Sandra L. Frazier, MD

UABHS Physician Health Officer

DEALING WITH DISRUPTIVE

FACULTY BEHAVIOR

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

“Surgeon Arrested After Throwing Fit”

OBJECTIVES1. 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

Measure performance

Set and communicate expectations

Appoint excellent faculty/staff

2

1

Sheff, MD and Sagin, MD

3

Provide feedback4

5 Manageperformance

6 TakeCorrective Action

THE PYRAMID

APPROACH

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. Owns responsibility for behavior

b. Commits to improve it

c. 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

Refer to policy

Deflect excuses

Constantly refer to data

Be persistent

Keep time limited

Close with faculty commitment

Explain documentation procedure

2 FORMULAS

I. F – State FactsI - State ImpactR - Give RespectR – Make Request

II. U - Understand other’s point of view 1st

S - State your SituationA - Alternative Action

Resources

a. professional assessment

b. human resources

c. legal/administrative counsel

d. educational materials

PHYSICIAN RESOURCE OFFICE

Assessment/ Counseling/

Consultation

Referral Assistance/Monitoring

Education/ Prevention/ Workshops

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 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

Planned Implementation

Compliance Monitoring

Non Retaliation Provisions

Code Enforcement

Resources/Options

Oversight Committee

Preventive Strategies

A faculty member constantly interrupts you during meetings and openly criticizes your suggestions.

• How would you handle this?

Case 1

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?