Current Trends In Coaching "Disruptive Physicians"

Effective January 1, 2009, The Joint Commission (JCAHO) issued new guidelines to respond to the negative behavior of physicians that often places patient care at risk while increasing medical errors. These new standards made it mandatory for Hospitals to establish written policies designed to address what is defined as "disruptive physician behavior." The following is one definition of what is considered "disruptive behavior":

Disruptive conduct can take many forms. Raised voice, profanity, name-calling, throwing things, abusive treatment of patients or employees, sexual harassment, disruption of meetings, repeated violations of policies or rules, or behavior that disparages or undermines confidence in the Hospital or its staff may be disruptive behavior, although this is not an exhaustive list. Unacceptable disruptive conduct can also include such behavior as:

I.    Attacks (verbal or physical) leveled at others that are personal, irrelevant, or go     beyond the bounds of fair professional comment.

2.     Impertinent and inappropriate comments written or illustrations drawn in patient medical records, or other official documents, impugning the quality of care in the Hospital, or attacking particular practitioners, employees, or Hospital policy.

3.     Non-constructive criticism, addressed to its recipient in such a way as to intimidate, undermine confidence, belittle, or to impute stupidity or incompetence.

4.     Refusal to accept medical staff assignments, or to participate in committee or departmental affairs on anything but his or her own terms or to do so in a disruptive manner.

5.     Imposing idiosyncratic requirements on the Hospital staff that have little impact on improved patient care but serve only to burden employees with "special" techniques and procedures.

When a practitioner's conduct disrupts the operation of the Hospital, it affects the ability of others to get their jobs done, creates a "hostile work environment" for Hospital employees or other practitioners, or begins to interfere with the practitioner's own ability to practice competently, action must be taken. Courts have consistently held that if a practitioner creates disharmony or disruption, the Hospital has a duty to intervene.

In addition to written policy and promotion of these new policy guidelines, physicians who are determined by the appropriate hospital committee or disciplinary unit to be "disruptive" must be mandated to participate in an appropriate intervention to address these issues and acquire appropriate interpersonal skills along with self-control, empathy, self-awareness and other key emotional intelligence skills.

Rarely are these physicians psychiatrically impaired, substance abusers or sexual abusers. Therefore, none of these options are available as resources without specific justification and documentation.
The typical physician referral is a highly skilled surgeon who is accused of throwing an instrument, cursing a staff member, yelling at co-workers or was impatient or discourteous to a patient. Stress is almost always a significant factor in the physicians' behavior.
Resources For "Disruptive Physicians"

Physicians and Healthcare Organizations nationwide are under pressure to find coaching resources for "disruptive physicians." Mandating any physician to participate in an intervention for "disruptive behavior" is difficult for Physician Well-Being Committees, Medical Directors and Hospital Credential Committees as well as State Medical Licensing Boards.

Leaders responsible for managing physicians are willing to look the other way or do almost anything to avoid complying with this new Joint Commission requirement.
By delaying the decision to take action based on a distaste for adversarial tension, pressure begins to mount as the year comes to an end. Many organizations need to show evidence that they are following the Joint Commission Policy relative to mandating assistance for "disruptive physicians".
Two of the three major programs for "disruptive physician behavior" are already filled for 2017. These programs are the Distressed Physician Program at Vanderbilt University School of Medicine at Nashville and the PACE Program at the University of California School of Medicine at San Diego. Both the Vanderbilt Program and the PACE Program only accepts 8 physicians each quarter for its respective classes.

The largest provider of individual coaching for disruptive physicians is Los Angeles based Anderson & Anderson, APC. The uniqueness of the Anderson & Anderson curriculum is that it was specifically designed for "disruptive physicians." The Practice of Control, the client workbook and all of the DVDs, CDs and ancillary training material are carefully designed to improve assertive communication, increase self-awareness, self-perception, social awareness and relationship management and stress management.

Anderson & Anderson has a well trained Certified Coaching Faculty with the capacity to offer the internationally recognized EQ-i-2.0 Emotional Intelligence Assessment and intensive coaching On-site anywhere in the U.S. followed by six months of Aftercare and Post Tests. Emotional Intelligence Classes For The Prevention of "disruptive" Behavior at Work. In order to keep JCAHO accreditation, every hospital now must have a system in place for recognizing and effectively dealing with disruptive physicians — whether they’re on staff or simply have hospital admitting privileges.
In order to minimize the risk of adverse events and malpractice suits, medical groups must have the awareness and skill set to intervene effectively when a colleague or employee first begins behaving unprofessionally.

Organizations that identify and deal with disruptive behaviors and performance problems at the earliest stages can not only save a considerable amount of time and money — but also mitigate risk.
Since Emotional Intelligence is the core of most of the intervention programs for "disruptive behavior," it seems reasonable to offer general courses in emotional intelligence to physicians, nurses and other ancillary staff.

Such courses may focus on leadership, interpersonal relationships, self-control, social awareness, relationship management, stress management, decision -making or any of the many other emotional intelligence scales.

The American Medical Association as well as local medical associations are offering and/or promoting presentations on how to prevent or manage disruptive physician behavior. Kaiser Permanente of Southern California has taking the lead in being proactive in preventing the consequences of "disruptive physician behavior" in hospitals and healthcare organizations.

 George Anderson, MSW, BCD, CAMF, CEAP