Intimidating and disruptive behaviors

Chain of command in healthcare refers to an authoritative structure established to resolve administrative, clinical, or other patient safety issues by allowing healthcare clinicians to present an issue of concern through the lines of authority until a resolution is reached.

Frontline healthcare clinicians, who have witnessed poor performance by their peers or supervisors, may be hesitant to use this means of communication because of the fear of retaliation or uncertainty about its importance in patient outcome.

Sadly, disruptive behavior among healthcare professionals and staff is not uncommon, and it represents a serious patient safety concern.

According to the American College of Surgeons (ACS), the majority of healthcare professionals have encountered colleagues engaging in disruptive behaviors with coworkers, patients, relatives, and others.

The article discusses actions organizations can take to eliminate healthcare clinicians’ inappropriate actions and attitudes in order to boost effective communication, teamwork, and collaboration and improve patient safety.

Chain of command is a system whereby authority passes down from the top through a series of executive positions or military ranks in which each individual is accountable to their direct superior.

Of these events, 73 (41%) were due to conflicts between healthcare clinicians, 30 (17%) to procedures not followed, 17 (10%) to absence of responses or delays, 22 (12%) were listed as other, and behaviors for the remaining 35 (20%) were not given.

Individuals at the top of the hierarchy that exhibit disruptive or unapproachable behaviors may further hinder communication between healthcare clinicians.Chain of command in healthcare is the line of responsibility to both the delivery of appropriate patient care and feedback about perceived appropriateness and the impact of that care.An effective chain of command in healthcare organizations facilitates, rather than impedes, communication, teamwork, and collaboration between the decision maker and the frontline clinician.Implementation of a chain-of-command protocol could have resulted in different outcomes.Examples follow of reports describing conflicts between healthcare clinicians, refusals to adhere to procedures, and absences or delayed responses that resulted in patient care delays and increased risks for healthcare-associated infections or burns.

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