3 Keys to Overcoming Disruptive Physician Behavior
Speaking up, stopping bullies, and considering alternatives to the incident report can help clinicians from different disciplines find common ground.
The following is an excerpt from a guest column by Olivia Loeffler, CPCS, CPMSM, director of medical staff services, Adventist Health Glendale in Glendale, California. It originally appeared on the Credentialing Resource Center, September 27, 2017.
It can be difficult to establish and maintain a healthy esprit de corps between physicians and hospital staff. Some of this difficulty emanates from the structure of independent medical practice in which the physician is accountable to the hospital but, at the same time, is the institution’s partner and key customer. These structural contradictions make it difficult for hospital administrators to set and maintain performance standards for things like medical records, operating room start times, core measures, and—last but not least—professional conduct.
Since we all want to work in a safe and pleasant environment, we must find ways to bring professionals across disciplines together in a productive manner. This begins with clear and enforceable policies that establish proper expectations on both sides of the equation: physicians and hospital staff. Once a policy is in in place, we must take additional steps to ensure its tenets are applied in practice, resulting in healthy interdisciplinary relationships.
At my hospital, the chief nursing officer invited me to present a seminar to the nurses—leaders and bedside clinicians—on how to effectively respond to disruptive physician behavior. The following are three of my top strategies for resolving incidents and strengthening bonds among clinicians, who are, after all, united in their pursuit of quality patient care.
Many incidents involving inappropriate behavior can be managed in the moment when the person being attacked informs the disruptive person that his or her tone is unprofessional or offensive. For instance, if a physician is yelling on the phone, the nurse on the other end of the line might say, “Dr. Smith, your tone is unprofessional and inappropriate. I will end this call unless we can speak professionally. If you need some time and would like to call back later, that will be fine.” Your sense of self-respect is powerful, so use it!
Don’t let yourself (or anyone else) be bullied
This guidance builds on my previous point about speaking up but should be reserved for the tensest situations. If a staff member is being bullied, reinforcements must be accessed immediately. This may include bringing in a supervisor, charge nurse, or on-call administrator. Bullies only succeed when they think no one is watching or no one will care. When they realize that this isn’t the case, they will change their ways or go somewhere else—willingly or otherwise. In my hospital, the only immediate summary suspension in the last five years occurred due to bullying.
Consider a stub-your-toe conversation
This is a chance to address a low-level incident after the fact with the intent of changing behavior and building relationships. During my seminar, I emphasized this approach to our nurse leaders.
Later, one of the directors informed me that she had used the technique to reconcile a conflict between a nurse and a doctor. Although she was very nervous, she calmly approached the doctor in private and informed her what had happened and how it had made the nurse feel. Fortunately, the doctor was unaware of the impact of her actions and was remorseful. She immediately apologized to the nurse, and things got better.
This approach avoided the cold bureaucracy of the incident report and got to the heart of the matter in a way that preserved everyone’s dignity and built trust. This was the ideal approach and outcome for the situation at hand.