Systems approach to address incivility and disruptive behaviors in health-care organizations

Adv Health Care Manag. 2011;10:239-65. doi: 10.1108/s1474-8231(2011)0000010020.


In response to the growing evidence that disruptive behaviors within health-care teams constitute a major threat to the quality of care, the Joint Commission on Accreditation of Healthcare Organization (JCAHO; Joint Commission Resources, 2008) has a new leadership standard that addresses disruptive and inappropriate behaviors effective January 1, 2009. For professionals who work in human resources and organization development, these standards represent a clarion call to design and implement evidence-based interventions to create health-care communities of respectful engagement that have zero tolerance for disruptive, uncivil, and intimidating behaviors by any professional. In this chapter, we will build an evidence-based argument that sustainable change must include organizational, team, and individual strategies across all professionals in the organization. We will then describe an intervention model--Toxic Organization Change System--that has emerged from our own research on toxic behaviors in the workplace (Kusy & Holloway, 2009) and provide examples of specific strategies that we have used to prevent and ameliorate toxic cultures.

MeSH terms

  • Agonistic Behavior*
  • Delivery of Health Care / organization & administration*
  • Delivery of Health Care / standards
  • Guidelines as Topic
  • Hostility*
  • Humans
  • Institutional Management Teams / organization & administration
  • Institutional Management Teams / standards
  • Interprofessional Relations*
  • Joint Commission on Accreditation of Healthcare Organizations
  • Leadership*
  • Organizational Culture
  • Organizational Policy
  • Patient Care Team / organization & administration
  • Patient Care Team / standards
  • Social Dominance
  • United States