Mar 27, 2018

eNewsletter Article: Unprofessional Behaviour – Issues and Solutions

In any industry, a stable and productive workplace will result in higher job satisfaction, morale and retention rates. In healthcare, it can also lead to safer medical care and more positive outcomes for patients. Conversely, unprofessional behaviour by physicians and other healthcare professionals can destabilize the work environment and put patients at risk.

The College of Physician and Surgeons of Ontario describes unprofessional behaviour as “any inappropriate conduct, whether in actions or in words, that interferes with or has the potential to interfere with quality healthcare delivery”[1]. Unprofessional behaviour can take many forms, ranging from being chronically late for scheduled appointments or treating colleagues in a condescending manner, to outright demonstrations of aggressive behaviour or threatening physical force. These types of behaviour can impede the smooth functioning of a healthcare team and impact the safety of patients under their care.

Although a survey of physicians indicated that 99% believe that unprofessional behaviour ultimately affects patient care[2], it remains a prevalent issue within the healthcare sector. A 2017 study found that 98% of clinicians reported witnessing disruptive behavior in the last year and 70% reported being treated uncivilly[3]. Another study cited an 87% increase in disruptive behaviour from 2006 to 2015[4].

A key issue in the past was apprehension on the part of those affected to come forward. In a U.S. study in 2013-2014, younger doctors and residents reported speaking up less frequently about unprofessional behaviour than about traditional safety threats despite their view that it was important for patient safety. The authors of the study concluded that these behaviour-related safety threats were more difficult to address because they were less likely to change even if reported.[5]

Support and Resources for Positive Change

In today’s environment, individuals across all industries are more empowered to call attention to inappropriate behaviour. In Canada, all provinces and territories now have legislation regarding obligations to address harassment and safety in the workplace.[6] This legislation is helping to raise awareness and encourage action in the face of problematic behaviour. For example, since the Ontario “Sexual Violence and Harassment Action Plan” became law in Ontario in September 2016, Ministry of Labour complaint statistics regarding workplace harassment have doubled.[7]

This societal shift can also positively impact healthcare. Healthcare leaders can build on this momentum and reassure team members that complaints will be taken seriously and addressed appropriately, including those regarding individuals in positions of authority. Leaders must ensure that their team members are aware of the processes to follow and steps to take when they encounter problematic behaviour, so that they always feel supported and equipped to speak up.

Increasingly, resources, educational tools and training opportunities are also being made available to physicians, healthcare teams and their leaders to help them tackle behavioural issues. These include physician health programs that offer resources specifically aimed at addressing disruptive behaviour[8], as well as specific tools like the CMPA Good Practices Guide[9] and in-depth professional development programs, like those provided by Saegis. Specialized communication workshops for physicians and healthcare professionals can mitigate the problem, as can intensive programs that help healthcare leaders develop the skills to manage unprofessional behaviour more effectively and engender a culture of safety within their teams and institutions.

What Lies Ahead

In many cases, the root causes of unprofessional behaviour, such as overwork, stress and personal difficulties, may be difficult and complex to resolve. Nonetheless, the more healthcare professionals become aware of how to react and of the resources available to them, the more likely problematic behaviour can be effectively addressed. At the same time, the societal shift that is empowering more people to speak up about inappropriate workplace behaviour and demand action from those in a position of authority, will also support positive change. Healthcare leaders, physicians and other healthcare professionals will all be in a better position to uncover behavioural issues and implement strategies to resolve them, ultimately improving the working environment and patient care.

Saegis offers a communication skills program, “Effective Team Interactions”, for physicians and other healthcare professionals, as well as programs for healthcare leaders, “Strategies for Managing Unprofessional Behaviour” and the “Just Culture Certification Course”.  

[1] College of Physicians and Surgeons of Ontario,“Guidebook for Managing Disruptive Physician Behaviour,” 2008, p.4

[2] Disruptive Physician Behavior, Owen MacDonald, Group Publisher, QuantiaMD, 2011, p. 12

[3] Villafranca A Can J Anesth (2017) 64:128-140

[4] Risk Management in Canadian Healthcare RMCHC vol 19#2 2017; # of hospital proceedings involving disruptive physicians increased 87% in 10 yrs from 2006-2015

[5] Speaking up about traditional and professionalism-related patient safety threats: a national survey of interns and residents., Martinez W, Lehmann LS, Thomas EJ, et al.  (BMJ Qual Saf Journal 2017)

[6] Addressing physician disruptive behaviour in healthcare institutions, 2013, resources: Advice & Publications > Browse articles > Duties and responsibilities


[8] Addressing physician disruptive behaviour in healthcare institutions, 2013, resources: Advice & Publications > Browse articles > Duties and responsibilities


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