Intimidation still a problem in health care workplace

Survey reveals patients also victims.

​Recently released survey results from the Institute for Safe Medication Practices (ISMP) show that bullying, intimidation, and other types of disrespectful behavior remain a problem in the health care workplace and continue to erode professional communication, essential to patient safety and quality.   Ten years ago, ISMP conducted a national survey regarding intimidation that indicated disrespectful behaviors were not isolated events. Between July and August 2013, ISMP conducted a similar survey to determine how things have changed in the last decade. The 2013 survey included 4,884 respondents—more than double the number of 2003 participants. Most were nurses (68 percent) or pharmacists (14 percent), but more than 200 physicians and almost 100 quality- and risk-management staff also participated in the survey. Seventy percent had more than 10 years of experience. Following are some highlights of the findings.   The most frequent disrespectful behaviors reported are: Negative comments about colleagues (reported by 73 percent at least once, by 20 percent often) Reluctance or refusal to answer questions or return calls (77 percent at least once, 13 percent often) Condescending language or demeaning comments (68 percent at least once, 15 percent often) Impatience with questions or hanging up the phone (69 percent at least once, 10 percent often) Reluctance to follow safety practices or work collaboratively (66 percent at least once, 13 percent often) Although physical abuse (7 percent); throwing objects (18 percent); insults due to race, religion, or appearance (24 percent); and shaming or humiliation (46 percent) were not encountered frequently by most respondents, nearly a quarter reported that those behaviors were among the top three encountered during the past year.   Who is involved or affected? In both 2003 and 2013, respondents reported that physicians and other prescribers engaged in disrespectful behavior most often; more than half of 2013 respondents said physicians and other prescribers had often (6 percent) or at some time during the year (51 percent) yelled, cursed, or issued verbal threats. However, they also made it clear that it is not just physicians—in many cases, encounters with other health care professionals were nearly as frequent.   Repeated occurrences of disrespectful behavior did not arise from a single individual—36 percent reported that three to five individuals were involved in incidents. The survey also showed that gender of the individual affected has little impact; only minor differences were reported in the frequency with which men and women encountered disrespectful behaviors.   Impact on safety Almost half of the 2013 respondents said their past experiences with intimidation altered the way they handle questions about medication orders. At least once during the year, 33 percent of respondents had concerns but assumed an order was correct rather than interact with an intimidating prescriber. More than one-third asked another professional to talk to a disrespectful prescriber about an order. Eleven percent reported a medication error that occurred primarily due to intimidation. It also appears that 2013 respondents were less satisfied than 2003 respondents with organizational efforts to address the problem. While 70 percent of respondents in 2003 reported that their organization would support them if they reported disrespectful behavior, just 52 percent of the 2013 respondents felt this way.   The results of ISMP’s surveys expose health care’s continued tolerance of disrespectful behavior in the workplace and reveal that little progress has been made in the last decade to eradicate intimidation and bullying. The institute plans to issue recommendations on how health care professionals and organizations can address disrespectful behavior in a future issue of the ISMP Medication Safety Alert! newsletter. RNL   2013 survey findings 2003 survey findings   Published 10/10/2013, Vol. 39, No. 4