When I speak with hospital administrators, many times the topic of disruptive physician behavior comes up. Now that has some obvious reasons. Disruptive physician behavior can damage the hospitals reputation tremendously and it can cost the organization lots of money. It is actually estimated that unnecessary turnover rates alone costs health care organizations more than $150,000 per disruptive physician.
Additionally, a new survey about physician-nurse relationships uncovers a strikingly high prevalence of disruptive physician behavior that is affecting nurse retention. It showed that disruptive behavior by physicians is contributing to fuel the nationwide nursing shortage, heavily impacting job satisfaction and morale for nurses.
The survey results also revealed the seriousness of the issue and highlight a lack of physician awareness, appreciation, value and respect for nurses. As a result, disruptive physician behavior has a negative impact on patient quality care and increases the likelihood of medical errors.
Now what is disruptive physician behavior? There are many definitions available, however, the American Medical Association sums it up succinctly by “defining disruptive behavior as a style of interaction with physicians, hospital personnel, patients, family members, or others that interferes with patient care.”
Obviously, disruptive behavior cannot be neglected and needs to be addressed at the organizational level. Of course every hospital has a process in place how they address those kind of interferences but unfortunately, the success rates are many times not as high as they envision them.
So what else can be done to reduce disruptive behavior?
When you look at the incidences closely, you can see that disruptive physician behavior is the result of a lack of self-management, a lack of interpersonal skills or both.
No physicians gets up in the morning with the intention of cussing a nurse out, interrupting the success of their surgery by throwing instruments through the OR, or screaming at a hospital administrator. I don’t think that any physician has such bad intentions because then they would definitely not be suited for this profession and should look for a job where human interactions are non existent. Instead, I look at disruptive physician behavior as a sign that their self-management and interpersonal skills are underdeveloped.
At the end disruptive behavior is the symptom of an underlying cause, call it frustration with life, overwhelm with their professional responsibilities, inability to cope with the demands of life, incapability to effectively communicate with people.
Handing the physician a warning or having a conversations with the physician about repercussions will not cure the behavior but rather only band aid on it. In order to get to the source of the behavior, the conversations and the revelations have to go deeper and need to address topics such as:
– how to effectively control oneself in stressful situations
– how to resolve conflict with a win-win outcome
– how to communicate effectively in any kind of situation
– how to resolve frustrations and strive to create more harmony and balance in one’s life and many more.
As a result, rather than educating and lecturing physicians about the negative consequences of their behaviors, hospitals need to invest time and resources into preventative workshops that address those skills, performing self-assessments, increasing staff awareness of the issue, opening lines of communication and creating great collaboration among peers.
If hospitals don’t do this, the problem will continue to grow and patients, nurses, and the financial situation of the organization will continue to needlessly suffer.
An ounce of prevention is worth a pound of cure.”
– Henry de Bracton, De Legibus in 1240
I look forward to your comments and hearing from you.
Iris Grimm
www.BalancedPhysician.com
It is encourging to not that the JCAHO’s new proprosed guidelines for “disruptive physicians” is already resulting in a dramitic increase in self and mandated referrals to Executive Coaching/Anger Management resources for “disruptive physicians.
The three main resources for physicians all report such increases.
Your blog is interesting!
Keep up the good work!
I wanted to reply to this article because as a physician I am VERY concerned about the JCAHOs new push to address disruptive physicians. I really feel that there are much bigger fish to fry. Do not get me wrong, I feel that abuse by a physician to a colleague is unacceptable and in cases where physicians are repeat offenders should be evaluated for this problem. However, as a physician and a surgeon, I am VERY concerned about these types of policies. Patients NEED patient advocates. For example, you schedule a surgery requesting instruments and then you arrive to do the surgery and the hospital staff either does not have the instruments or they are not sterilized. What should the response be now that the patient is asleep? The appropriate response is to report it and do the best you can for that patient with the inadequate instruments you have. Now imagine this happening OVER and OVER again….get the picture? Somone has to be an advocate for the patient and somone pulling a 12 hour shift at fifteen dollars an hour really doesnt care about the patient…they just want their shift to end. Another example that just happened 1 month ago…I wrote orders for my patient to have her temperature checked every 4 hours because she was addmitted for a pelvic abscess. She did not have her temperature checked for over 12 hours. What do you do there? Of course, you report it. Well, imagine that happening every day (not the exact same error) maybe a missed bloood draw, or a failure to report results, or not sending a patient for a study, or an order not performed in the chart. These things happen every day…unfortunately, the doctors that complain and get upset have less of these things happen to their patients and the system breeds these types of physician attitudes. Maybe JCAHO should adopt a zero tolerance policy for hospitals AND staff that make these types of errors. These errors go overlooked because doctors never report them. Patients need advocates and if doctors do not press staff to do the right things for patients and hold them to a higher standard of care then who will? When the patient has a bad outcome and the lawsuit comes down…its always the doctor in the lawsuit and not the person who didnt take the temperature for 12 hours. Maybe have JCAHO set strict (reasonable) standards for patient to nursing ratios…hey theres a thought…or maybe make them purchase new instruments when the doctor says the old one is insufficient instead of letting the hospitals get away with using the same old instruments when they do not function properly. Instead, a better solution, take the doctor who gets upset about these things and send them to a 5 day inpatient evaluation and 12 CME credits lol that will solve the problem.
have a nice day