Do your bylaws define professional behavior?
This week's CRC Daily topic, medical staff governance, is an area where MSPs' knowledge of both medical staff bylaws and accreditors' requirements makes them a valuable resource for their organization. Below is a recent Medical Staff Briefing column addressing impaired and uncooperative practitioners, and the role bylaws can play.
The Federation of State Medical Boards (FSMB) recognizes disruptive behavior is a serious problem that requires a full discussion beyond the scope of its impairment policy. Disruptive behavior, however, impairs the ability of the healthcare team to function effectively, thereby placing patients at risk. The majority of physician health plans (PHP) address disruptive behavior. FSMB recommends PHPs and their boards work cooperatively to devise contractual language and agreed-upon strategies, ensuring that this important issue is carefully addressed in each state.
A more subtle behavioral trait pointed out by the FSMB is process addiction. This is compulsive activity or psychological dependence on a behavioral activity. The process consumes the attention of the individual to the exclusion of other aspects of the individual's life, and it thereby creates problems. The following are some examples of activities—if compulsive and excessive—that fall into the category of process addictions:
- Gambling
- Spending/shopping
- Video gaming
- Workaholism
Understanding that workaholism is categorized as a process addiction can be an important first step toward early identification to mitigate risks. A process addiction, according to FSMB, can be problematic or even impairing in itself, and it can contribute to relapse of a physician in recovery. Given this, FSMB recommends process addictions be identified and treated.
Bylaws and policies
In order to meet the requirements of The Joint Commission to manage practitioner conduct and behavior, professional behavior as well as disruptive behavior (i.e., behavior that is adverse to patient safety) needs to be defined in medical staff bylaws and/or policies. Such policies should also require practitioners to immediately disclose any actions taken by another hospital, whether it be in response to impairment or disruptive behavior ("Legal and Practical Strategies," Michael R. Callahan, Katten Muchin Rosenman, LLP).
Hospitals should establish a clearly defined policy that requires reporting of suspected impairment or disruptive behavior whenever there is an occurrence or a reasonable suspicion (Katten). The policy should also specify the required procedure for communicating such occurrences to maintain the due process rights of the practitioner along with safeguarding other participants' immunity protections.
Medical staff bylaws and policies should provide a framework for developing an intervention that offers an "alternative to discipline" as we have previously discussed; however, for those who fail to cooperate, the ramifications should be clear.
We noted that a licensee who refuses to enter recommended treatment or leaves treatment prior to its successful conclusion would be subject to state medical board notification by the PHP medical director. It is also important for hospital policy to specify that uncooperative practitioners will be subject to disciplinary action up to and including suspension of privileges and potential loss of medical staff membership.
While disciplinary action is a last resort, setting forth the consequences for uncooperative/disruptive behavior can obviously serve as a deterrent. Legal experts point out that it is important to treat all individuals in the same manner, regardless of whether they are independent or employed. Even though the processes to address behavior issues may vary depending upon the particular individual's status (i.e., employed versus independent), conduct requirements should remain the same.
From Medical Staff Briefing, July 2105. Read the complete column by Patricia A. Furci, RN, MA, Esq., and Samuel J. Furci, MPA, principals at Furci Associates, LLC, here.