When it comes to disruptive behavior, especially within the medical staff, hospital executives should institute a zero tolerance ap­proach, according to experts on patient safety.

Lucian Leape, adjunct professor of public health policy at the Harvard School of Public Health, contends that disruptive behavior is one of the underlying problems plaguing patient safety and quality of care.

"Changing the culture is a leadership responsibility," Leape says. "Without clear, sustained and committed leadership, it won't happen."

Leape made his remarks this summer at the Seventh Annual Telluride Patient Safety Educational Roundtable. The week-long meeting is an opportunity for patient and consumer advocates to work side by side with safety experts and medical educators to explore ways of improving care delivery.

To bolster his point, Leape pointed to the safety program at Alcoa Inc. Former Treasury Secretary Paul O'Neill made safety a top priority at the Pittsburgh manufacturer when he was CEO and chairman in the 1990s. Employees are guided by three principles:

  • I am treated with respect by everyone else, regardless of position, education or pay.
  • I have the education and training, the tools, and the support to develop to my full potential.
  • My work is noticed and appreciated.

Paul Schyve, M.D., senior adviser, for health care improvement at the Joint Commission, says that a culture of safety is built upon three components — trust, reporting and improvement methods — each feeding off the other. The goal is to teach providers to report bad things that occur, or almost occur, and then have systems in place to improve outcomes.

"The more trust, the more reporting there will be," Schyve says. "Intimidating or disruptive behavior breaks that trust and interrupts the cycle, as does failure to act on the reports."

In 2009, the Joint Commission issued leadership standards requiring hospitals to have a code of conduct in place defining acceptable, disruptive and appropriate behavior, and also have processes in place to manage disruptive behavior when it occurs.

Schyve is quick to point out that some behaviors, such as the surgical time-out, increase patient safety and should be lauded within an organization. It is the intimidating behavior that contributes to medical error and poor patient satisfaction that needs to be addressed.