A Better Strategy for Dealing with Bad Physicians

While HR handles most personnel issues in hospitals, the use of professionalism committees is on the rise. Staffed by physicians, they confront peers who are exhibiting disruptive behavior and they provide counseling.

As a human resources professional, have you ever felt like there's a cultural gap between your team and the clinicians employed by your organization? Perhaps you've felt you're not the right person to speak directly with a physician known for being nasty or with the too-casual resident who fails to respond to pages?

If so, you're not alone. The sentiment that the cultural chasm between HR and physicians might be a bit too hard to cross is becoming increasingly recognized and understood by both parties.

"There are some things human resources are good at, but, regarding professionalism, I think a peer-to-peer, physician-to-physician conversation is what's needed. It's complicated to talk to a physician about unprofessional behavior," says Daniel Wolfson, Executive Vice President and Chief Operating Officer of the American Board of Internal Medicine Foundation, an organization with a dedicated mission to spread professionalism among medical staff. 

While HR handles most personnel issues in hospitals, a small-yet-growing number of organizations have been developing professionalism committees. These are groups outside of human resources that confront physicians who are exhibiting disruptive behavior, provide counseling, and follow up on the issue to ensure things have been remedied. Members of these committees are often physicians.

For Physicians, By Physicians
"I absolutely one hundred percent agree [that feedback from fellow physicians is more impactful]," says Pamela Galowitz, program manager at the Center for Professionalism & Peer Support at Brigham and Women's hospital in Boston. "Other physicians understand the pressures, the dynamic on the team, the responsibility that falls on their shoulders."

"HR is about rules," Lee Fleisher, chair of both the department of Anesthesiology and the department of professional liability and University of Pennsylvania told me. "The professionalism committee is about changing behaviors and determining if those behaviors can be changed."

Another advantage of having a professionalism committee that is run by physicians is that it is an opportunity for medical professionals to regulate themselves. "If you can't self-regulate, you're in peril of being regulated, whether by state licensing boards, the government, or another entity," says Wolfson.

Fleisher agrees, and adds that it is very powerful as a profession to decide together that certain behaviors are not acceptable. "Behaviors that were acceptable 20 years ago are no longer acceptable," he says.

The medical community has come to accept that disruptive behavior—including yelling, demeaning others, lack of boundaries or other unprofessional actions within the hospital setting, whether toward patients, nurses, support staff or other doctors is unacceptable," says Fleisher. He points out that making coworkers uncomfortable creates an uncommunicative atmosphere where people are afraid to work together.

Peer-to-Peer Feedback
Galowitz describes her committee's procedures for providing feedback to a disruptive physician as follows:

"We work with the doctor, trying to understand their frame of mind. One common response we hear from physicians is that they feel they have to behave in an assertive way because they're protecting their patient, and they mistakenly believe that the best way to do it is to be aggressive or yell."

In this situation, her team explains to the physician that this behavior undermines patient safety. "This is not helping your patients, not reaching the goals you think it's reaching," Galowitz would tell them.

The next stage is to monitor the employee to ensure that they got the message. "Sometimes, more senior physicians are brought into the conversation," Galowitz added. Other times, they organize meetings with behavior coaches who can help them understand the root of their behaviors and how to change them.

Occasionally, they also introduce the offending physician to an employment lawyer. "They'll let the physician know they can keep doing this if they want, but there can be real legal consequences for these behaviors," said Galowitz.

Galowitz says her team receives a wide range of responses when physicians are confronted about their behavior. Sometimes, the physician doesn't realize they're behaving inappropriately, or they're frustrated and feel like things being done correctly, and that being insensitive and yelling is the only way to make the urgency of the situation known.

University of Pennsylvania's Fleisher agrees. "I think one of the most important questions is, 'are these bad people? Or is this a system or a culture that allows bad behaviors to occur that, with proper training and education, would disappear?

"We assume that these are not bad people," he says.

Not the Place for Human Resources
"I think in terms of coaching or mentoring, it's far more beneficial to have physicians work with physicians. Regarding professional issues, I'm quite certain that physicians will respond in virtually every case better to other physicians than they will to 'civilians,'" says Ken Hertz, principal at MGMA Healthcare Consulting Group, a healthcare management consultancy.

"Effectively, HR does not have a major role in this," Fleisher said. Professionalism committees, teams and groups are for physicians, by physicians. "This is really medicine policing itself… It's much more powerful to have colleagues talk to you about your behavior and create a plan to help modify your behavior than have a non-colleague create rules."

It's time for human resources professionals to realize that there are certain personnel processes HR should not have complete control over. HR's proper role is to step in if the professionalism committee can't handle its physicians. HR should ultimately be working to promote a strong culture to promote the values of its organization, but let the committee take the first crack at managing its people.

"What's most important is a consistent culture and consistent values within an organization, whether you're a receptionist, or a physician, or a CEO," Hertz says.