Although the negative impact of disruptive clinician behavior on quality health care delivery has gained attention recently, little systematic effort to address this issue has been reported. To facilitate empirical research to reduce disruptive clinician behaviors, an assessment tool (Johns Hopkins Disruptive Clinician Behavior Survey [JH-DCBS]) with 5 discrete subscales was developed using a 2-step design. First a pool of items was generated from focus group studies and the literature, and then a psychometric evaluation of the survey was conducted with a sample of clinicians (N = 1198) practicing in a large urban academic medical center. The results indicated that the tool was reliable (Cronbach α = .79-.91), showed high content validity (Content Validity Index = .97), and had significantly high correlations with theoretically selected variables. The study team concluded that the JH-DCBS provides a valid empirical assessment of disruptive behavior. Assessment results may be used to design strategies to improve the health and safety of practice environments.
HicksonGBPichertJWWebbLEGabbeSG. A complementary approach to promoting professionalism: identifying, measuring, and addressing unprofessional behaviors. Acad Med. 2007;82:1040-1048.
3.
KaplanKMestelPFeldmanDL. Creating a culture of mutual respect. AORN J. 2010;91:495-510.
4.
HollowayEKusyM. Systems approach to address incivility and disruptive behaviors in health-care organizations. Adv Health Care Manag. 2011;10:239-265.
5.
PorathCLPearsonCM. The price of incivility. Harv Bus Rev. 2013;91(1-2):114-121, 146.
6.
RosensteinAHO’DanielM. Impact and implications of disruptive behavior in the perioperative arena. J Am Coll Surg. 2006;203:96-105.
7.
CortinaLMMagleyVJWilliamsJHLanghoutRD. Incivility in the workplace: incidence and impact. J Occup Health Psychol. 2001;6:64-80.
8.
PearsonCPorathCL. On the nature, consequences and remedies of workplace incivility: no time for “nice”? Think again. Acad Manage Exec. 2005;19(1):7-18.
9.
The Joint Commission. Defusing Disruptive Behavior: A Workbook for Healthcare Leaders. Oak Brook, IL: Joint Commission Resources; 2007.
10.
LeapeLLShoreMFDienstagJL. Perspective: a culture of respect, part 1: the nature and causes of disrespectful behavior by physicians. Acad Med. 2012;87:845-852.
CorbinJMStraussAL. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Thousand Oaks, CA: Sage; 2008.
15.
LynnMR. Determination and quantification of content validity. Nurs Res. 1986;35:382-385.
16.
LevineREFowlerFJJrBrownJA. Role of cognitive testing in the development of the CAHPS hospital survey. Health Serv Res. 2005;40(6 pt 2):2037-2056.
17.
WalrathJMDangDNybergD. Hospital RNs’ experience with disruptive behavior: a qualitative study. J Nurs Care Qual. 2010;25:105-116.
18.
NunnallyJCBernsteinIH. Psychometric Theory. 3rd ed.New York, NY: McGraw-Hill; 1994.
19.
WalrathJMDangDNybergD. An organizational assessment of disruptive clinician behavior. Findings and implications. J Nurs Care Qual. 2013;28:110-121.
20.
CarminesECZellerRC. Reliability and Validity Assessment. Beverly Hills, CA: Sage; 1979.
21.
EinarsenSHoelHNotelaersG. Measuring exposure to bullying and harassment at work: validity, factor structure and psychometric properties of the Negative Acts Questionnaire-Revised. Work Stress. 2009;23(1):24-44.
Agency for Healthcare Research and Quality. Patient Safety Primer: Disruptive and Unprofessional Behavior. Rockville, MD: Agency for Healthcare Research and Quality; 2009.
American Medical Association. Report of the Council on Ethical and Judicial Affairs: Physicians with Disruptive Behavior (CEJA Report 2-A-00). Chicago, IL: American Medical Association; 2009.
27.
American Association of Critical Care Nurses. AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence. http://www.aacn.org/WD/HWE/Docs/HWEStandards.pdf. Published 2005. Accessed August 20, 2013.
28.
CroskerryPAbbassAWuAW. Emotional influences in patient safety. J Patient Saf. 2010;6:199-205.
29.
GuidrozAMBurnfield-GeimerJLClarkOSchwetschenauJMJexSM. The nursing incivility scale: development and validation of an occupation-specific measure. J Nurs Meas. 2010;18:176-200.
30.
MartinRJHineDW. Development and validation of the uncivil workplace behavior questionnaire. J Occup Health Psychol. 2005;10:477-490.
31.
HambletonRKSwaminathanHRogersWH. Fundamentals of Item Response Theory. Newbury Park, CA: Sage; 1991.
