Healthcare organizations are working to both discipline and reform physicians who display disruptive behavior. The process requires leaders to strike a tricky balance between "managing disruptive behavior" and "caring for and protecting the victims," says one expert.
A physician shoving a colleague in the operating room? A doctor yelling at a nurse, resulting in patient harm?
Two years ago, reports of those incidents were included in an American College of Physician Executives' study on disruptive physician behavior [PDF], which revealed that more than 2 out of 3 doctors witness other physicians disrupting patient care or collegial relationships at least once a month.
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"Disruptive physician behavior is the issue that just won't go away," Barry Silbaugh, MD, of the ACPE said in a statement after that report was released. Indeed, it doesn't.
Just this week, the Robert Wood Johnson Foundation released a report linking physician verbal abuse of nurses to nurses' low opinion of their work environments. As one of the co-authors noted, "Physicians' verbal abuse of nurses is a long-standing problem and one we need to do much more to address."
Indeed, disruptive behavior can be wide-ranging in its scope, ranging from verbal abuse to physical or sexual harassment, to confrontations or conflicts that cause significant fallout. When physicians are disruptive, disciplinary action may follow.
Sometimes, the situation is hopeless, and a know-it-all, bombastic physician won't try to change his attitude and outbursts. In those cases, the doctor has to be dismissed. But other physicians who act in a disruptive way may recognize trouble with their own behavior, have a desire to improve, and make a commitment to work vigorously for change.
That's why it is important to examine the root causes of disruptive behavior, understand the culture of medicine, and develop programs that could rehabilitate physicians from an organizational and individual perspective, says Hardley Paolini, PhD, LP, a licensed psychologist and director for Physician Support Services at Florida Hospital in Orlando.
Hospitals straddle the line in determining which physicians must be ousted after failing to respond to disciplinary action, and identifying those who can be rehabilitated. Making inroads in this improvement process can be a sensitive balancing act.
Too often, Paolini says, healthcare has not kept up to the challenge of disruptive physicians. "We have not trained our physicians for the resiliency they need, for the teamwork they need right now. When you see 40 to 60% of burned-out physicians, you are going to see some of these behaviors come out not only in depression, but also in aggression," she says.
It's important for hospitals and physician groups to address disruptive behavior when it first appears, by not making excuses for "high performers and politically protected employees who harm others," says William "Marty" Martin, PsD, MS, MPH, PsyD, CHES, director and associate professor at DePaul University in Chicago and a former member of the American College of Physician Executives faculty.
Healthcare organizations must deal with the issues incrementally, from the first "cup of coffee," trying to understand the issue when discussing it with a physician, Martin says. If the issue recurs, a peer review may be needed, and possibly followed by disciplinary action.
"You have to make it a bit more formal. You have to put on your risk management hat because you don't want to railroad that particular physician, but you do want to balance what's good for the organization and what's good for the individual. "That includes, of course, discussions with someone who may have filed a complaint.
Hospitals must strike the balance of "managing disruptive behavior" and "caring for and protecting the victims," he says. At Florida Hospital, physicians who engage in disruptive behavior have a chance to retain their positions, depending on the circumstances.
Over the last decade, the hospital has intervened with at least 1,000 physicians and their family members. At least 100 physicians who may have lost their positions were able to keep their jobs because of the hospital's intervention services, Paolini says.
Those services include counseling, psychotherapy, wellness programs, and a safe harbor reporting system. Among their techniques is having counseling staff "embedded" with the physicians, coaching them toward improvements in relationships with other staffers. "We rub shoulders with them, "she says. "We have a comprehensive approach."
The hospital also conducts retreats for the doctors. "We take them out of town and address the whole burnout issue. We examine where the gaps are. We've been very proactive about it," says Paolini, who is also author of a book on the issue.
The hospital has been successful in helping physicians. But not everyone. For some of those, "if it's broken, it can't be fixed. And when that happens, you know," Paolini says.
Next week, this column will examine the issue of disruptive patients.
To learn more about disruptive physicians, join the HealthLeaders Media webcast, Reining in Disruptive Docs, Strategies to Manage Risk and Reduce Turnover on Tuesday, August 27, 2013, at 1:00 – 2:30 PM ET with William "Marty" Martin, MA, MS, MPH, PsyD, CHES and Herdley O. Paolini, PhD, LP.
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
