Target, Managing Disruptive Physician Behavior - Book Report/Review Example

A Summary: On Target, Managing Disruptive Physician Behavior by the American College of Physician Executives The academic journal On Target, Managing Disruptive Physician Behavior is a compilation of articles written by health professionals and seasoned writers on healthcare who aims to equip the physicians, nurses, and executives alike in addressing disruptive behaviors of physicians in the healthcare setting. Although each article presented several methods in determining the causative factors leading to disruptive behavior and the credible solutions in managing it, many facts and strategies were repeatedly mentioned in each of the articles which are a proof of its verity and feasibility. The first article Poll Results: Doctor’s Disruptive Behavior Disturbs Physician Leaders by David O. Weber is a discussion on the results of the 2004 study of the American College of Physician Executives (ACPE) on the type of disruptive behaviors of physicians and its frequency. In the study, executive physician respondents revealed that disrespect was the most common type of disruptive behavior involving the same physician for a period of time (American College of Physician Executives 10). The article discusses as well the internal and external factors that influence the behaviors of some physicians turning them into a problem doctor. The internal factors discussed were low emotional quotient and problems with drug and alcohol addiction while the external factors told included organizational bureaucracy, difficult patients, and institutional financial crisis. The study also revealed some difficulties in handling disruptive behavior of physicians including the executive’s struggle in managing them and the offenses that are easier and difficult to solve. The second article still by Mr. Weber For Safety’s Sake Disruptive Behavior Must be Tamed is a discussion of another study done by the Institute of Safe Medication Practices (ISMP) with nurses, pharmacists, and other hospital workers. Some results of the survey in this article reiterate the results from the ACPE study such as nurses falling as the primary victims of a physician’s disruptive behaviors contributing to rapid turnover of nurses at hospital settings and the superiority complex of physicians which contributes to the disruptive behavior (20). This article ends with the ISMP recommendations on how to handle misbehavior of physicians in the healthcare setting through leadership by example and institutionalization of codes of conduct and resolution strategies for disruptive behaviors involving all health care employees in its creation and implementation. The role of executive physicians in handling disruptive behaviors of colleague is presented in the article on Managing Unmanageable Physicians by Timothy Keogh and William Martin. This article puts emphasis on the need of executive physicians to evaluate how they proactively respond to the disruptive behaviors of their colleague as a complement to the institutional policies, and the significance of listening and communication skills as important tools in getting the cooperation of the disruptive physician and the entire organizational team. In addition, this article explains why the executive physicians are held accountable for the achievements and failures of their colleague and staff. The authors elucidated as well how the executive physicians can help prevent disruptive behaviors by instilling respect as part of the organizational culture. To equip the executive physicians, the authors presented The Ripple Effect of Executive Action as a framework of analysis on determining the kind of intervention to take for a disruptive behavior. The next article on Disruptive Behavior and the Law by Susan Lapenta is a discussion on the importance of the institutional steps on how to resolve physician disruptive behavior. Good and top performing physicians were told to be the same people involved in disruptive behavior thus it becomes harder for the harassed or the victims to complain and for the physician executives to take action against the misconduct of a colleague. Furthermore, disruptive physicians are known to file counter complain against those who seek implementation of disciplinary action. The author stresses the equal importance of the procedural and legal steps in responding to physician disruptive behavior. To support such theory, the author provided three simple steps to counter physician disruptive behavior with the use of collegial intervention, adoption of the organizational code of conduct, and documentation of the incidents and actions taken (28). The fifth article entitled Doctors Doing Drugs and Drinking written by Monique Fields expounded how alcohol or substance abuse can affect physician and the people around them and how it can be overcome and managed by citing the stories of three doctors who succumbed and survived the addiction. The author referred her article to the 2004 study of the American College of Physician Executives (ACPE) where 51.9% of the respondents revealed that 1%-10% of the physician disruptive behavior in their organization was linked to alcohol or substance abuse (31). The article reiterates as well the fact that disruptive physicians are mostly the performing physicians thus their colleagues and even families tolerate the addiction to help the former keep their career which results to even graver problem that would require longer periods of disease treatment and rehabilitation. In answer to this dilemma, the article ends with recommendations from two physician counsels who have handled colleagues with disruptive behaviors stressing on the importance of educating physicians on the proper avenues to disruptive behavior management. Misbehaving Physicians and Professional Ethics by Richard E. Thompson elucidates how ethics and misbehavior are correlated. The article discus as well the external factors that contribute to sudden outburst or recurrent disruptive behaviors of physicians, and the important role of the executive physicians in preventing and managing disruptive behaviors in the health care system. Accordingly, physician frustrations that results to disruptive behavior stems from organizational bureaucracy, too much paper work, patient referral limitations, and cost based instead of need based diagnostic procedures (36). In