IAMSS 36th Annual Education Conference May 18, 2017

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Presentation transcript:

IAMSS 36th Annual Education Conference May 18, 2017 WHO ME? Understanding and Managing the Disruptive Practitioner James L. Nevin, MD, VPMM

UNDERSTANDING DISRUPTIVE BEHAVIOR Captain-of-the-Ship Doctrine

INDIVIDUAL FACTORS Dealing with High Stakes / Emotional Situations Fatigue Self-Centeredness / Immaturity / Defensiveness

SYSTEMIC FACTORS Increased productivity demands Cost containment requirements Embedded hierarchies Fear of litigation

MORE SYSTEMIC FACTORS Roles/values of professional on the health care team Daily flux in shifts/rotations/staff Communication challenges

UNREPORTED DISRUPTIVE BEHAVIOR ENABLES THE BEHAVIOR Normalized deviance Fear of retaliation Perceived consequences of reporting high revenue generating physicians

THE CONSEQUENCES OF DISRUPTIVE BEHAVIOR Increases medical errors Increases preventable errors Increases cost of care

STILL MORE CONSEQUENCES Increases turnover of qualified personnel Decreases patient safety and satisfaction

DISRUPTIVE BEHAVIOR INCLUDES: Intimidation Verbal outbursts Physical threats

BUT WAIT – THERE’S MORE... Uncooperative attitudes Reluctance / refusal to answer questions Failure to return phone calls / pages

AND MORE….. Condescending language Impatience with questions

INTIMIDATING AND DISRUPTIVE CANNOT BE TOLERATED Threatens patient safety Creates unhealthy / hostile work environments Creates unnecessary risk

DISRUPTIVE BEHAVIOR MUST NOT BE TOLERATED Team effectiveness is undermined Impedes reporting of events Destroys trust

MANAGING DISRUPTIVE BEHAVIOR Medical staff bylaws Hospital code of conduct Clearly communicate to physicians staff expectations regarding behavior to the entire healthcare team

IMPLEMENT POLICIES AND PROCEDURES THAT ADDRESS DISRUPTIVE BEHAVIOR Reduce fear of intimidation and retaliation Hold all team members accountable for behavior Be consistent and fair

EDUCATION AND COACHING FOR PHYSICIANS/NON-PHYSICIAN LEADERS Provide skills-based training Reinforce appropriate behavior Communicate, communicate, communicate

CREATE A CULTURE OF RESPECT, TRANSPARENCY AND JUSTICE Changing a culture takes time It comes from the top It’s a journey, not a destination

Thanks for letting me disrupt your day. Any questions?