Interdepartmental Conflict: A Hidden Crisis in Hospitals

Posted on: October 8, 2007

The worst kept secret in hospitals nationwide is the widespread tension and conflict between physicians, nurses, physician assistants, nurse practitioners, administrators and other ancillary staff such as inhalation therapists and nurse anesticists.

Work stress is par for the course in almost all areas of inpatient hospital care. It is not reasonable to expect an absence of stress in Emergency Rooms, or among Cardiologists, Surgeons, Neurologists, Gynecologists, Oncologists and most other critical care specialists. However, medical staff, working in any of these areas of specialization can and should be expected to be able to recognize and manage their own stress rather than have it turn into anger, abuse or person-directed aggression.

The nature of the work in all of the areas mentioned is, in itself stressful. There are however, additional stressors which until recently, have not been adequately addressed.

These include the debilitating stresses placed on all hospitals by the constraints of Managed Health Care. Physicians are no longer able to provide the level of care to their patients which are needed. Rather, they must seek/beg for permission from some non-physician (MBA) at the end of an 800 line to approve or disapprove of each procedure based on cost. Therefore, doctors tend to displace their frustration, anger and stress on to nurses and other members of the treatment team including technicians and ancillary staff.

Hospitals are being forced to close Emergency Rooms because a lack of adequate funding which adds to staff stress and patient distress.

Patient care is no longer based on the needs of the patient but instead on the cost of the procedure. This is demeaning to physicians and life threatening to patients. Unfortunately, patients are angry at the physicians for not providing the care needed without recognizing the current limitation placed on physicians by the patients’ own health care plan.

In an attempt to address at least part of this quiet crisis in healthcare, the Joint Commission on Hospitals Accreditation issued a directive to all hospitals requiring written policies to be in place effective April 1, 2007 to address the issue of “disruptive physicians”. Disruptive physician is defined as those physicians whose “aggressive, abusive behavior” impact patient care and treatment team effectiveness.

Simply put, nurses, physicians and other treatment staff can now formally complain about unfair treatment/abuse from physicians in the course of their hospital work.

Enlightened Hospital Administrators, Physician Well-Being Committees and Hospital Admitting Staff Credential Committees have begun to move quickly to require that doctors who are defined as “disruptive” are required to complete an Executive Coaching/anger Management Class to enhance skills in recognizing and managing stress, anger, enhancing assertive communication and increasing emotional intelligence.

Nurses and ancillary staff are now being required to participate in Organizational Training Courses in which the same topics along with an assessment is given with the option of small group anger management classes for those who score in the deficit range in managing stress, anger, communication or emotional intelligence.

In summary, previously ignored behavior which impacts patient care and staff morale are being address by using anger management and executive coaching for physicians and ancillary staff in most hospitals. This will likely have the impact of reducing litigation and increasing staff morale as well as increasing effective patient care nationwide.

George Anderson, MSW, CAMF, BCD.


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October 2007
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