order to explain how misbehavior can be managed, the author provided a short story that involves a conflict and resolution among two physicians and a nurse, stressing the important aspect of communication as well as the need for “accurate analytical and observational skills” (37). The article Reviewing Your Physician Compensation Plan written by Rick Weymier is about the importance of the financial recompense of a physician. This article explains the value of finances for a physician by comparing and contrasting how a private and public physician manages his/her career to attain financial stability and how financial instability can affect his/her practice of the medical profession. The article stated strongly that disruptive behaviors of physicians can be well prevented with a good compensation plan that promotes quality services and rewards those who continuously adhere with the organizational ethical standards. This plan however has to be evaluated annually in order to par with the current market and measure how effective and beneficial it has been for the individual physicians. This article is intended for executive physicians in order to manage the sudden outburst or repetitive occurrence of physician misbehavior due to problems with institutional compensation packages. To better guide the executive physicians, the article offers key components to be considered when drafting or evaluating physician compensation plan. The article on Disruptive Physician Behavior Contributes to Nursing Shortage by Alan H. Rosenstein, Henry Russell, and Richard Lauve is a presentation of a study by VHA, Inc. on the “overall status of physician-nurse relationship” (43). The survey highlights presented in the article included the types of physician disruptive behaviors, the level of physicians who usually commits misbehavior, occurrence and frequency of the disruptive behavior, probable causes of the misbehavior, consequences of the disruptive behaviors to the physician and nurses, actions taken against the disruptive behaviors, and how much a disruptive behavior can affect the morale and satisfaction of a nurse. The article dwells more into the causes of physician behavioral problems highlighting the differences in perceptions among executives, physicians, and nurses on the causes and solutions regarding physician-nurse relationship and capped with several suggestions on how to improve such relationship. The article JCAHO Standards Help Address Disruptive Physician Behavior written by Michael D. Youssi is intended to educate the reader on the role of the Joint Commission for Accreditation of Healthcare Organization (JCAHO) in organizational management of physician disruptive behavior. Accordingly, JCAHO is an organization that established standards to assist medical staff in dealing with disruptive physicians to prevent severe consequences in healthcare such as fast turnover of nurses, compromised patient health, and recurrence of physician misbehavior leading to progression of abuse. This article illustrates the organizational standards needed and provides a clear definition of roles of the executives and non-executives alike in the healthcare setting, while promoting an organized and respectful manner in dealing with disruptive physicians. The last article entitled Understanding and Managing Physicians with Disruptive Behavior by Kent E. Neff is a thorough discussion on the organizational “framework, strategies, and methods” (50) in managing physicians with disruptive behaviors. Accordingly, more time is being spent in figuring the causative factors contributing to physician disruptive behaviors than in formulating appropriate and standard organizational policies and procedures in managing the problem. As with the previous articles, the disruptive physicians are mostly those who generate more income in the organization thus considered as important, clinically competent, are influential, and able to retaliate back to the complainant with a counter protest. And if these disruptive behaviors are left without prompt intervention, it could complicate the problem leading to breakdown in social relationships in the organization; it can directly or indirectly affect patient care or clinical performance; and it can severe the progression of the physician’s illness. In the light of establishing standards and regulations in the health care organization, it is pertinent for a health care organization to have a common definition on what is considered as disruptive behavior not only for the physicians but for all the employees. A formal behavior standard must be set in a consultative manner to get equal ideas and participation of all the health care employees and to educate everybody at the same time. Initially, a disruptive behavior is any behavior in form of language, habits, or actions that can result to problems in patient care and in performing duties and responsibilities in the organizational setting. The article provides sets of samples on what can be possibly considered as a disruptive behavior in the health care environment. Subsequently, legal measures should be in place in the organization but must be considered very carefully as it could create tension to the physician and hospital administration. Before resorting though to legal measures a dialogue must be done amongst the disruptive physician, the complainants, and the physician executives and administration. Inconsiderate or too much use of legal action can do more harm to the organization and involved people as it creates tension and defensive mode from the physician in question. Managing disruptive physicians as noted by many health practitioners requires planning from the health care organization to establish appropriate strategies and policies as opposed to responding to crisis only when it emerge. Failure to institute appropriate procedures and policies is known to lead to organizational failure by losing valuable physicians. In this manner the article suggest a paradigm shift on how to approach disruptive behavior of physicians by citing a story of a valuable physician who showed disruptive behavior and was managed with “productive communication and interaction” (53) which eventually solved the problem without having to resort to legal measures, promoting positive tolerance and non-punitive approach. In order to respond effectively to a physician’s disruptive behavior the author deemed it