Disruptive Behavior in Obstetrics: A Hidden Threat to Patient Safety

Abstract

A serious threat to patient safety-which is based on effective communications and interdisciplinary teamwork-is disruptive or intimidating behavior on the part of healthcare professionals. Prior to this study, there were no reports on such behavior in labor and delivery units. Thus, the author investigated disruptive and intimidating behavior in the obstetric setting in the states of Oregon, Washington, and California and the effects of such behavior on patient safety.In October 2005, questionnaires were sent to the nurse managers of 100 labor/delivery units regarding unit volume of deliveries, incidence of disruptive behavior among medical personnel, the disciplines or specialties involved, whether nurses had quit or transferred out of units because of this behavior, near misses or actual adverse outcomes attributable to the behavior, and the hospital administration's and medical staff's ability to control this type of behavior.A total of 56 questionnaires were returned, with disruptive behavior occurring in 34 units (60.7%). There was a trend of increases in such behavior as the volume of deliveries on the unit increased. Among the 34 affirmative replies, 81 healthcare professionals demonstrated disruptive behavior, with physicians (obstetricians, anesthesiologists, family practitioners, pediatricians, and neonatologists) accounting for the largest incidence (56/81 cases). Nurses (registered nurses, midwives, certified registered nurse anesthetists, and nurse administrators) accounted for the rest (25/81). The highest incidence was among obstetricians (26/81), with anesthesiologists coming in second (16/81). Of 30 units reporting on the frequency of disruptive behavior, 23 said that the behavior occurred monthly (8 units), weekly (12), or daily (3). A common complaint by nurses is that physician disruptive behavior is not dealt with effectively by the medical staff leadership and hospital administration, which leads to decreased morale and an additional reluctance to report the behavior, even when safe care is threatened. Thirteen of 33 units reported that nurses had left because of disruptive behavior; 17 of 32 said that the behavior contributed to near misses, and 13 of 31 said that specific adverse outcomes occurred because of disruptive behavior. Nurse managers noted that physician disruptive behavior created an environment of fear and intimidation in the labor/delivery units.Disruptive and intimidating behavior apparently occurs frequently on labor and delivery units, most often demonstrated by obstetricians and other physicians. It is important for patient safety that organizations make every effort to educate themselves about the dangers of such behavior-including increased liability and decreased patient safety-and to try to eliminate it. Discussion by Gainer Pillsbury, MDPatient safety is a major priority in many hospitals; however, despite all the pertinent regulations and public reporting systems, success depends on whether there is a culture of safety within the hospital. Effective communications am...

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