There’s often a thin line between frustration and disruptive, abusive behavior on the part of some providers that can have widespread impact on both staff and patients.
Dr. Christopher Kodama, MD, MBA, a former health system CEO and founder of the healthcare consulting firm EverSparq, highlights this subject in a discussion with Daniel Williams while previewing his upcoming session at the MGMA Leaders Conference on the same topic.
“Disruptive behavior is disruptive behavior, whether you’ve got an MD or a DO after your name or not,” he says. “But I do believe we look at physicians differently in the workplace, particularly when it comes to matters such as dynamics around hierarchy. That can make this very intimidating for a practice manager who may not be a physician, or particularly comfortable in this area.”
Defining Disruption
Just like any other workplace, there’s a wide range of behavior that occurs that might be qualified as disruptive and actionable. However with physicians, the stakes tend to be higher when those problems can quickly move into areas of patient safety.
Disruptions, Dr. Kodoma explains, can run the gamut from verbal abuse and demeaning language to physical confrontations or even frustrated physicians throwing things in the OR. There’s also more passive-aggressive forms of disruption such as excluding staff who’ve spoken up about such behavior.
Dr. Kodama says he turns to guidance provided by the American Medical Association to supplement the observations he’s made over his own years of running healthcare facilities.
“As the AMA has described, disruptive behavior is any conduct in the workplace that distracts others to the extent that it interferes with their ability to do their job optimally,” he says.
Breakdowns in practice quality, Dr. Kodoma explains, are the primary reason disruptions need to be dealt with directly with grace, fairness and respect, rather than turning a blind eye to bad behavior.
Identifying the Signals at a Practice
Dr. Kodama says the first signs of issues with disruptive providers often manifest in what he describes as a “dark aura” hovering over the practice environment, not unlike a family home where abuse may be taking place. Staff may become cynical, burnt out, disengaged or even resentful about doing their job, but still manage to do the work.
“Conversely, what you’ll find is a very polished exterior with a lot of chaos underneath,” he says. “People are putting on a brave face because they believe that’s what they need to do for the benefit of their colleagues and their patients. If disruptive behavior is chronic and indolent, it’s as if these people have figured out ways to cope and rationalize in an abusive situation.”
Dr. Kodoma highlights how those staff are less likely to come forward with their concerns, so it takes time to understand the culture of what’s acceptable and what isn’t necessarily a problem. Watching how staff interact with each other or treat patients can offer more tangible, subtle clues of what’s really happening.
Do Some Research Before “Having the Talk”
Once a problem becomes public, Dr. Kodama says it’s critical to engage directly with a disruptive provider as quickly as possible, using language that keeps the discussion productive, rather than punitive. At the same time, he recommends doing research before launching into any conversation, as many conflicts in a medical environment may also not be what they seem on the surface.
“Initially, I recommend you gather your facts and evaluate the situation, because it’s an allegation until proven otherwise, and there may be more sides to the story than what you’re being told,” he suggests. “Understanding the facts and doing your due diligence is really important.”
He also recommends considering the dynamics present in your practice: What individuals inside and outside are involved, and to what degree? While a particular employee may have been targeted, sometimes a provider’s frustration is less focused, but can still be felt by every member of the practice, even those with peripheral contact with the provider.
“That latter group still needs some attention because they’re watching and listening, and they want to see how this is going to be handled, as this sets the tone for the interactions that people have with one another when you’re not around as a leader.”
Work With a Script
When it comes time for a discussion with the provider, Dr. Kodama suggests creating an outline of issues to address, then sharing those with the individual involved ahead of time in a formal meeting, not an on-the-spot confrontation.
“In other words, avoid the ambush tactic. I like to be succinct and focused. Going through a laundry list of specific infractions or grievances – I don’t find that to be particularly helpful.”
Focus on a primary theme and directly address it, he advises: “’You seem really angry and you’re taking it out on the staff, and it’s coming across in your patient interactions,’ rather than ‘you did this, this and this.’”
Dr. Kodama says he follows the SBI feedback framework:
- Situation: Start with a succinct statement of a specific situation in which the disruptive behavior occurred
- Behavior: State what the observed behavior was
- Impact: Describe the impact that it had on those involved
This provides documentation an individual can review after the conversation, and also offers a record that all parties can use as a reference in the future if there are further issues. A follow-up afterwards can also help mitigate risk with impacted parties.
Monitor the Changes
After any direct intervention, practice managers are encouraged to monitor the situation through leader rounding and a measured level of interaction with both provider and staff to help ensure that behavior has been addressed and changes made. Dr. Kodoma suggests asking standardized, targeted questions to see if people are seeing and feeling any differences in behavior, and to know that they have your support.
“There needs to be a growth mindset where people learn from their mistakes and then move on and not dwell.”
Dr. Kodoma will host a session titled, “Strategies of Managing Disruptive Physician Behavior,” during the MGMA Leaders Conference on Wednesday, October 1st in Orlando.
Resources:
- MGMA Leaders Conference - Register Here
- Visit the EverSparq website to learn more
- Connect with Christopher Kodoma on LinkedIn
