Addressing behavior and performance issues that threaten quality and patient safety: What your attorneys want you to know

Disruptive (“non-teamwork-promoting”) behavior by medical professionals undermines healthcare quality and a culture of safety, decreases staff morale, increases healthcare expense and increases litigation risk. Despite these untoward outcomes, disruptive behavior, defined as any performance that impacts the team's ability to achieve intended outcomes, often goes unacknowledged and unaddressed. Aggressive outbursts and other unprofessional behaviors frequently arise in high stress arenas, such as operating rooms, medical–surgical units, and intensive care units. Passive–aggressive and passive actions also interfere with individual performance, team cohesion, and system reliability. Given these observations, it's no surprise that pediatric cardio-thoracic surgeons, cardiologists, and their leaders – in fact all healthcare professionals – must sometimes deal with issues of personal behavior that impair healthcare team performance, cross-discipline relationships, and patient safety.This article begins with a problematic clinical event, then identifies key concepts for dealing effectively with colleagues whose behavior is not consistent with professional standards, group policies or practices. Five principles, reinforced by several action oriented tips and practical tools, are offered as guides to promoting professionalism and professional accountability in support of quality team-oriented care, patient safety and, if necessary, legal defense if disruptive colleagues challenge disciplinary interventions. The principles and tips revolve around issues of justice, assembling data that permit reasonable certainty that action is appropriate, minimizing or eliminating conflicts of interest between reviewers and those reviewed, aiming to help those whose performance is reviewed achieve insight about their disruptive behavior's impacts, and, ultimately, restoration to the norms of professional practice. Readers are challenged to consider how to increase the reliability of their processes; maximize colleagues' opportunities for receiving performance- and professionalism-related feedback; serve patients, families, and colleagues well; and reduce concomitant litigation risk.