Disruptive clinician behaviours in healthcare: prevalence, impact and strategies for cultural reform

Zayed Alnefaie; Sadeen Fadhlalmwla; Rawan N. Obaid; Ghaida O. Alsharif

doi:10.18203/2394-6040.ijcmph20260717

Authors

Zayed Alnefaie Department of Anatomy and Embryology and Genetics, Al Rayan National Colleges, Saudi Arabia
Sadeen Fadhlalmwla Department of Anatomy and Embryology and Genetics, Al Rayan National Colleges, Saudi Arabia
Rawan N. Obaid Department of Anatomy and Embryology and Genetics, Al Rayan National Colleges, Saudi Arabia
Ghaida O. Alsharif Department of Anatomy and Embryology and Genetics, Al Rayan National Colleges, Saudi Arabia

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20260717

Keywords:

Disruptive behavior, Patient safety, Community medicine, Medical workforce, Healthcare culture, Workplace incivility

Abstract

Disruptive clinician behavior (DCB)—ranging from incivility to overt aggression—undermines team dynamics, clinician well-being, and patient safety, particularly in community healthcare systems where resources and oversight may be limited. This narrative review synthesizes evidence from peer-reviewed and gray literature published between January 2013 and June 2024, focusing on the prevalence, typologies, drivers, and institutional responses to DCB, with special attention to its impact in community-based settings and broader public health implications. Using sources from PubMed, Scopus, and Google Scholar, and search terms such as “disruptive behavior,” “workplace incivility,” “medical bullying,” and “patient safety,” eligible studies included hospital and community healthcare workers, trainees, and medical students. Findings reveal DCB is highly prevalent and disproportionately affects junior staff and women, driven by factors such as hierarchical power imbalances, inadequate institutional oversight, cultural permissiveness, and reporting barriers. The consequences are far-reaching, ranging from increased burnout and reduced clinical performance to weakened team cohesion. Effective interventions include peer-support programs, simulation-based professionalism training, and leadership-led cultural reform. Addressing DCB demands systemic change grounded in psychological safety, policy clarity, and leadership accountability, with these principles integrated into medical education and community health governance to foster safer, more equitable healthcare environments.

Metrics

Metrics Loading ...

References

Villafranca A, Hamlin C, Enns S, Jacobsohn E. Disruptive behaviour in the perioperative setting: a contemporary review. Can J Anaesth. 2017;64(2):128-40. DOI: https://doi.org/10.1007/s12630-016-0784-x

Rosenstein AH, O’Daniel M. A survey of the impact of disruptive behaviors and communication defects on patient safety. Jt Comm J Qual Patient Saf. 2008;34(8):464-71. DOI: https://doi.org/10.1016/S1553-7250(08)34058-6

Urwin R, Pavithra A, McMullan RD, Churruca K, Loh E, Moore C, et al. Hospital staff reports of coworker positive and unprofessional behaviours across eight hospitals: who reports what about whom? BMJ Open Qual. 2023;12(4):e002413. DOI: https://doi.org/10.1136/bmjoq-2023-002413

Dabekaussen KFAA, Scheepers RA, Heineman E, Haber AL, Lombarts KMJMH, Jaarsma DADC, et al. Health care professionals’ perceptions of unprofessional behaviour in the clinical workplace. PLoS One. 2023;18(1):e0280444. DOI: https://doi.org/10.1371/journal.pone.0280444

Westbrook JI, Urwin R, McMullan R, Badgery-Parker T, Pavithra A, Churruca K, et al. Evaluation of a culture change program to reduce unprofessional behaviours by hospital co-workers in Australian hospitals. BMC Health Serv Res. 2024;24(1):722. DOI: https://doi.org/10.1186/s12913-024-11171-0

Keller S, Tschan F, Semmer NK, Timm-Holzer E, Zimmermann J, Candinas D, et al. “Disruptive behavior” in the operating room: a prospective observational study of triggers and effects of tense communication episodes in surgical teams. PLoS One. 2019;14(12):e0226437. DOI: https://doi.org/10.1371/journal.pone.0226437

Cooper WO, Hickson GB, Dmochowski RR, Domenico HJ, Barr FE, Emory CL, et al. Physician specialty differences in unprofessional behaviors observed and reported by coworkers. JAMA Netw Open. 2024;7(6):e2415331. DOI: https://doi.org/10.1001/jamanetworkopen.2024.15331

