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.
- 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