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Disrespectful Behavior: A History of Tolerance in Healthcare

February 06, 2015

As we enter into 2015, our thoughts have been with the many exceptional efforts that have been undertaken in the past year to improve medication safety. But despite the many safety accomplishments in 2014, we can’t help but mull over persistent medication safety gaffes that continue unresolved and doggedly test our tenacity, often landing in the Institute for Safe Medication Practice’s Worth repeating... newsletter feature, over and over again. Over the next couple of entries, we would like to share our examples of the safety gaffes of 2014 with the hope that you will join us in bringing attention to these crucial issues and the compelling need for their resolution.

Bullying, incivility, and other forms of disrespectful behavior are still rampant in healthcare and allowed to exist while we tolerate the behavior, remain silent, or make excuses in an attempt to minimize the profound devastation that disrespectful behavior causes. An ISMP survey conducted in 2003 clearly demonstrated the scope of disrespectful behavior among many levels of interdisciplinary staff, and an ISMP survey a decade later demonstrates little progress.

Our slow progress is not due to lack of resources or know-how but to a dysfunctional culture, central to which is an ethos that favors a sense of privilege, status, and autonomy, thus impairing teamwork and communication. Disrespect diminishes a person’s ability to think clearly, make sound judgments, speak up regarding questions, or avoid at-risk behaviors. Disrespectful behaviors also underlie a resistance to collaborate with others, follow procedures that promote safe practices, or implement new safety practices. While a culture of disrespect is harmful on many levels, its effect on patient safety makes it a matter of national urgency. 

How would you described the culture where you work? Are the leaders in your organization actively involved in addressing unsafe practices stemming from the culture?


Matthew Grissinger, RPh, FISMP, FASCP, is the Director of Error Reporting Programs at the Institute for Safe Medication Practices.

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