Addressing Disruptive Physician Behavior - PowerPoint PPT Presentation

Loading...

PPT – Addressing Disruptive Physician Behavior PowerPoint presentation | free to download - id: 6c0be4-MDUyN



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Addressing Disruptive Physician Behavior

Description:

Addressing Disruptive Physician Behavior Counseling Peers William Hopkinson, MD Orthopaedic Program Director, Loyola University Medical Center AAOS Fall Meeting ... – PowerPoint PPT presentation

Number of Views:10
Avg rating:3.0/5.0
Slides: 35
Provided by: LUH1
Learn more at: http://www3.aaos.org
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Addressing Disruptive Physician Behavior


1
Addressing DisruptivePhysician Behavior
  • Counseling Peers

William Hopkinson, MD Orthopaedic Program
Director, Loyola University Medical Center AAOS
Fall Meeting, October 19, 2012
2
XXX Disclosure XXX
  • Any opinions expressed in this presentation are
    solely my own
  • Retired USA MC
  • Part-time VA
  • Full time academic faculty at private university
  • Member AAOS Committee on Professionalism
  • Judiciary Committee
  • No financial conflicts of interest

3
SPECIAL BEHAVIOR
  • Disruptive Inappropriate
  • Interferes with function/flow of workplace
  • If unaddressed, usually escalates.

4
Disruptive Behavior Examples
  • Yelling
  • Profanity/Verbal abuse
  • Threatening body gestures
  • Failing to adhere to usual authority, such as
  • Not providing ID
  • Not participating in Time Out
  • Not returning calls/pages

5
More Serious Behavior
  • Threatening
  • Physical actions just short of contact
  • Oral/ written /implied threats
  • Legally defined as assault
  • Violent
  • Physical behavior or specific threats of physical
    harm
  • Harmful or offensive contact
  • Legally defined as battery

6
(No Transcript)
7
Is there a rationale for DB?
  • Surgical Stress/ Frustrations
  • -Increased complexity/ more regulations
  • High volume
  • Low margin
  • of error

8
Reason for DB
  • Substance abuse/psych issues
  • Narcissism/perfectionism
  • Personal issues

9
Reasons for Tolerating DB
  • Nonebut
  • Majority of surgeons are non-confrontational
  • Respect/tolerance of rainmakers
  • Rationalizing behavior
  • Not my .. problem /patient/ resident/ issue
  • If I ignore, maybe the problem will go away
  • ETC

10
What they think they are
  • Perception is Reality

What others see
11
Why deal with disruptive behavior?Easy
  • Directly linked to adverse events
  • Professionalism issue
  • Lawsuits
  • Poor morale

12
How to deal with disruptive behavior?The Hard
Part
13
Pyramid upside down
Level of action Persons involved
One-on-one intervention Fellow professional
Awareness meeting- self-improvement plan Fellow professional/ authority figure
Formal report/action plan Institutional /Task Force
Disciplinary action Institution Reportable/appealable
14
My Experience
  • Department Vice-Chair
  • Residency Program Director
  • Professional Standards and Peer Review Committee,
    Loyola
  • Loyola PARS Program
  • Co-chair and mentor
  • AAOS Committee on Professionalism

15
My Experience in the trenches
  • One-on-one- peer interactions
  • Authority figure
  • Our local PARS activity
  • LUMC Professionalism Committee
  • AAOS COP and Judiciary Committee

16
Cup of coffeeconversation
  • Why behavior noted
  • When soon
  • Where safe/quiet place
  • How balance empathy and objectivity
  • stay on message
  • Expectations Self-correction

17
Cup of coffee conversation
  • To be meaningful stay on topic
  • Avoid the following tendencies
  • Control contest
  • Curbside therapy
  • Enabling
  • Oh, by the way, now that we are here

18
Can an authority figure do this?Can you do this
to the boss?
  • Yes with care
  • Non-judgmental
  • Empathy and objectivity
  • Focus on the behavior
  • Perception is reality

19
Prepare for full range of responses
20
When a lot of coffee doesnt work
  • Cre

Self-creating an improvement plan
21
Local Hospital Task Force
  • Generating a report
  • Review by Committee of Peers
  • Actions taken can range from
  • No action
  • Fines
  • Mandated activities local/national programs
  • Dismissal

22
The Loyola PARS Program
  • Using unsolicited patient complaints to measure
    physician risk
  • At Loyola, 2 co-chairs and 20 mentors
  • Program started in 2003
  • Mentor selection and training
  • Assigning mentors
  • Annual update

23
PARS Reducing Malpractice Risk, Professionalism
and Self-Regulation
  • Conceptual Framework Professionalism
  • Professionals commit to
  • Technical and cognitive excellence
  • Professionals also commit to
  • Clear and effective communication
  • Modeling respect
  • Being available
  • Professionalism promotes teamwork
  • Professionalism demands self-regulation

24
Loyola PARS Experience
  • 2003-2011 Phys. Interventions No.
  • 2003-2007 First Interventions 28
  • 2008 First Interventions 9
  • 2009 First Interventions 7
  • 2010 First Interventions 7
  • 2011 Proposed First Year 6
  • (Excluding 1 Recidivist)
  • Total 57

25
Results to date - LUMC
  • Total high complaint physicians 57
  • First follow-up in 12 6
  • Departed After Initial Intervention 4
  • Total with follow-up results 47
  • Results for those with follow-up data
  • Good Intervention visits suspended
    21 (45)
  • Good Anticipate suspension in 12 9
    (19)
  • Some improvement -- Still need tracking
    1 (2)
  • Subtotal 31 (66)
  • Unimproved/worse 14 (30)
  • Departed Unimproved 2 (4)
  • Total follow-up results 47

26
AAOS Standards of Professionalism
  • 6 SOPs establishing minimum standards of
    acceptable conduct for Orthopaedic surgeons
  • Each SOP has an aspirational statement with one
    or more mandatory standards

27
AAOS SOPs
  • Covers a range of professional topics
  • One AAOS member files a grievance against another
  • All other administrative actions should have been
    completed

28
SOP on Professional Relationships
  • Aspirational
  • Good relationships among physicians, nurses, and
    other health care professionals are essential for
    good patient care
  • The orthopaedic surgeon should promote the
    development and utilization of an expert health
    care team that will work together harmoniously to
    provide optimal patient care.

29
SOP on Professional Relationships
  • Mandatory standards
  • An Orthopaedic surgeon
  • Shall maintain fairness, respect, and appropriate
    confidentiality
  • Shall conduct themselves in a professional manner
    in interactions
  • Shall work collaboratively with others to reduce
    medical errors, increase patient safety, and
    optimize outcomes

30
(No Transcript)
31
Professional Compliance Program
  • Actions to date (April 2012)
  • 125 grievances submitted
  • 47 COP Hearings
  • 21 Appeals to Judiciary Committee
  • Results
  • 18 No action
  • 2 Letters of concern

32
Grievances Filed by SOP
Providing MS Services 3
Professional Relationships 9
Expert Witness Testimony 94
Expert Opinion 9
Research/academic responsibility 0
Advertising 9
Conflicts of interest 1
33
AAOS Professionalism Program
  • 30 Official Actions of AAOS BOD
  • 7 Censures
  • 23 Suspensions
  • Ranging from months to 3 years
  • 0 Expulsions

34
Summary
  • Disruptive behavior is disabling to health care
  • An organized process can be effective
  • It starts with one-on-one
  • Elimination of DB requires an organizational
    commitment
  • We all need to be involved
About PowerShow.com