Is Your Institution Doing Enough to Reduce Disruptive Physician Behavior?
Disruptive physicians are staple characters on television shows about the medical field. Some of the most recent T.V. doctors of this vein that come to mind are Dr. Gregory House of House and Dr. Perry Cox of Scrubs. While Dr. House and Dr. Cox present entertaining caricatures of disruptive physician behavior (“DPB”), in “real life” DPB has long presented many significant workplace challenges for health care institutions.
The American Medical Association defines DPB as, “personal conduct, whether verbal or physical, that that negatively affects or that potentially may negatively affect patient care constitutes disruptive behavior.”
In July 2008, The Joint Commission issued a Sentinel Event Alert about DPB noting that, “intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators and mangers to seek new positions in more professional work environments.” To combat DPB and its negative impact on the health care industry, The Joint Commission introduced a new Leadership standard that required hospitals to develop a code of conduct that defines disruptive and inappropriate behaviors as well as a process for managing these behaviors.
While The Joint Commission’s efforts have helped healthcare institutions become more aware of DPB, ten years later, industry consultants observe that many medical professionals remain afraid to report DPB for fear of retaliation. A March 2018 article published in the Journal of Hospital Medicine entitled, “Disruptive Physician Behavior: The Importance of Recognition and Intervention and Its Impact on Patient Safety,” echoes the sentiment that there is more work to be done. Specifically, the article suggests four interventions that hospitals should take to limit disruptive behavior and its attendant potential legal and financial consequences:
Prevent the Behavior. Make physician health and wellness a priority. Encourage physicians to seek professional care for their own health and wellness. If your institution has an employee assistance program, consider hiring a clinician trained in dealing with DPB. Stress the importance of a peaceful and professional work environment.
Build the Right Infrastructure. Create a fair system for reliable reporting and monitoring. Develop a medical staff “Professionalism Committee” tasked with investigating DPB complaints, and making recommendations. Ensure that a system exists for a fair hearing.
Take a Progressive Approach and Be Consistent. Minor incidents should be addressed with verbal coaching in a timely manner. If incidents are more serious or if informal warnings have been provided in the past, institutional progressive discipline policies should be adhered to consistently for all physicians.
Collaborate. Involve counsel, human resources, the office of medical affairs, and the hospital’s medical board when drafting policies and making decisions.