necessary for the health care organization to understand the factors that contribute to such behavior instead of conducting an intervention only on the disruptive acts. One of the known causative factors is the health care environment. Physicians nowadays are required to work more with limited pay. The changes in the health care system contribute to the anxiety of the physician that can affect his clinical practice and relations with colleague and medical staff. Another factor is the organizational issues like the existing determinant cultures that either promotes or discourages disruptive behavior. An organization that tolerates or ignores physician disruptive behavior will create a precedent and will worsen the problem compared to an organization with preventive measures and established behavioral codes. Some physicians were reported to have committed disruptive behavior due to superiority complex that they can’t accept complaints about their misbehavior. This is told to be linked to their medical education and training where they were trained as good physicians increasing their superiority complex barring opportunities for self-examination. Another causative factor is developmental issues which are unresolved and untreated since childhood resulting to diminished self-esteem and confidence. In addition is a psychiatric disorder that requires appropriate intervention and treatment before a physician can continue or return to clinical practice. Physical illness can be direct or indirectly contribute to a physician disruptive behavior which can threaten both life and career. The litigation stress for those physicians with complaints or patients with court cases can bring secondary consequences such as “anger, depression, and physical illness” (59). Managing the disruptive behavior of a physician is not only the work and responsibility of the physician in question and the executive but involves as well the nurses and other health care staff. However, it is not advisable to include families and personal associates to be involved in the management because it might jeopardize the process due to probable denial and cover up. The article thus provides management guidelines that promote respect to the disruptive physician, confidentiality, appropriate and timely response, objectivity in dealing with the behavior problem, and constant monitoring, evaluation, and follow-up of the physician. In the conduct of monitoring and follow-up, it is advised that assessment be made by a third party to ensure that physician is recovering well enough to go back into clinical practice and to prevent inadequate evaluation that would lead to relapse or continuation of the illness that causes behavioral problem. Separate teams to handle evaluation and treatment may be called for other cases such when resistance from physician is observed, or if the complained physician is not confident to disclose information from the same team handling the evaluation and treatment. To better respond to special or severe causes of disruptive behavior, a multidisciplinary team is called for. Samples of special cases include sexual harassment cases, alcohol or substance abuse related, the physician is politically affiliated or professionally valuable, and cases involving risks to licensure and hospital privileges (66). Multidisciplinary team is also called for in situations where the executive physicians or administration have difficulty being objective and insistent with their colleague. Moreover, the article promotes the organization set up of a hospital or group physician health committee that can serve as the focal group in charge of creating awareness and educating the physicians, nurses, and the rest of the medical and non-medical staff on the standard behavioral code in the organization. There is also the state Physician Heath Programs (PHPs) as a significant resource that offers services to physicians with disruptive behavior. The PHPs assists in educating physicians, identification of disruptive physicians and other management resources, evaluation and monitoring of the problem physicians, and even referring patients to other facilities if necessary. Conduct of monitoring and follow up to the physician displaying disruptive behavior assists the executives in determining whether the physician in question is fit to go back to clinical practice, see if the physician is compliant with the treatment, and evaluate if the procedures and management strategies were effective. Monitoring however should be done not only to those physicians with disruptive behaviors but to all the medical staff as part of their performance evaluation to detect any misbehavior or problems in performing their clinical duties ad functions. Monitoring performances will also help erase the false belief on physician immunity to consequences of disruptive behavior. To better equip the physician executives and health care administrators, the article provided concrete samples of a guiding principle of partnership in an organization and an organizational checklist in managing physicians with disruptive behaviors. The guiding principles contain a preamble that acknowledges the differences, roles, and capabilities of all the health care professionals in the organization. It is followed by six guiding principles that would assist physicians and staff in creating a productive and harmonious working environment. The guiding principles to wit are respectful treatment, language, behavior, confidentiality, feedback, and clarification of roles (70-71). Lastly, the organizational checklist in managing physician with disruptive behavior is an enumeration of concrete steps to embark should the need arise. The steps include conduct of rapid initial assessment, data collection and thorough investigation, assessment of clinical performance, definition of behavioral problems, defining if behavior merits certain action, planning and rehearsing the intervention meeting, taking action in a respectful manner, and follow up and monitoring of progress (72-76). In both sample guidelines, it is worth noting that careful consideration of the physician’s individuality as a person is always considered coupled with outmost respect and professionalism in handling cases of physician disruptive behavior. Works Cited American College of Physician Executives. On Target, Managing Disruptive Physician Behavior. Web. 15 March 2012 Read More