dealing with disruptive faculty behavior
DESCRIPTION
DEALING WITH DISRUPTIVE FACULTY BEHAVIOR. “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. - PowerPoint PPT PresentationTRANSCRIPT
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?