Transcript DEALING WITH DR. DIFFICULT

DEALING WITH
DISRUPTIVE
FACULTY
BEHAVIOR
Sandra L. Frazier, MD
UABHS Physician Health Officer
“Surgeon Arrested After Throwing Fit”
Oakland, CA March 26, 2006
A neurosurgeon was wrestled to the floor by
sheriff’s deputies outside the operating room
after he threw a fit because he had to wait for
instruments to be sterilized, authorities say.
USAToday.com
OBJECTIVES
1.
to explore the impact of and possible
causes of difficult behavior
2.
to describe the process of intervention
3.
to identify resources to assist in
managing challenging faculty
4.
to discuss possible prevention/proactive
strategies
THE
PYRAMID
APPROACH
6
5
Take
Corrective
Action
Manage
performance
4
Provide feedback
3
2
1
Measure performance
Set and communicate expectations
Appoint excellent faculty/staff
Sheff, MD and Sagin, MD
DISRUPTIVE BEHAVIOR

“personal conduct, whether verbal or
physical, that negatively affects or that
potentially may negatively affect patient
care”.
EXAMPLES OF
UNACCEPTABLE BEHAVIOR







Profane/disrespectful language
Outbursts of rage
Racial or ethnic jokes
Demeaning/intimidating behavior
Sexual comments or innuendo
Throwing objects
Criticizing other professionals in public
UAB
Code of Conduct for
Professional Behavior
2004 SURVEY

>95% of physician execs encounter
disruptive behavior on a regular basis

Of the 1600 respondents, 1 in 3 said they
observe problems with physician
behavior either weekly (14%) or monthly
(18%)

Weber, D.O. (2004) Poll Results: Doctors’ disruptive
behavior disturbs physician leaders. The Physician
Executive, 30, 4, 6-10
IMPACT

Affects patient care and safety

Disrupts facility operations

Creates hostile work environment

Lowers community’s confidence
WHY ARE SOME FACULTY
CHALLENGING?

System level issues

Personality Issues

Lack of Skills

Medical/Mental Illness

Work Stress Syndromes
Remember:
Difficult docs are often docs in difficulty
WHAT CAN WE DO?

Undertake a cultural transformation

Devote adequate time/resources

Provide extensive education/training

Develop thorough policies/bylaws

Enforce policies
INTERVENTION
Goal is to ensure that faculty

a.
b.
c.

Owns responsibility for behavior
Commits to improve it
Takes active steps
Schedule follow up visit
ESCALATING INTERVENTIONS
Collegial
“doc in the box”
PLANNING THE
INTERVENTION

Who?
1-2 people

Where? Private setting

When? As close to event as possible

What are faculty’s likely responses?

What is plan B?

How will you monitor any changes?
PRACTICE THE
INTERVENTION

Identify the
problem behavior

Be persistent

Refer to policy

Keep time limited

Deflect excuses

Close with faculty
commitment

Constantly refer
to data

Explain documentation
procedure
2 FORMULAS
I.
II.
F–
IRR–
State Facts
State Impact
Give Respect
Make Request
USA-
Understand other’s point of view 1st
State your Situation
Alternative Action
Resources
a. professional assessment
b. human resources
c. legal/administrative counsel
d. educational materials
PHYSICIAN RESOURCE OFFICE
Education/
Prevention/
Workshops
Assessment/
Counseling/
Consultation
Referral
Assistance/
Monitoring
UAB Highlands
930-7680
RESOURCES AVAILABLE
THROUGH HR

HR Relations – consultation, policy
interpretation

Dr. Pam Burks – facilitated conversations

The Resource Center – free, confidential
counseling for faculty and their family
members
LEGAL COUNSEL
Educational Materials
1.
Difficult Conversations, by Douglas
Stone, et al
2.
Crucial Conversations, by Kerry
Patterson, et al
3.
Dealing With Different, Diverse, and
Difficult People, -audio series, by
Barbara Braunstein
Possible Recommendations

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Individual counseling/coaching
Educational event/workshop
Workplace “monitor”
Regular feedback meetings
360° surveys for all faculty
Psychological testing
Inpatient evaluation
Corrective action
PREVENTION/PROACTIVE
STRATEGIES

New faculty orientation

Educate regarding Code of Conduct

Annual performance evaluation

360° feedback surveys

Clearly communicate goals/expectations
for Dept/Div/faculty member
Be consistent
IN SUMMARY

Universal Code of
Conduct

Code Enforcement

Planned
Implementation

Resources/Options

Compliance
Monitoring

Oversight Committee
Non Retaliation
Provisions

Preventive
Strategies

Case 1
A faculty member constantly
interrupts you during meetings and
openly criticizes your suggestions.
•
How would you handle this?
Case 2
QZ has been a productive faculty
member in your division for 5 years.
However you have received
numerous complaints from both staff
and patients that he is rude and
demeaning, and the complaints are
increasing.
•
•
What would you do?
Would it make a difference if he is tenured vs
non tenured?