According to a report published in the AMA Journal of Ethics, the number of patients expressing bias toward healthcare workers based on race, ethnicity, gender, sexual orientation, or religion is on the rise. To address and respond to such discrimination, the Mayo Clinic has instituted a Patient and Visitor Conduct Policy that balances the dual needs of providing optimal patient care while maintaining a supportive, respectful workplace for staff.

The Mayo Clinic policy recommends 5 steps for employees to respond to patient or visitor misconduct: (1) step in when you observe behavior that does not align with the organization’s values; (2) acknowledge the inappropriate behavior; (3) focus on the organization’s values and affirm qualifications of all staff; (4) explain the organization’s expectations and set boundaries with the patient or visitor; and (5) report and document any inappropriate behavior using the Patient Misconduct form.

The policy was developed to equip all staff with resources for resolving bias incidents — for example, when a patient requests reassignment based on nonmedical criteria. The policy stipulates that derogatory or abusive behavior by patients or visitors will not be tolerated and that depending on the severity of the situation, such behavior may result in termination of care. The only exception for which a reassignment request may be granted is if the patient is medically unstable or in immediate danger.

Continue Reading

Related Articles

The policy protects the organization from legal liability in instances where a patient’s right to refuse care does not outweigh an employee’s right to work free of discrimination. It further indicates how the policy can be implemented by properly informing and training staff. This includes outlining the policy in all new staff orientations educating employees on their rights and available resources, training staff to distinguish patients’ needs from their preferences, providing a consistent or central mechanism for reporting violations, and championing sustained change in the organization’s culture.

The researchers suggest that the Mayo Clinic policy can serve as a singular model for other healthcare organizations by allowing healthcare workers to address aggressive behaviors by patients or visitors in a way that supports the rights and responsibilities of the staff and their organization.


Warsame RM, Hayes SN. Mayo Clinic’s 5-step policy for responding to bias incidents. AMA J Ethics. 2019;21(6):e521-e529.