In July 2008, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) issued a sentinel event alert concerning “intimidating and disruptive behaviors” that undermine a culture of safety and lead to errors, decreased patient satisfactions, preventable adverse out-comes, increased healthcare costs, and loss of qualified per-sonnel (JCAHO, 2008). These undesirable behaviors include overt actions such as verbal outbursts and physical threats, as well as passive activities like refusing to perform assigned tasks or an uncooperative attitude. Disruptive and intimidating behaviors are often demonstrated by health-care providers in power positions and can manifest as: reluctance or refusal to answer questions, return phone calls or answer pages; condescending or intimidating lan-guage or voice tone/volume; and impatience.
This problem prompted JCAHO to include new standards on leadership effective January 2009. Any accredited healthcare organization must have a code of conduct that defines acceptable and disruptive and inappropriate behav-iors. Additionally, leaders in these organizations must create and implement a process for managing disruptive and inap-propriate behaviors (JCAHO, 2008). Several action steps have been suggested to accomplish this new standard of behavior.