Effective management strategies to meet the Joint Commission's new leadership standard for disruptive behavior

Effective January 1, 2009, the Joint Commission (TJC) has implemented a new leadership standard (L.D.03.01.01) requiring all accredited healthcare organizations to create a code of conduct that defines disruptive and inappropriate workplace behaviors and a process for managing these behaviors. The standard has developed from TJC's historical concern that disruptive behavior fosters medical errors, patient dissatisfaction, malpractice risk, hostile work environment, communication breakdown, and staff turnover. The purpose of this study is to identify a system-level solution to reduce the frequency and intensity of disruptive behavior.

Effective management of disruptive behavior promotes a caring, team-building culture for all stakeholders. Organizations need an ongoing surveillance and remediation system to respond to disruptive behavior promptly and effectively. First, organizations must identify its underlying causes. Second, organizations need to develop a universal code of professional conduct and provide examples to guide appropriate and detect disruptive behavior. Third, this universal code should be incorporated into by-laws/policies and adopted by all team members through orientation, training, and retraining. Fourth, vigorous compliance monitoring and timely evaluation are implemented to detect incidence of disruptive behaviors that are unidentified through voluntary reporting. Fifth, individuals participated in voluntary reporting and investigation must be protected by non-retaliating policy. Six, corrective actions including progressive disciplinary policy and remediation program should be written in by-laws/policies and enforced on all violators. Finally, the best time to address a problem is before it occurs. Resources must be available to coach and reward individuals to promote professional behaviors. Preventive strategies such as known best practices of conflict resolution and communication techniques should be used.

Disruptive behaviors can no longer be ignored or tolerated. With the new standard, TJC has set the bar high for healthcare organizations. Managers who fail to address disruptive behaviors risk losing TJC accreditation, Medicare and Medicaid reimbursement, and malpractice litigation.