ago.

“I didn’t do anything,” she said. “I was a staff nurse — I looked around and saw no one was going to take this on, and I wasn’t going to step in and do it myself.”

Today, from her perch as a consultant, Porto says she reports such incidents directly to hospital CEOs. But hospital employees may not be so willing to stick out their own necks until they’re convinced it’s safe.

Correction: An earlier version of this post referred incorrectly to the Joint Commission on Accreditation of Healthcare Organizations.

This article is originally featured in the Wall Street Journal. Please use the below link to find the original web version of this article.


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