Disruptive behaviour in the workplace

• Inappropriate and unacceptable behaviour between colleagues can impact patient care.
• Disruptive behaviour should be addressed early – start by giving feedback in an informal setting, then escalate if necessary.
• In private practice, ensure systems and processes are in place to respond to disruptive behaviour.

Disruptive behaviour has been defined as:

any abusive conduct, including sexual or other forms of harassment, or other forms of verbal or non-verbal conduct that harms or intimidates others to the extent that quality of care or patient safety could be compromised¹.

Some examples of disruptive behaviours are:

• verbal intimidation or challenge including making threats or using threatening language directed at another person
• physical intimidation or challenge including pushing, grabbing or striking another person 
• throwing instruments, charts or other items
• threats of violence or retribution
• persistent inappropriate behaviour
• repeated threats of litigation
• sexual or other forms of harassment.

Disruptive behaviour is also a psychosocial hazard, with the potential to cause psychological or physical harm to colleagues. It needs to be identified and managed as part of an organisation’s duty to provide a safe workplace (see Avant’s Psychosocial hazards factsheet).

Early identification of disruptive behaviours, regular feedback, and holding staff accountable for their behaviour, all help to improve workplace culture and reduce the impact on staff and patients.

Disruptive behaviours can also impact patient safety as some behaviours contribute directly to medical errors and undermine a culture of safety.

Consequences for the workplace

Disruptive behaviour by a doctor is a threat to staff retention, increases the probability of burnout and promotes jousting (one healthcare professional criticising another or an institution).

Disruptive behaviours may constitute bullying (see Avant’s How to navigate workplace bullying factsheet). 

Disciplinary consequences

Engaging in disruptive behaviour can be grounds for disciplinary action. Serious breaches of workplace conduct may lead to disciplinary action including termination of employment and/or a complaint to a medical regulator such as Ahpra, NSW Health Care Complaints Commission or Queensland’s Office of the Health Ombudsman. Examples of a serious breach include criminal behaviour or a significant departure from expected standards.

Managing disruptive behaviour is in everyone’s best interest – doctors, other health professionals and patients. We suggest these steps for addressing disruptive behaviour:

• give feedback
• escalate if needed  
• address workplace systems and processes.

Giving feedback

Giving feedback is crucial to managing doctors with disruptive behaviour. Without feedback, disruptive behaviour can become accepted as the norm.

Whenever possible, try to initially bring disruptive behaviour to the attention of the person through an informal discussion. The person giving the feedback can be someone directly involved in, or witness to, the behaviour or may be a colleague tasked with having the conversation.

Feedback might be saying to the doctor, “We want you to know how your colleague perceived what occurred”. The doctor involved needs to understand the feedback is based on a perception, which may or may not have merit.

A 360-degree review is another form of feedback that could be considered. This formal process can be instigated in response to an individual’s behaviour, or as a hospital or practice initiative. It involves seeking feedback from colleagues at the same level, more senior and those who report to the person.

Escalation processes

If raising the issue informally does not change the behaviour, there needs to be a process in place to escalate the situation.

The management level responsible for the doctor should develop a formal assessment and management plan. This plan needs to define expectations and maintain accountabilities.

At a hospital or practice level, the following five elements can help to create an environment that rejects disruptive behaviour and encourages a culture of safety and respect:

1. A doctrine or code of conduct that all professionals believe in and live out – agree on a set of values for everyone in the workplace to abide by, whether or not they are formalised into a code of conduct. If everyone follows this, people will feel more comfortable and supported to tell a colleague that their behaviour is inconsistent with the organisation's beliefs and values.
2. Leadership – leaders should ensure your organisation's doctrine or code of conduct applies to everyone. They should lead by example, follow the agreed values, and take consistent action if those values are breached.
3. Appropriate responses – there's a big difference between a doctor who behaves badly on a regular basis and one who has an isolated episode of bad behaviour. Create a guide to help staff match the right level of intervention with the behavioural event or series of events.
4. Monitoring – ensure there is a feedback system for receiving and dealing with patient complaints, conduct regular employee satisfaction surveys, or consider a ‘hotline’ that allows staff to anonymously report a colleague's actions.
5. Training resources – only a few people enter the workplace trained to talk with colleagues about poor behaviour, so it’s up to the practice or hospital leaders to make sure an organisation's managers have the tools to conduct such conversations.

For medico-legal advice, please contact us on nca@avant.org.au or call 1800 128 268, 24/7 in emergencies.