Cultivate medical staff buy-in to behavioral expectations

Dear Medical Staff Leader:

Physicians are achievers by nature, selection, and training. Therefore, if you tell physicians clearly what is expected of them in virtually any aspect of their performance, the vast majority will meet and usually exceed those expectations-provided they agree with the expectation.

For that reason, setting and communicating expectations of physician performance, including behavioral expectations, is not simply an exercise in drafting a policy. Before developing a policy, you must first secure medical staff support for the behavioral expectations. The best way to cultivate that buy-in is to involve physicians in designing them. There are at least two approaches to doing so: Developing a written set of performance expectations for physicians that include behavioral expectations or developing a separate physician behavior policy.

Medical staffs who take the first approach should begin the process by educating medical staff members about. The second step is to appoint a task force to draft an initial set of physician performance expectations. In essence, this task asks physicians to personally define "being a good doctor." In this context, behavioral expectations for how physicians treat their fellow physicians and hospital staff will become embedded in an overall set of physician performance expectations. If you decide to embed behavioral expectations in a comprehensive set of physician performance expectations, keep them general so the complete list of expectations doesn't become too long and cumbersome. If disruptive physician behavior is a significant issue in your facility, you may wish to adopt a specific physician behavior policy.

Drafting, discussing, and adopting such a policy is an excellent method of directing the medical staff's attention to this problem. The policy can be specific enough to ensure all physicians know which behaviors are not allowed to continue. And the discussion can be long enough and in-depth enough to ensure optimal buy-in by the time the policy is adopted.

Regardless of which approach you medical staff takes, it is important that the expectations are shared with all medical staff members in draft form. Encourage and solicit their input. Make it an explicit agenda item for a meeting in each department when it is still in draft form. And seek out opportunities to discuss the draft with physicians in the hallways, in the operating room lounge, and even in social settings.

That's all for this week.

All the best,

Rick Sheff, MD