Audit concludes Infoway missed program targets.

© 2011 Canadian Medical Association or its licensors CMAJ, May 17, 2011, 183(8) 893 years ago, it began requiring codes of conduct as a condition of hospital accreditation. The codes have to define acceptable, disruptive and inappropriate behaviours, Schyve says, adding that the purpose of such codes is to encourage a culture of safety, where people feel free to report adverse events, close calls, hazards and unsafe conditions. Intimidation in the workplace discourages such reporting. “Specific behaviours can sour the work environment,” says Schyve. “We often use the phrase ‘disruptive behaviors,’ though that is probably not the best phrase. A better one would be ‘intimidating behaviours,’ which keep people from reporting important incidents.” As for criticisms that hospital codes of conduct single out doctors and don’t apply to other medical staff members, that is not the case at all, according to a Joint Commission paper, Behaviors that undermine a culture of safety (www.joint commission.org/sentinel_event_alert_iss ue_40_behaviors_that_undermine_a_cul ture_of_safety/). It notes that although most research in the area has focused on “disruptive behaviors among physicians and nurses, there is evidence that these behaviors occur among other health care professionals, such as pharmacists, therapists, and support staff, as well as among administrators.” Therefore, the Joint Commision suggests that all hospital employees, “both physicians and non-physician staff,” be educated on appropriate professional behaviour as defined in their codes. Furthermore, hospitals should “enforce the code consistently and equitably among all staff regardless of seniority or clinical discipline.” US hospitals can’t be forced to adopt codes of conduct, but without accreditation from The Joint Commission, they can’t receive payments from Medicaid or Medicare, so most do — around 80%, says Schyve. Hospitals are granted latitude in terms of the exact content of their codes, and, for the most part, there have been few complaints about them. “There has been very little negative reaction from hospitals,” says Schyve. Hospitals that adopt codes of conduct should also determine how they will handle cases that violate the code, says Kathryn Clarke, senior communications coordinator for the College of Surgeons of Ontario. “The second part is establishing a protocol so that if the code of conduct is breached, you know how people will be treated.” The best way to handle incidents is to intervene early, identify the people involved and the alleged violations, and then resolve the issue before it escalates, according to the college’s guidebook for managing disruptive physician behaviour (www.cpso.on.ca/policies /positions/default.aspx?id=1730). There is nothing unusual, adds Clarke, about employers clearly defining the expectations they have for their employees. “Codes of conduct are not unique to hospital settings,” says Clarke. “It’s a universal principal. You set expectations for people in advance, and you implement a fair process for dealing with concerns as they come up.” — Roger Collier, CMAJ