Tricco AC, Rios P, Zarin W, Cardoso R, Diaz S, Nincic V, et al. Prevention and management of unprofessional behaviour among adults in the workplace: a scoping review. PLoS One. 2018;13(7):e0201187. DOI: https://doi.org/10.1371/journal.pone.0201187

Craig LB, Buery-Joyner SD, Bliss S, et al. To the point: gender differences in the obstetrics and gynecology clerkship. Am J Obstet Gynecol. 2018;219(5):430-5. DOI: https://doi.org/10.1016/j.ajog.2018.05.020

Fnais N, Soobiah C, Chen MH, Lillie E, Perrier L, Tashkhandi M, et al. Harassment and discrimination in medical training: a systematic review and meta-analysis. Acad Med. 2014;89(5):817-27. DOI: https://doi.org/10.1097/ACM.0000000000000200

Fujimoto M. Issues and perspectives for the study of disruptive clinician behavior. Cureus. 2024;16(6):e63314. DOI: https://doi.org/10.7759/cureus.63314

Villafranca A, Magid K, Young A, Fast I, Jacobsohn E. Abusive behaviour in Canadian and US operating rooms. Can J Anaesth. 2019;66(7):795-802. DOI: https://doi.org/10.1007/s12630-019-01334-7

Gupta A, Thompson JC, Ringel NE, Kim-Fine S, Ferguson LA, Blank SV, et al. Sexual harassment, abuse, and discrimination in obstetrics and gynecology: a systematic review. JAMA Netw Open. 2024;7(5):e2410706. DOI: https://doi.org/10.1001/jamanetworkopen.2024.10706

Zeidan A, Patel J, Dys G, Dean L, Curt A, Lin MP, et al. “Why bother?”: barriers to reporting gender and sexual harassment in emergency medicine. Acad Emerg Med. 2022;29(9):1067-77. DOI: https://doi.org/10.1111/acem.14544

Australian Salaried Medical Officers Federation. Medical workplace bullying and harassment report. Sydney: ASMOF. 2019. Available at: https://www. asmofnsw.org.au/images/ASMOFNSW/ASMOF%20Sexual%20Harassment%20and%20Gender%20Equity%20Survey-%20DiT%20Report.pdf. Accessed on 20 November 2025.

Liu J, Zhang C, Ye W. Factors influencing nurses’ willingness to report workplace violence: a cross-sectional study in China. J Nurs Manag. 2021;29(7):2110-7.

Klinefelter Z, Hirsh EL, Britt TW, George CL, Sulzbach M, Fowler LA. Shift happens: emergency physician perspectives on fatigue and shift work. Clocks Sleep. 2023;5(2):234-48. DOI: https://doi.org/10.3390/clockssleep5020019

Hickson GB, Pichert JW, Webb LE, Gabbe SG. A complementary approach to promoting professionalism: identifying, measuring, and addressing unprofessional behaviors. Acad Med. 2007;82(11):1040-8. DOI: https://doi.org/10.1097/ACM.0b013e31815761ee

Martinez W, Lehmann LS, Thomas EJ, Etchegaray JM, Shelburne JT, Hickson GB, et al. Speaking up about traditional and professionalism-related patient safety threats: a national survey of interns and residents. BMJ Qual Saf. 2017;26(11):869-80. DOI: https://doi.org/10.1136/bmjqs-2016-006284

Shapiro J, Whittemore A, Tsen LC. Instituting a culture of professionalism: the establishment of a Center for Professionalism and Peer Support. Jt Comm J Qual Patient Saf. 2014;40(4):168-77. DOI: https://doi.org/10.1016/S1553-7250(14)40022-9

Leape LL, Shore MF, Dienstag JL, Mayer RJ, Edgman-Levitan S, Meyer GS, et al. Perspective: a culture of respect, part 2: creating a culture of respect. Acad Med. 2012;87(7):853-8. DOI: https://doi.org/10.1097/ACM.0b013e3182583536

Upstate University Hospital. U-TURN conflict resolution tool: staff training manual. Syracuse (NY): Upstate University Hospital. 2020. Available at: https://www.upstate.edu/hr/document/whitepaper_u_turn_model_january_2023.pdf. Accessed on 20 November 2025.

Berger JT. Can institutional policies on professionalism improve the quality of care? Am J Bioeth. 2014;14(12):17-24.