Determining who should conduct an intervention with a practitioner

Conducting an intervention with a practitioner who is impaired, disruptive, or performing poorly can be emotionally draining for even the most experienced physician leader. The process is made a bit easier if the leader is prepared. Therefore, plan, practice, and then carry out the intervention.

The question of who should conduct the intervention really has two parts:

• How many people will conduct the intervention?
• Who will conduct the intervention?

The first intervention is collegial, and only one person should carry it out. However, if the physician displaying disruptive behavior is particularly combative or litigious or if the medical staff leader anticipates significant resistance, it may be wise to have two people present. Subsequent interventions are less collegial, so it is wise to have a second person present, whether it is for a show of strength or merely to have a witness. Any more than two people carrying out the intervention at this stage can create a hostile environment and detract from the success of the intervention. Only at a final warning, with a potential appearance at the medical executive committee (MEC) or to invoke some other action, would it be appropriate to have more than two people present.

The person who will most successfully conduct the intervention is the one who should do it. Generally, the department chair should conduct the first and second interventions unless there is a potential conflict of interest or unless he or she is not a strong leader. When the disruptive physician is recalcitrant, is a high admitter, or has significant influence within the medical staff, it may be more appropriate for the chief of staff to perform the intervention, usually in conjunction with the chief medical officer (CMO)/vice president of medical affairs (VPMA) or the CEO of the hospital. The board chair may also participate in the delivery of a final warning when the disruptive physician is especially difficult.

Source: The Medical Staff Leader’s Practical Guide: Survival Tips for Navigating Your Leadership Role by William K. Cors, MD, MMM, FAAPL.