Hartley Stern, MD, FRCSC, FACS Best Practices in Annual Physician Reappointment, Performance Management, and Dealing with Disruptive Behaviour 2014 Annual HIROC Risk Management Conference Monday, April 28, 2014 Hartley Stern, MD, FRCSC, FACS

Best practices in physician performance management Develop a culture of accountability that is expected of all physicians, other healthcare professionals, and staff Implement an appropriate structure for organized physician peer review and performance measurement Use opportunities afforded by physician assessment to address the needs of the doctor (and the organization) Monitor for exceptional practices that will allow the physician and organization to build on and share strengths (clinical, education, or research)

Best practices in physician performance management Monitor for “sentinel events” and bring patterns of recurring or clustered problems to the attention of medical leadership Use a quality review or other committee structure to make recommendations based on the physician assessment Identify opportunities for change in the organization or for the imposition of limitations on privileges Source: Cochrane, D., BC Patient Safety & Quality Council. Investigation into Medical Imaging, Credentialing and Quality Assurance Phase 2 Report. August 31, 2011

Annual physician reappointment Hospital or institution has obligation to ensure each physician is competent Reappointment is a perfect time to evaluate competency Maintain clear delineation of standards which spell out qualifications for granting clinical privileges Establish a robust committee with clear lines of authority and responsibility Aim for continuous, ongoing review

Annual physician reappointment Collect information from multiple sources for evaluation Peers Utilization Performance standard reports Patient care/outcomes Patient complaints Develop specific eligibility criteria for specialized privileges Medical staffs and hospitals should strive to create an intra-professional versus adversarial environment

Physician disruptive behaviour Prevalence Recent studies report recurrent disruptive behaviour occurs in 3-6% of practicing physicians Physicians are concerned about disruptive behaviour but are not comfortable confronting the issue What is disruptive behaviour? CPSO 2008 “Disruptive behaviour is demonstrated when inappropriate conduct, whether in words or actions, interferes with, or has the potential to interfere with, quality healthcare delivery.” - May be a single egregious act (assault) - More often a pattern of behaviour

Dealing with disruptive behaviour Early identification Early intervention - Remedial approach Staged approach - Disruptive behaviour pyramid Early and continuing education - Students, trainees/residents, physicians, medical leaders, administration Source: Hickson GB, Pichert JW, Webb LE, Gabbe SG, Acad Med, Nov, 2007