Healthy communication in practice environments.

The contemporary emphasis on the importance of teamwork, communication, and collaboration around patient safety concerns has brought to the forefront an age-old issue, that of verbal abuse and incivility in the workplace. While typically thought of as a nurse-physician issue, it actually exists within and across all health provider groups (Porter & Lauve, 2006). The abusive communication has often been tolerated because of issues related to authority and power, but it is now clear that it will no longer be tolerated. Toward that end, The Joint Commission now requires that accredited health care organizations create a code of conduct that defines acceptable and unacceptable behaviors along with a formal process for managing unacceptable behavior when it does occur ( The Joint Commission, 2008 ). We are all familiar with what is gently referred to as disruptive behavior. Examples include condescending attitudes, rude language, demeaning behavior, verbal outbursts, or other forms of uncivil communication or behavior. It is easy to understand how they would defy teamwork and collaboration in both intra- and interdisciplinary work groups. With the Joint Commission's requirement, a zero tolerance environment for abusive forms of communication and behavior now exists. While these forms of unacceptable behavior are not expected to disappear overnight, it is evident that everyone has a responsibility to ensure that they are addressed and dealt with when they occur in the practice environment. There is a history of tolerance and indifference to disruptive and intimidating behaviors in health care settings. The causal factors can be both individual and environmental. If these types of behaviors are not addressed, they come to be viewed as acceptable. Practice environments are characterized as high stakes, high stress, demanding places to work. Cost containment and fear of litigation are examples of ever-present forces. In addition, these environments are embedded with hierarchies. Factors such as these can strain the development of trust and effective communication among work groups. It is human nature to be reluctant to confront intimidating behavior. This, coupled with fear of retaliation, often contributes to underreporting or not dealing with root causes of the behavior. The Institute of Medicine studies have identified the need for health care organizations to create work environments in which communication flows freely and respectfully. This is essential for working cultures in which everyone has the responsibility to communicate concerns about potentially unsafe situations that can result in adverse events ( Kohn, Corrigan, & Donaldson, 2000 ). In effective safety cultures, patterns of communication are not hierarchical or influenced by dynamics of real or perceived power. Communication patterns with steep authority gradients can result in unquestioning compliance with directives and disincentives to question or challenge a situation that has potential for harm or errors to occur ( Page, 2004 ). The effects of disruptive behavior among health care providers have been well documented. They have been shown to contribute to medical errors, preventable adverse outcomes, and staff and patient dissatisfaction ( Rosenstein & O'Daniel, 2005 ). Evidence exists that employees who are verbally abused are more likely to have low job satisfaction and morale. …