Strategies for Dealing with Disruptive Physicians

by Holly Hayes

In 2009, The Joint Commission established a standard (LD.03.01.01) that addresses disruptive physicians:

• EP 4: The hospital/organization has a code of conduct that defines acceptable and disruptive and inappropriate behaviors
• EP 5: Leaders create and implement a process for managing disruptive and inappropriate behavior

How prevalent is disruptive behavior among physicians? The American College of Physician Executives and QuantiaMD published a survey of 844 physician executives on this topic:

More than 70% of physicians say that disruptive physician behavior occurs at least once a month at their organizations, and more than 10% say that such incidents occur on a daily basis.

The physicians surveyed also provided insights into their own ability to deal with disruptive physician behavior, showing a mixed level of confidence about how individual physicians cope with this issue. Over half of respondents (51%) agreed that they were comfortable reporting incidences of disruptive behavior; while slightly less (47%) agreed that they were comfortable directly confronting it.

There was little disagreement among respondents that disruptive behavior can affect patient care at least some of the time, with only 1% of respondents saying that patient care is never impacted. In addition, patient-related issues topped the list of consequences from disruptive behavior that respondents had experienced.

Survey respondents also weighed in on what topics related to disruptive behavior they wanted more education on, with most physicians (61%) saying they were interested in methods to confront disruptive behavior. Other topics included education on improving culture and disciplining disruptive behavior (both at 55%), as well as improving communication (50%), indicating that healthcare organizations have ample opportunity to address disruptive behavior from a cultural and systematic perspective.

How can leaders become more comfortable addressing disruptive behavior? An article on the website Strategies for Nurse Managers.com addreses the topic of disruptive clinicians. Carol S. Cairns, CPMSM, CPCS, president of PRO-CON, suggests asking Human Resources for help and guidance when approaching a disruptive physician. “Sometimes medical staff leaders are not trained to do that type of intervention,” she says. “HR people very often are. Maybe the chief of a department or the credentials chair might be counseled by a vice president of HR who understands how to do that process; someone who does this more commonly with employees and they know how to do it effectively.”

How can nursing staff become more comfortable addressing disruptive behavior? The website DoctorsLounge published the results of a study on the impact of communication skills education from the May issue of the AORN Journal. Rebecca Saxton, Ph.D., R.N., from the Research College of Nursing in Kansas City, Mo., conducted a pretest and a posttest of nurses to review the impact of “educational communication skills intervention on the ability of perioperative nurses to address disruptive physician behavior”.

A 10-item Self-Efficacy to Address Disruptive Behavior Scale was administered to 17 nurses before and after participation in a two-day communication skills program presented by a certified Crucial Conversations (a VitalSmarts product) trainer.

Saxton found that there was a significant increase in total mean self-efficacy scores both immediately after the intervention and at four weeks post-intervention. Four weeks after the intervention, participants reported the ability to address disruptive physician behavior 71 percent of the time.

“The results of this study suggest that one intervention strategy to address the serious threat of disruptive physician behavior to patient safety is to educate nurses in communication skills,” Saxton concludes.

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Holly Hayes is a mediator at Karl Bayer, Dispute Resolution Expert where she focuses on mediation of health care disputes. Holly holds a B.A. from Southern Methodist University and a Masters in Health Administration from Duke University. She can be reached at holly@karlbayer.com.