DEALING WITH DISRUPTIVE FACULTY BEHAVIOR

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DEALING WITH DISRUPTIVE FACULTY BEHAVIOR
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Surgeon Arrested After Throwing Fit

• Oakland, CA March 26, 2006
• A neurosurgeon was wrestled to the floor by
  sheriffs deputies outside the operating room
  after he threw a fit because he had to wait for
  instruments to be sterilized, authorities say.
• USAToday.com

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OBJECTIVES

1. 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

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Measure performance
Take Corrective Action

THE PYRAMID APPROACH
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Manage performance
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Provide feedback
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Set and communicate expectations
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Appoint excellent faculty/staff

Sheff, MD and Sagin, MD
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DISRUPTIVE BEHAVIOR

• personal conduct, whether verbal or physical,
  that negatively affects or that potentially may
  negatively affect patient care.

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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

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• UAB
• Code of Conduct for
• Professional Behavior

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2004 SURVEY

• gt95 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

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IMPACT

• Affects patient care and safety
• Disrupts facility operations
• Creates hostile work environment
• Lowers communitys confidence

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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

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WHAT CAN WE DO?

• Undertake a cultural transformation
• Devote adequate time/resources
• Provide extensive education/training
• Develop thorough policies/bylaws
• Enforce policies

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INTERVENTION

• Goal is to ensure that faculty
• Owns responsibility for behavior
• Commits to improve it
• Takes active steps
• Schedule follow up visit

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ESCALATING INTERVENTIONS

• Collegial doc in the box

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PLANNING THE INTERVENTION

• Who? 1-2 people
• Where? Private setting
• When? As close to event as possible
• What are facultys likely responses?
• What is plan B?
• How will you monitor any changes?

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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

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2 FORMULAS

• F State Facts
• I - State Impact
• R - Give Respect
• R Make Request
• U - Understand others point of view 1st
• S - State your Situation
• A - Alternative Action

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Resources

• a. professional assessment
• b. human resources
• c. legal/administrative counsel
• d. educational materials

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PHYSICIAN RESOURCE OFFICE
UAB Highlands 930-7680
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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

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LEGAL COUNSEL
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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

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Possible Recommendations

• Individual counseling/coaching
• Educational event/workshop
• Workplace monitor
• Regular feedback meetings
• 360 surveys for all faculty
• Psychological testing
• Inpatient evaluation
• Corrective action

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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

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IN SUMMARY

• Code Enforcement
• Resources/Options
• Oversight Committee
• Preventive Strategies

• Universal Code of Conduct
• Planned Implementation
• Compliance Monitoring
• Non Retaliation Provisions

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Case 1

• A faculty member constantly interrupts you
  during meetings and openly criticizes your
  suggestions.
• How would you handle this?

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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?