Research Results About Leaders’ Ability to Address Disruptive Behaviors

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Disruptive BehaviorsWhile most healthcare leaders deal with disruptive behaviors in the workplace daily and understand the angst this causes them and their teams, many are unaware of the tremendous impact to patient safety, the patient experience, team performance, and the bottom line. Numerous studies show the deleterious effects disruptive behaviors in the workplace have on employee morale, turnover and a high rate of medical error and adverse patient outcomes (The Joint Commission, (2008, 2016).


  • Healthcare organizations spend between $30,000 and $100,000 per year for every employee who experiences workplace violence in the form of bullying and incivility (P. Lewis & Malecha, 2011, p. 41).
  • A related study showed that for each percentage point increase in nurse turnover annually, costs to the healthcare system are $373,200 (NSI Nursing Solutions, 2016, p. 1).
  • In a study in 102 hospitals with 4,530 participants, 67% agreed that intimidating behaviors were linked with adverse effects including 27% stating this resulted in a patient’s death (Rosenstein & O’Daniel, 2008).

The evidence is clear. When disruptive behaviors go unaddressed in healthcare, bad things happen to patients and employees.

Therefore, healthcare organizations have an ethical responsibility to their patients and a financial responsibility to their organization to do something about disruptive behaviors in the workplace.

The questions are…

Who is ultimately responsible? What do you do and where do you start?

At the Healthy Workforce Institute, an organization dedicated to eradicating bullying and incivility in healthcare, we have had 30 years of experience in understanding who is responsible, what to do, and where to start.

Who is responsible?

Front line leaders are ultimately responsible for addressing disruptive behaviors in their departments.  Unfortunately, they do not always understand how to deal with the incivility and bullying of their employees, especially the employees who are so clinically competent. Therefore, they often do what’s comfortable – they do nothing.  As a result, they are hemorrhaging great employees, losing valuable time and financial resources, and harming the very patients they’re serving.

Healthcare organizations can no longer afford to use silence as a strategy.

What do you do?

You equip your front-line leaders with the skills, tools, and support they need to address disruptive behaviors and hold their employees accountable for professional conduct.

How do you equip your leaders?

You equip your leaders by giving them essential skills they need to eradicate bullying and incivility in their departments.

Introducing, Eradicating Bullying & Incivility: Essential Skills for Healthcare Leaders

To equip leaders, the Healthy Workforce Institute (HWI) developed an online virtual learning program designed to equip front line leaders with the skills and tools they need to set behavioral expectations and hold their employees accountable for professional conduct.

What leaders learn

Leaders begin the course by taking a baseline assessment based on five critical categories.  This information helps leaders determine their current understanding of disruptive behaviors and the degree to which they are incorporating healthy workforce best practices into their department culture. The baseline also helps assess effectiveness from pre- to post-baseline.

There are 5 modules in this course:

  1. Getting Clear on Bullying Behavior
  2. Recognizing Disruptive Behaviors
  3. Setting Behavioral Expectations
  4. Confronting Disruptive Behaviors
  5. Holding Employees Accountable

Each of the five modules included in the course contain interactive audio-visual lessons, action guides, and resources.  Leaders engage in monthly live Q & A calls with other leaders from across the country, receive personalized coaching from Dr. Renee Thompson, CEO and Founder of the Healthy Workforce Institute, and receive ongoing resources with practical tips they can use immediately to begin making positive changes!

To wrap up the program, leaders will retake the Healthy Workforce Assessment and compare their new score with the preassessment results and receive a certificate of completion.

And the results are in!

Of the 430 leaders who have enrolled in the EBI course and completed both pre- and post-tests, results showed marked improvement in all critical categories!

Quantitative Findings About Disruptive Behaviors

In the pre- and post-assessments, leaders answer four questions per each of the five content categories (total of 20 questions with a maximum of 200 points).

Overall, leaders who completed the course experienced a 62% improvement.

Of the five content categories included in the course, leaders experienced the following improvements:

Getting Clear on Bullying67% improvement in comprehension of what bullying really is. This means that the leaders who took the EBI course now understand the essentials of bullying and incivility. They learned why bullying continues and can clearly articulate what bullying is and what it is not.

Recognizing Disruptive Behavior57% improvement in the ability to recognize disruptive behavior. These leaders now more readily recognize common overt and covert behaviors.  They can define the characteristics of bullying behavior in the workplace, identify the most common themes experienced in healthcare, and describe the impact and costs of inaction to individuals, the organization, and patients.

Setting Behavioral Expectations – 55% improvement in how to set behavioral expectations.  The leaders have learned how to establish department norms with current and new staff and begin the process of identifying consequences.

Confronting Disruptive Behavior – 55% improvement in confronting bullying behavior, clearly communicating with staff using assertive techniques, and employing powerful scripting techniques.

Holding Employees Accountable – 68% improvement in building strong partnerships with human resources, utilize existing policies and codes of conduct to create a process for handling disruptive incidents and know how to build a case through powerful documentation.

What’s interesting is that the hard data tells us that leaders are not equipped with the skills and tools they need to recognize and confront disruptive behaviors, set clear expectations for professional conduct, and hold employees accountable.

What we heard from the leaders

Overall, the leaders identified the scripting tools, confronting techniques, and strategies to set behavioral expectations as their greatest wins.

Phrases taught such as, “Can I count on you…”  or, “I haven’t witnessed this myself, but I believe it to be true” were commonly cited as incredibly helpful.

One leader wrote, “I am not scared to address it now. I no longer just sweep it under the rug.”

“This course has taught me to critically look at behaviors and not just rationalize, ‘oh that’s just _____’.”


When leaders are equipped to address disruptive behaviors, the good employees stay, patients achieve better outcomes, and resources are preserved. Results clearly demonstrated that by heightening awareness of behaviors that undermine a culture of safety, equipping leaders with the skills needed to set behavioral expectations and hold employees accountable, leaders created and sustained a healthy, professional, and respectful workforce culture.  These beneficial actions resulted in retention of staff, improved patient outcomes, and healthier bottom lines.  Best of all, there are tangible improvements in staff interactions.

Contact us at [email protected] to find out how you can gift this program to your frontline leaders.

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