Three Essential Steps To Deal With Disruptive Practitioners

Emily Berry, May 21, 2010

If you still think a practitioner's clinical skills trump interpersonal skills, think again. A poll of medical staff services departments nation-wide revealed that 68% of medical staffs take behavioral evaluations as seriously as clinical evaluations, and exercises disruptive behavior policies as needed.

This is good news for hospitals. Unchecked bad behavior among practitioners can lead to anything from dings on accreditation surveys to costly legal battles with patients.

Medical staffs looking to improve their disruptive behavior policies may use the following three tips as a starting point.

1. Identify the process for handling disruptive behavior. It's essential that medical staffs develop a roadmap for handling a practitioner's disruptive behavior, should it occur. "Our hospital tries to handle it at the lowest level first, with the manager of the department," says Becky Cochran, CPMSM, CPCS, director of medical staff services at San Juan Regional Medical Center in Farmington, NM, and a public member of the New Mexico Medical Board. If the practitioner's disruptive behavior continues after discussing the matter with his or her manager, then the departmental chair is alerted of to the issue.

2. Have a mechanism for tracking and trending behavior. The most challenging disruptive behaviors to discipline are the ones that appear to occur irregularly. For example, if a practitioner is argumentative two days out of every five days he or she works, peers will notice, but they may be hard pressed to give examples in a disciplinary meeting. However, if the medical staff services department tracks such behavior, it can more easily detect a clear pattern of disruptive behavior and address it accordingly.

3. Develop a fast track disciplinary process for egregious behavior. Serious actions call for serious measures. If a practitioner commits an egregious action, such as blatant sexual harassment or physical violence, it would be inappropriate for the medical staff to follow the same process it would for a practitioner with a minor offence, such as being overly sarcastic. At the same time, regulatory standards require hospitals to adhere to their policies. Therefore, the medical staff needs to create a policy with separate pathways for disciplining serious disruptive behavior and minor disruptive behavior.

"Most people's policies say if it's egregious enough, it will go straight to your medical executive committee, and your bylaws will say your chief of staff or the CEO will have the ability and authority to suspend that physician's clinical privileges," says Cochran.

Emily Berry is an associate editor for Briefings on Credentialing and Credentialing Resource Center Connection, and manages the Credentialing Resource Center. You can reach her at
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