Interpersonal Conflict: A Hidden Crisis in Hospitals

The worst kept secret in hospitals nationwide is the widespread tension and conflict between physicians, nurses, physician assistants, nurse practitioners, administrators and other ancillary staff such as inhalation therapists and nurse anesticists.

Work stress is par for the course in almost all areas of inpatient hospital care. It is not reasonable to expect an absence of stress in Emergency Rooms, or among Cardiologists, Surgeons, Neurologists, Gynecologists, Oncologists and most other critical care specialists. However, medical staff, working in any of these areas of specialization can and should be expected to be able to recognize and manage their own stress rather than have it turn into anger, abuse or person-directed aggression.

The nature of the work in all of the areas mentioned is, in itself, stressful. There are, however, additional stressors which, until recently, have not been adequately addressed. These include the debilitating stresses placed on all hospitals by the constraints of Managed Health Care. Physicians are no longer able to provide the level of care to their patients which are needed. Rather, they must seek/beg for permission from some non-physician (MBA) at the other end of an 800 line to approve or disapprove of each procedure based on cost. Therefore, doctors tend to displace their frustration, anger and stress on nurses and other members of the treatment team, including technicians and ancillary staff.

Hospitals are being forced to close Emergency Rooms because of a lack of adequate funding. This adds stress and patient distress. Patient care is no longer based on the needs of the patient. Instead, it is based on the cost of the procedure. This is demeaning to physicians and life threatening to patients. Unfortunately, patients are angry at their physicians for not providing the care needed;and they do not recognize the current limitation placed on physicians by the patients’ own health care plans.

In an attempt to address at least part of this quiet crisis in healthcare, the Joint Commission on the Accreditation of Healthcare Organizations issued a directive requiring that on January 1, 2009,  all hospitals must have in place written policies that address the problem of “disruptive physicians”. The “disruptive physician” is defined as a physician whose “aggressive and abusive behavior” impacts patient care and treatment, as well as team effectiveness.

Simply put, nurses, physicians and other treatment staff can now formally complain about unfair treatment/abuse from physicians in the course of their hospital work. Enlightened Hospital Administrators, Physician Well-Being Committees and Hospital Admitting Staff Credential Committees have begun to move quickly, requiring that doctors who are defined as disruptive complete an Executive Coaching/Anger Management course to enhance skills in recognizing and managing stress, anger, enhancing assertive communication and increasing emotional intelligence.

Nurses and staff are now being required to participate in Organizational Training Courses, in which the same topics, along with an assessment, are given with the option of small group anger management classes. The assessment is utilized to determine the individual’s current level of functioning in stress, anger, communication and emotional intelligence. In summary, previously ignored behavior, which impacts patient care and staff morale, are being addressed by using Executive Coaching/Anger for physicians and ancillary staff in most hospitals.

Executive Coaching/Anger management will likely have the impact in reducing litigation and increasing staff morale, as well as increasing effective patient care nationwide.

George Anderson, MSW, BCD, CAMF, CEAP
Diplomate, American Association of Anger Management Providers
Anderson & Anderson®, The Trusted Name in Anger Management


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