Planning and practicing an intervention

Dear Medical Staff Leader,

Last week's issue discussed planning an intervention as soon as a physician's performance comes into question. Planning ahead can turn an awkward situation into a productive one, but as with anything, practice makes perfect. Practicing an intervention, whether in front of a mirror or alone in the car, will help you stay on track when the heat is on.

The following tips will help with a difficult intervention:

1. Reference your role
2. Identify the problematic behavior or incident
3. Refer to previously agreed upon expectations or the approved policy
4. Invite the physician to provide another side of the story
5. Deflect excuses and justifications
6. Constantly refer to data
7. Focus on the behavior, not the person
8. Clarify the nonretaliation policy
9. Be persistent
10. Keep the intervention time-limited
11. Close with the physician's commitment and the next steps
12. Inform the physician how the meeting will be documented

Referencing your role validates your authority and informs the physician that the intervention is not an informal colleague-to-colleague discussion. Reference the physician's behavior to medical staff policies or to expectations of performance that the medical staff as a whole has agreed upon. As noted in the preceding section, the physician will frequently have another side of the story and offer excuses and justifications for his or her behavior, but you must keep the focus on the behavior itself.

No matter the excuse or justification, poor behavior will not be tolerated. Offer data that supports your claims objectively. The physician may feel personally attacked by this discussion and attempt to retaliate. To prevent this from occurring, focus on the behavior as a problem, not the person. Make sure you clarify the nonretaliation policy and inform the physician that retaliation is an immediate reason for corrective action.

These interventions are difficult and emotionally draining-for both parties. Keep the interventions time-limited, usually no more than 20 minutes and if a satisfactory resolution is not reached, conclude the meeting and reschedule a follow-up meeting in the near future. Close with a commitment to action but also notify the physician how his or her behavior will be monitored in the future. At the conclusion of the meeting, inform the physician how the meeting will be documented.

Now that you have planned and practiced the intervention, it is time to carry out the intervention. Know that everyone makes a few mistakes the first few times they conduct a difficult intervention. Just do your best and learn from the experience. The best learning is gained by debriefing with a mentor and working to improve for the future.

The above paragraphs have been excerpted from Medical Staff Leaders' Practical Guide, Sixth Edition, by William K. Cors, MD, MMM, FACPE; Mary J. Hoppa, MD, MBA; and Richard A. Sheff, MD.