A survey of the impact of disruptive behaviors and communication defects on patient safety.

BACKGROUND: A recent survey was conducted to assess the significance of disruptive behaviors and their effect on communication and collaboration and impact on patient care. SURVEY: VHA West Coast administered a 22-question survey instrument--Nurse-Physician: Impact of Disruptive Behavior on Patient Care--to a convenience sample. Of the 388 member hospitals (in four VHA regions) invited, 102 hospitals participated in the survey (26% response rate). Results from surveys received from January 2004 though March 2007 are represented. Of the 4,530 participants, 2,846 listed their titles as nurses, 944 as physicians, 40 as administrative executives, and 700 as "other."
RESULTS: A total of 77% of the respondents reported that they had witnessed disruptive behavior in physicians--88% of the nurses and 51% of the physicians. Sixty-five percent of the respondents reported witnessing disruptive behavior in nurses at their hospitals--73% of the nurses and 48% of the physicians. Sixty-seven percent of the respondents agreed that disruptive behaviors were linked with adverse events; the result for medical errors was 71%, and patient mortality, 27%. DISCUSSION: The results from the survey show that disruptive behaviors lead to potentially preventable adverse events, errors, compromises in safety and quality, and patient mortality. Strategies to address disruptive behaviors should (1) prevent disruptive events from occurring, (2) deal with events in real time to prevent staff or patient harm, and (3) initiate postevent review, actions, and follow-up. RECOMMENDATIONS: Twelve recommendations--including recognition and awareness, policies and procedures, incident reporting, education and training, communication tools, discussion forums, and intervention strategies--address what hospitals and other organizations can do now to address disruptive behaviors.