Behavioral Health Enterprise Risk Management (ERM) Operational Patient Safety/Clinical Care

Reducing Violence Potential with a Patients’ Code of Conduct

Threats and acts of violence have continued to escalate in health care organizations and physician practices across the nation[i]. The following are recommendations and methods for reducing aggressive behavior in the physician practice setting.


  1. Set the standard for behavior with the first visit. When introducing your practice to new patients, also outline how they can address their complaints, what behaviors are expected in the waiting rooms, how you expect them to speak to your staff, what is considered problematic behavior for your specialty and what patients can do if they feel they have not been heard.
  2. Encourage your team members to communicate to each other using an internal incident reporting system any problematic behavior or issues they are having with a patient/family member.
  3. Ensure all staff members know that the organization is interested in hearing about what they experience in the everyday practice setting. Patients seem to be more likely to be hostile, demeaning and aggressive with staff while less likely to direct this behavior against the physician first. Again, create an environment where staff have a mechanism for notifying the physician and practice leadership of a behavior concern.
  4. Ensure that all aggressive events, whether happening on the phone or in your physical office, are documented in the medical record. Don’t stop there – also document what the practice and team did about it.
  5. Consider having your medical malpractice insurance company conduct training.
  6. Post notices, fliers or signage that aggressive actions against staff or acting out behavior will not be tolerated. An example of signage could be:  

“Our practice follows a zero-tolerance policy for aggressive behavior directed by patients/visitors against our staff.”

Consider having a Code of Conduct for your patients to sign. Such as the following:


SAMPLE Code of Conduct for Patients

To provide a safe and healthy environment for staff, visitors, patients and their families, Name of Health Center expects visitors, patients and accompanying family members to refrain from unacceptable behaviors that are disruptive or pose a threat to the rights or safety of other patients and staff.

As a patient visiting our practice, please consider the following:

  • If you have any questions about the care or our unhappy with the service received in our office, please contact our practice manager before you leave our office so that any clarifications about your care or the services you received can be addressed.
  • Please communicate all issues that you wish to discuss with the doctor at the time your appointment is scheduled, so that an appropriate amount of time can be allotted. If you do not do this in advance, another visit may be necessary so that the doctor can give all patients the time and quality of care they deserve.
  • Questions about your billing can be addressed [insert process here].
  • Our practice follows a zero-tolerance policy for aggressive behavior directed by patients against our staff.
  • Please be courteous with the use of your cell phone and other electronic devices. When interacting with any of our staff, please put your devices away. Set the ringer to vibrate before storing away.
  • Adults are expected to supervise their children. 

The following behaviors are prohibited:  

• Possessing firearms or any weapon

• Intimidating or harassing staff or other patients

• Making threats of violence through phone calls, letters, voicemail, email or other forms of written, verbal or electronic communication

• Physically assaulting or threatening to inflict bodily harm

• Making verbal threats to harm another individual or destroy property

• Damaging business equipment or property

• Making menacing or derogatory gestures

• Making racial or cultural slurs or other derogatory remarks

If you are subjected to any of these behaviors or witness inappropriate behavior, please report to any staff member. Violators are subject to removal from the facility and/or discharge from the practice.

[Consider adding a signature/date/witness line here]


1 Finnegan, J. (June 9, 2017). Fierce Healthcare. Tragedy Averted as police stop terminally ill cancer patient before planned “massacre” of oncologists. Retrieved March 2019.

Joan M. Porcaro, RN, BSN, MM, CPHRM, is a senior risk management consultant.

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