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Joint Commission Drops Term 'Disruptive Behavior'

Publish Date: 12/7/2011

The Joint Commission’s leadership standard LD 03.01.01, “Leaders create and maintain a culture of safety and quality throughout the hospital,” was implemented in January 2009. Recognizing that behavior that intimidates others and affects morale or staff turnover can be harmful to patient care, the Joint Commission’s intent in introducing LD 03.01.01 was to require a formal process to manage unacceptable behavior in accredited hospitals. The Leadership standard consists of ten elements of performance (EPs), two of which specifically address disruptive behavior:

EP 4: Leaders develop a code of conduct that defines acceptable, disruptive, and inappropriate behaviors.

EP 5: Leaders create and implement a process for managing disruptive and inappropriate behaviors.

In its November 9 publication, Joint Commission Online, the Joint Commission revealed that the term “disruptive behavior” in these two EPs is being revised to read “behavior or behaviors that undermine a culture of safety.” According to the Joint Commission, its staff was made aware that the term “disruptive behavior” is not viewed favorably by some in health care and can be ambiguous for some audiences. This change will published in the next update to the accreditation manuals in the spring of 2012.

AORN believes that disruptive behavior is an impediment to communication and promotes a comprehensive, zero-tolerance approach to disruptive and intimidating behavior. Behaviors that undermine a culture of safety can occur laterally or horizontally.  At this time, it is unclear if the change in the language of this Joint Commission standard will affect the processes that hospitals have put in place to deal with behavior that disrupts safety and quality in care settings. Because of the importance of this issue to nursing and patient safety, if changes are proposed to medical staff or other codes of conduct in hospital bylaws or policies and procedures as a result of this Joint Commission announcement, perioperative nurses and other nurse leaders should work to be involved or consulted in the decision-making process. 

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