Sandra L. Frazier, MD UABHS Physician Health Officer DEALING WITH DISRUPTIVE FACULTY BEHAVIOR

Oakland, CA March 26, 2006 A neurosurgeon was wrestled to the floor by sheriff’s deputies outside the operating room after he threw a fit because he had to wait for instruments to be sterilized, authorities say. USAToday.com “Surgeon Arrested After Throwing Fit”

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

Measure performance Set and communicate expectations Appoint excellent faculty/staff 2 1 Sheff, MD and Sagin, MD 3 Provide feedback 4 5 Manage performance 6 Take Corrective Action THE PYRAMID APPROACH

DISRUPTIVE BEHAVIOR “personal conduct, whether verbal or physical, that negatively affects or that potentially may negatively affect patient care ”.

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

UAB Code of Conduct for Professional Behavior

2004 SURVEY >95% 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

IMPACT Affects patient care and safety Disrupts facility operations Creates hostile work environment Lowers community’s confidence

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

WHAT CAN WE DO? Undertake a cultural transformation Devote adequate time/resources Provide extensive education/training Develop thorough policies/bylaws Enforce policies

INTERVENTION Goal is to ensure that faculty a. Owns responsibility for behavior b. Commits to improve it c. Takes active steps Schedule follow up visit

ESCALATING INTERVENTIONS Collegial “doc in the box”

PLANNING THE INTERVENTION Who? 1-2 people Where? Private setting When? As close to event as possible What are faculty’s likely responses? What is plan B? How will you monitor any changes?

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

2 FORMULAS I. F – State Facts I-State Impact R -Give Respect R – Make Request II. U -Understand other’s point of view 1 st S - State your Situation A - Alternative Action

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

PHYSICIAN RESOURCE OFFICE Assessment/ Counseling/ Consultation Referral Assistance/ Monitoring Education/ Prevention/ Workshops UAB Highlands

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

LEGAL COUNSEL

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

Possible Recommendations Individual counseling/coaching Educational event/workshop Workplace “monitor” Regular feedback meetings 360° surveys for all faculty Psychological testing Inpatient evaluation Corrective action

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

IN SUMMARY Universal Code of Conduct Planned Implementation Compliance Monitoring Non Retaliation Provisions Code Enforcement Resources/Options Oversight Committee Preventive Strategies

A faculty member constantly interrupts you during meetings and openly criticizes your suggestions. How would you handle this? Case 1

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?