JCAHO Makes Healthcare the Pioneering Industry

Healthcare is institutionally prone to bullying because of its unique mix of highly-skilled and educated individuals interacting in an environment charged by internal hierarchical and external challenges. The survey conducted by the Institute for Safe Medication Practices found that 61% of respondents said their organization dealt ineffectively with intimidators and 93% reported a medication error attributable to a professional's intimidating behavior. Research by the American College of Physician Executives reported that 38.9% of high revenue generating physicians seem to bully with impunity. Everyone's afraid of confronting the powerful, threatening individual.

In 2008, the Indiana Supreme Court upheld a lower court verdict and award in favor of a chief perfusionist against a cardiologist who had been branded an "abuser" in the nation's first "bullying trial." Liability for employment practices looms on the horizon for an industry that faces crippling malpractice premiums.

The historical tolerance of emotionally abusive conduct during the protracted education of physicians and ancillary professionals explains much of the subsequent on-the-job intimidation. Nonetheless, hospitals and accredited organizations, as employers, are responsible for curbing the abusive conduct where and when it happens.

Stepping squarely into the middle of this issue, The Joint Commission's bold new Leadership Standard to address intimidating, disruptive and inappropriate behaviors makes healthcare the first industry to police itself in advance of state or federal regulations.

In addition, Medical Staff must demonstrate Core Competencies for physicians through the credentialing process (MS.4).

At first glance, the new requirements may appear redundant with existing organizational policies, but think again.

Existing Disruptive Physician policies are not effective. The problem is that fear of retaliation leads to serious underreporting and accusations of employer negligence.

Anti-harassment policies, compliant with state and federal laws, do little good unless the alleged offender is not a member of a protected status group. Sexual harassment and racial discrimination are very narrowly defined. They rarely apply in situations of status-blind cruelty.

Organizational Value Statements declaring "Respect for all individuals" ring hollow without the power of enforcement. And values are difficult to construe as an employer obligation

If these policies and declarations had worked, there would be no broad-based evidence to compel JCAHO to take this extraordinary step to require attention to the work environment in healthcare organizations.