The line between provider frustration and outright disruptive, abusive behavior can be thin — and when it's crossed, the impact reaches both staff and patients.

Christopher Kodama, MD, MBA, a former health system CEO and founder of the healthcare consulting firm EverSparq, highlighted this subject on a recent MGMA podcast episode while previewing his session at the 2025 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

Like any workplace, a medical practice sees a range of behaviors that may be classified as disruptive or actionable. But with physicians, the stakes are higher: problems can quickly move into areas of patient safety.

Disruptions, Dr. Kodama explains, runs the gamut — from verbal abuse and demeaning language to physical confrontations and frustrated physicians throwing things in the OR. It also takes more passive-aggressive forms, such as excluding staff who’ve spoken up about such behavior. 

To supplement what he has observed over years of running healthcare facilities, Dr. Kodama leans on guidance from the American Medical Association.

“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, he explains, are the primary reason disruption has to be addressed directly — with grace, fairness and respect — rather than ignored.

Identifying the Signals

The first signs of trouble, Dr. Kodama says, often show up as what he calls a “dark aura” hanging over the practice environment, not unlike a family home where abuse is taking place. Staff may become cynical, burnt out, disengaged, or even resentful about doing their job, yet 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.”

Because affected staff are less likely to come forward, Dr. Kodama notes, it takes time to read the culture and distinguish what is acceptable from what is genuinely a problem. Watching how staff interact with each other and with 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. Kodama 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.”

Resources: 

• Visit the EverSparq website to learn more
• Connect with Christopher Kodama on LinkedIn