1. 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

2. 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)

3. 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

4. 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

5. 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

6. 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

7. 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