Red Flags for Disruptive Behavior in Healthcare Professionals

Laura M. Cascella, MA, CPHRM

Sadly, disruptive behavior among healthcare professionals and staff is common, and it poses a threat to patient safety and staff well-being. In a recent survey of healthcare professionals at an academic hospital in the United States, 63 percent of participants experienced unprofessional behavior at least once a month.¹ These behaviors can take a serious toll on members of the patient care team and can increase the risk of adverse events.

Disruptive behavior can manifest in various ways. Sometimes the behavior is manipulative; other times it might be threatening or intimidating. In some cases, disruptive behavior is passive, such as avoidance, failure to follow standard policies or procedures, and chronic tardiness. Regardless of how the behavior presents, it creates disorder and often ensnares the disruptive provider’s colleagues in turmoil and chaos.

Although prevention is not always possible, healthcare leaders and providers can take proactive steps to identify colleagues who might be at risk for potentially toxic and harmful behaviors. Doing so may help address problems before they escalate and lead to safety issues. Early identification of disruptive behavior also might create opportunities to provide support and guidance for clinicians whose actions reflect burnout, mental or physical health problems, cognitive impairment, substance abuse, or other disorders.

Some potential red flags for disruptive behavior in healthcare professionals might be apparent during the hiring and credentialing process. Examples may include individuals who:

• Have a history of changing jobs frequently, often with geographic relocations and unexplained periods of unemployment.
• Have been employed in jobs that were inappropriate for their qualifications.
• Are reluctant to give permission to contact previous employers or organizations.
• Make excuses for not producing appropriate or adequate references. (Letters of reference might be “vague” and may not tell the story of the individual’s accomplishments and skills.)
• Have a history of voluntary or involuntary relinquishment of licensure/registration or medical staff membership.
• Have a history of limitation, reduction, or loss of clinical privileges.
• Have an unusual pattern or excessive number of professional liability actions resulting in final judgments against them.
• Have a history of board of medical examiner investigations or prior professional disciplinary actions.
• Have a history of poor performance evaluations.

In some cases, disruptive behavior develops over time as a result of personal or professional circumstances. Providers who were previously congenial might exhibit inappropriate or unprofessional actions that develop into patterns of disruptive behavior. For example, these individuals might:

• Exhibit personality changes. Although everyone has “off” days, large-scale changes in a person’s overall demeanor and behavior might indicate a potential problem.
• Make inappropriate comments. They may become excessively sarcastic, negative, or antagonistic.
• Complain about being misunderstood or overworked.
• Have frequent absences or tardiness and become irritable when pressed to improve.
• Skip meetings and fail to meet deadlines; staff members might begin to double-check work to prevent errors.
• Have a change in personal appearance or hygiene that is concerning (e.g., a disheveled appearance, body odor, dirty clothes, etc.).
• Seem shaky, nervous, jittery, or sweaty.
• Forget commitments, arrive late, be unprepared, or act unpredictably.
• Withdraw from activities that previously were of interest or behave inappropriately during such activities.
• Show signs of having a substance abuse disorder.
• Have legal concerns (e.g., arrests, impaired driving citations, divorce proceedings, etc.).
• Receive frequent complaints from patients.

Importantly, the examples listed above do not necessarily imply that someone will become disruptive. Each person copes with life and work situations differently, and many people are able to maintain professional behavior even under stressful circumstances. Further, the Journal of Medical Regulation notes that, “A single episode of disruptive behavior does not render a physician a disruptive physician.”² Rather, disruptive behavior is a pattern of actions that interferes with clinical performance, quality of care and safety, efficiency, and teamwork.

Awareness of potential red flags for disruptive behavior is an essential element of human resource management for healthcare organizations, both large and small. Healthcare leaders, providers, and staff members should understand their organizations’ codes of conduct and professional standards as well as the appropriate procedures and chain of command for reporting disruptive incidents.

Taking a proactive approach to managing disruptive behavior and empowering employees to report potential safety issues will help healthcare organizations reinforce a positive work environment and robust culture of safety.

To learn more about disruptive behavior, take MedPro’s free continuing medical education course titled Disruptive Behavior in Healthcare: Identifying It and Addressing the Risks.

The following MedPro resources also provide helpful information:

• Risk Resources: Disruptive Behavior
• Risk Tips: Addressing Disruptive Behavior Among Healthcare Professionals
• The Corrosive Effect of Disruptive Behavior on Staff Morale and Patient Care
• The Patient Safety and Financial Implications of Disruptive Behavior

Endnotes

¹ Dabekaussen, K. F. A. A., Scheepers, R. A., Heineman, E., Haber, A. L., Lombarts, K. M. J. M. H., Jaarsma, D. A. D. C., & Shapiro, J. (2023). Health care professionals' perceptions of unprofessional behaviour in the clinical workplace. PloS one, 18(1), e0280444. doi: https://doi.org/10.1371/journal.pone.0280444

² Reynolds N. T. (2012). Disruptive physician behavior: Use and misuse of the label. Journal of Medical Regulation, 98(1), 8–19.

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