During the past week, the sports blogosphere, call-in radio shows and ESPN have been consumed by a troubling story out of Miami.

For those of you may who have been paying more attention to Kathleen Sebelius' multiple congressional committee visits, the NFL's Miami Dolphins are embroiled in a scandal that has touched off a firestorm of opinion. At the center of it all is Pro Bowl offensive lineman Richie Incognito, who is accused of bullying a fellow player and using racial slurs in the process.

Equally as disconcerting are reports that team leadership, including the head coach, may have encouraged the bullying or, at the very least, turned a blind eye to it.

The drama in Miami has sparked a much larger conversation on bullying in the workplace. Health care is not immune from this kind of upsetting behavior.

Five years ago, the Joint Commission was so concerned about the problem that it issued a Sentinel Event Alert, cautioning that "Intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcome…"

Ronald Wyatt, M.D., the commission's medical director, revisited the issue in an October blog. Beyond the obvious threat to patient safety, Wyatt points out that disruptive behavior poses the "highest litigation risk for American hospitals, and many would argue that such behavior is inconsistent with the highest professional standards. Such behavior also contributes to poor teamwork, difficult work environments, poor patient satisfaction, and problems recruiting and retaining nursing staff."

That point about teamwork can't be overstated as health care moves toward more team-based care. Clinicians can't function like a unit, with the best interests of the patient in mind, if there's a poisonous element in the mix.

Like so many other things, preventing bullying starts at the top. Leaders must create a culture of zero tolerance. Similar to the strides that have been made on the patient safety front, frontline staff need to know that it is not just OK, but expected that they'll call out improper behavior; and that they can do so without fear of retribution.