DEALING WITH DISRUPTIVE BEHAVIOR:

AN IDEA WHOSE TIME HAS COME

1.Creating a Culture of Safety and Professionalism and Acknowledging the Importance of Appropriate Behavior.

  • Review and specifically consider core competencies of professionalism, interpersonal communication skills, and a systems-based practice at initial appointment and reappointment.
  • Make professional behavior, interpersonal communication skills, and an understanding of systems-based practice part of your OPPE/FPPE process.
  • Commit to not appointing or employing a disruptive practitioner regardless of technical skill or perceived need for that specialty.
  • Educate healthcare professionals on the connection between disruptive behavior and patient safety.

2.Just What Is Disruptive Behavior Anyway?

  • Rude, disrespectful conduct?
  • Racial or ethnic slurs?
  • Physical altercations?
  • Criticisms of the hospital and other physicians?
  • Sarcastic comments?
  • Letters to the editor?
  • Accusations of incompetent care?
  • Threats of litigation?

3.Setting Ground Rules - Components of Code of Conduct Policy.

  • Articulate expectations for acceptable conduct.
  • Allow for broad reporting of concerns about conduct, including from patients and family members.
  • Define who will handle concerns about conduct.
  • Define the process for addressing concerns about conduct.
  • Include non-retaliation provisions.

4.You Have a Code of Conduct, Now What?

  • Education is key to compliance and enforcement.
  • Should hospitals provide training to staff and physicians on professional and acceptable conduct?
  • Let the leaders lead – setting a good example for acceptable conduct.

5.Implementing the Code of Conduct.

  • Are anonymous complaints OK? Should they be encouraged?
  • How do you handle the "He said, she said" situation?
  • Should complaints be destroyed if they are not found to be credible?
  • When do you reveal the source of a complaint?

6.Progressive Steps to Address Disruptive Conduct.

  • Collegial intervention.
  • Letters of guidance/education/warning/reprimand.
  • Referral to MEC.
  • Anger management/behavior modification.
  • Conditional reappointment and Personal Code of Conduct.
  • 360 degree evaluations.
  • Be careful of reacting to the "straw that broke the camel's back."
  • Precautionary Suspension – when is it legally appropriate?

7.Disruptive Physicians Raising Quality Concerns, Now What?

  • Don't ignore quality concerns no matter who raises them – the disruptive practitioner is likely to be the next whistleblower.
  • Indicate appropriate forum and method of delivery.
  • Maintain focus on inappropriate behavior.
  • Review concerns raised and follow up with practitioner as appropriate.

8.Triage Conduct – Potential Impairment or Pattern of Behavior?

  • All problems are not equal.
  • Use physical or mental evaluations for potential impairment, not for behavior.
9.What if the Disruptive Behavior Is Sexual in Nature?
  • Employers have a legal obligation to create a work environment that is free from sexual harassment.
  • Complaints that might constitute sexual harassment must be addressed promptly.
  • Resolution must be designed to stop sexual harassment.

10.Legal Protections Available When a Disruptive Practitioner Sues.

  • Health Care Quality Improvement Act.
  • Peer Review Statutes.
  • Release and immunity in application forms and bylaws.
  • Directors' and Officers' Policy.
  • Indemnification Policy.

External Programs (examples)

PULSE Program -

VanderbiltUniversityCenter for Patient and Professional Advocacy

Physician Assessment and Clinical Education Program (PACE)

HortySpringer Audio Conferences - 1