Too many hospital executives and board members wimp out rather than confront physicians and other staff who engage in disruptive behavior—and they're setting up their organizations to pay a high price when it comes to patient safety and their bottom lines.

That was one of the themes of yesterday's Leadership Day pre-conference session at the National Patient Safety Foundation Congress here on the Potomac River in Maryland, just outside of Washington, D.C. The annual conference officially got under way this morning with its usual stellar line-up of experts committed to teaching clinicians and hospital leaders how to deliver higher quality, safer care.

Leadership Day speakers made two things perfectly clear: (1) Patient safety begins with the C-suite and board of trustees and (2) disruptive behavior by staff—particularly physicians—is a major cause of medical errors. "If leadership is skeptical about dealing with disruptive behavior, it really doesn't matter if you have committed people at the bedside," said Barbara Youngberg, a visiting professor of law at the Beazley Institute for Health Law and Policy at Loyola University in Chicago.

Richard Boothman, chief risk officer at the University of Michigan Health System, detailed the case of a "superstar" surgeon who continually intimidated a patient, the patient's family members and other clinicians, but no one in the health system's leadership confronted him even when the consequences proved dire. In clinical matters, "the board was completely hands off; the CEO was completely hands off," Boothman said. "The CEO managed the balance sheets. The CMO managed the clinical side."

That, all the experts agreed, is a recipe for disaster.

But can a hospital leader dare confront the high-earning physicians who contribute so much to the bottom line?

"If you are only measuring the business these physicians bring in," Youngberg replied, "and not the downstream cost in risk management and patient satisfaction, then you are measuring the wrong thing."

Gerald Hickson, M.D., director of the Center for Patient and Professional Advocacy at Vanderbilt University Medical Center, said disruptive behavior can destroy staff morale to the point where some will leave, and that's costly, too. "How much does it take to replace nursing professionals?" he asked.

The audience consensus: at least $60,000 each.

More chillingly, verbal abuse and other boorish behavior by physicians discourages colleagues from speaking up even when they see potential errors. One health care system dramatically reduced malpractice claims after leaders actively began to encourage staff to speak up about behavior that might intimidate caregivers or otherwise hurt care in any way.

Here's what hospital executives and board members need to do, according to yesterday's speakers:

  • Have a clear, written credo and code of conduct that articulates the organization's policies on disruptive behavior.
  • Require medical staff to sign off on those policies. "Don't assume they automatically know or that they won't sue if you cancel their privileges," Youngberg warned.
  • CEOs should make rounds to show they really care that the policies are being followed and to learn if—and by whom—they're not being followed. "Senior leaders generally have a much rosier view of what happens in their organization than the people at the bedside do," Youngberg said.
  • The board—the full board, not just the risk review committee—must include patient safety and disruptive behavior issues as regular agenda items.

And finally, there must be consequences for those who violate policies on behavior. Allegations must be reviewed and appropriate responses, such as "awareness discussions" with violators, must take place. If the pattern of behavior persists, send the individual packing.

"You need leadership that will not blink, " Hickson said.

I'll have more from the NPSF meeting tomorrow.