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Document Disruptive Behavior

John Commins, for HealthLeaders Media, October 2, 2009

Disruptive employees aren't commonplace in most healthcare settings. But they aren't so rare that you shouldn't have a plan in place for how to deal with them. Unfortunately, that's a message a lot of medical groups and hospitals aren't getting.

"Many practices do not have formal employee personnel policy and procedure manuals," says John McDaniel of New Orleans-based consultancy Peak Performance Physicians, LLC.

"Even if they have some simple policies and procedures, they usually only relate to things like sick time, vacations, and holidays," McDaniel says. "In a large percentage of cases, they do not spell out a disciplinary process or how an employee grievance process should be conducted. That is what usually gets them in trouble."

Mary J. Witt, vice president of The Camden Group, a consulting firm in El Segundo, CA, says it's more effective to deal with disruptive behavior proactively—before it starts—but that's difficult if your organization doesn't have a code of conduct in place.

"One of the biggest problems I find when I go into practices is there are not measurable performance standards established for the various functions in the practice," Witt says. "Then it becomes difficult to hold staff or physicians accountable because you haven't clearly defined your expectations for good behavior and good performance."

Once you've established a code of conduct, and employees understand your expectations, "it is easier to come back and have discussions with the employee about what is not working," Witt says. "You've set the stage for what the expectations are. You've helped them clearly understand by your definition and performance standards what is expected, so it becomes easier to have that conversation."

Three types of disruptive behavior
Peak Performance Physicians breaks down disruptive behavior into three categories:

  • Group 1 is the garden-variety rudeness or yelling at physicians, patients, or fellow staff; a breach of confidentiality; or a failure to follow dress codes, which can usually be resolved with a quick corrective chat identifying the problem, a reminder of practice policies, and documentation that the event occurred.
  • Group 2 disruptive behavior would include ongoing problems that have been previously identified and addressed, but not rectified, along with issues like failing to complete assigned tasks.
  • Group 3 behaviors are usually severe, and could warrant immediate termination for offenses, such as embezzling or other theft of medications or equipment, or flagrant and consistent abuse or sexual harassment.

Except in the most extreme instances that warrant immediate termination, your physician practice should follow the same guidelines for every situation that requires an intervention, McDaniel says.

"The first step would be a verbal and or written reprimand. Even if it is verbal, notes need to be taken, it needs to be in writing, and both parties should sign it," McDaniel says. "If there is not improvement, the second step would be a probationary period—one more chance—in writing and dated. The third step is termination. It's a formal documented process."

When it comes to addressing disruptive behavior, Witt has three rules: "Document, document, document."

"That means that you have documented all along that you have spoken with the employee, you've told them what the problem was, and you've given them the opportunity to correct it. You have to make sure the documentation is there."

The signed documentation doesn't have to mean that the employee agrees with the corrective action, only that that he or she has been notified about it.

Witt also recommends having employees sign job description and code of conduct forms. "That way, I know they've gotten it and it is their responsibility to read it and understand it," she says.

Address disruptive behavior immediately. "You don't want to ignore those issues and then suddenly take them up six months after they happen," Witt says. "If a problem occurs, you want to immediately address that with the employee. Set for them what the expected behavior is so they clearly understand what is expected of them."

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