Healthcare News & Insights

Disruptive physicians hurt morale, patient care

166379409Hopefully, you don’t any have “disruptive physicians” in your hospital. But chances are good that if you surveyed the medical professionals in your facility, most of them would report having experience with such doctors behaving badly. 

In fact, a recent report in The Journal of the American Medical Association (JAMA) mentioned that there’s a perception in the industry that the problem is increasing.

Why it’s increasing isn’t clear. It could be because there’s increased scrutiny of physician behavior or it could be that more physicians aren’t acting professionally.

Affects patient care

This is a problem for a number of reasons — the main one being disruptive behavior can adversely affect patient care.

So what is disruptive behavior?

According to the JAMA report, disruptive/abusive behavior was originally defined as “a style of interaction by physicians with others, including hospital personnel, patients and family members, that interferes with patient care or adversely affects the healthcare team’s ability to work effectively.”

In 2008, the Joint Commission gave a more detailed definition which included “overt verbal anger and physical threats, as well as passive behaviors such as refusing to do assigned tasks and being uncooperative.” All these behaviors can lead to poor patient care by affecting morale, focus, concentration, collaboration, communication and information transfer.

And with patient care outcomes under such intense scrutiny nowadays, behavior issues should be the last thing you need to deal with in a professional environment.

Undermines safety culture

The hospital environment, however, is often one of high stress, where it’s easy to lose one’s cool — especially in life-or-death situations where every second counts.

And while physicians are human and it’s easy to see how they may not always put their best attitude forward, intimidating behavior can chip away little by little at a facility’s culture of safety.

A 2008 national survey of 2,846 nurses, 944 physicians, 40 administrative executives and 100 “others” in 102 hospitals found that a large portion of respondents reported losing focus due to feeling stressed and frustrated as a result of disruptive behaviors. These disruptive behaviors by others were linked:

  • 75% with adverse events
  • 71% with medical errors
  • 51% with compromises in patient safety, and
  • 71% with compromises in quality.

If you’re thinking these 6-year-old statistics don’t represent current times, a 2011 survey found much of the same. This survey asked 523 physician leaders and 321 staff physicians about disruptive behaviors, such as degrading comments/insults, refusal to cooperate with others and yelling. Here’s what it found:

  • 71% (598) of responding physicians said they’d witnessed disruptive behavior within the previous month, and
  • 26% (219) said they’d been disruptive at one point in their career.

As far as where the disruptive incidents occurred:

  • there was a higher frequency in surgical, anesthesia, and obstetrics and gynecology specialties, and
  • they occurred more often in the operating room, intensive care unit and emergency department.

Ongoing & focused evaluations

The Joint Commission in 2009 required that hospitals define elements of performance, including code of conduct which defines acceptable, disruptive and inappropriate behaviors, and have a process for dealing with these behaviors.

So while most hospitals have a policy that defines elements of performance, it’s not always followed because:

  • not all physicians are aware of it
  • the policy may lack clarity, and/or
  • the policy isn’t enforced.

In addition, there are the Ongoing Professional Practice Evaluation (OPPE) and the Focused Professional Practice Evaluation (FPPE). Theses evaluations establish a code of conduct, as well as require facilities to develop a reporting system, educate and train staff, and have a system in place for problem resolution.

They help create a culture in which physicians know the standards and strive to meet them.

Leader commitment

The key to an effective code of conduct is having physician leaders on board who promote acceptable behaviors and help identify unacceptable behaviors.

Once an unacceptable behavior is observed, steps need to be taken to prevent that behavior from happening again. For example, a physician colleague/leader needs to meet with the physician, discuss the unwanted behavior and help the offending physician change the behavior or seek assistance elsewhere.

When disruptive behaviors persist, it’s up to  the department chair, medical staff president or chief medical officer to deal with it. Such behavior can’t be left to continue — it could lead to compromised patient care and safety, which can lead to legal issues for the hospital.

It’s also the responsibility of executives and administrators to make sure their physicians aren’t under too much stress due to system problems within the facility. Physicians are under a lot of pressure to see more patients in less time, document everything, never make a mistake, keep patients happy, etc. The last thing they need is problems within the system that make their jobs harder.

Having physician leaders who are role models, mentors and have the trust of their colleagues can help hospitals prevent bad behaviors from escalating and promote a culture of caring for physicians as well as patients.

 

 

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