2009 Developments in Mediation: Joint Commission Standard on Code of Conduct

by Holly Hayes

Health care leaders have known for years that disruptive behaviors are a serious problem. Verbal outbursts, refusing to take part in assigned duties and condescending attitudes all create breakdowns in the teamwork, collaboration and communication needed to deliver patient care. A study by The Institute for Safe Medication Practices (ISMP) found that 40 percent of clinicians have remained passive or kept quiet during patient care events rather than confront a known intimidator.

In May, we reviewed an accreditation standard (LD.01.03.01) issued by The Joint Commission in January expected to prompt hospitals to explore an expanded use of mediation to manage conflict in the healthcare setting.

Conflict Management Standard LD.01.03.01 states, “The governing body is ultimately accountable for the safety and quality of care, treatment, and services.” Elements of Performance, or how The Joint Commissionwill score the standard, include: Development of a code of conduct that defines acceptable, disruptive, and inappropriate behaviors; and creation and implementation of a process for managing disruptive and inappropriate behaviors.

In an effort to put an end to disruptive behaviors among healthcare providers, the Joint Commission recommends that health care organizations take 11 specific steps, including the following:

  • Educate all health care team members about professional behavior
  • Hold all team members accountable for modeling desirable behaviors, and enforce the code of conduct consistently and equitably;
  • Establish a comprehensive approach to addressing intimidating and disruptive behaviors that includes a zero tolerance policy; strong involvement and support from physician leadership; reducing fears of retribution against those who report intimidating and disruptive behaviors; empathizing with and apologizing to patients and families who are involved in or witness intimidating or disruptive behaviors;
  • Develop a system to detect and receive reports of unprofessional behavior, and use non-confrontational interaction strategies to address intimidating and disruptive behaviors within the context of an organizational commitment to the health and well-being of all staff and patients.

A survey conducted by the American College of Physician Executives published in November, almost one year after the Joint Commission began requiring health care facilities to implement zero-tolerance policies for disruptive behaviors, tells us there is still work to be done in this area. According to anonymous responses to a national survey of 13,000 physician and nurse executives, ninety-seven percent experienced unprofessional outbursts and overreactions, with the majority saying these happened several times a year and sometimes weekly.

Physician and nurse executives respondants solutions to decreasing disruptive behavior included: setting clear expectations, implementing consistent enforcement and focusing on teamwork.

Mediation is one non-confrontational interaction strategy that can be implemented to resolve conflict, improve the working relationships of the parties involved and enhance teamwork and patient safety.

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Holly Hayes is a mediator at Karl Bayer, Dispute Resolution Expert where she focuses on mediation of health care disputes. Holly holds a B.A. from Southern Methodist Universityand a Masters in Health Administration from Duke University. She can be reached at: holly@karlbayer.com.

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