Prepare for physician intervention

Dear medical staff leader,

In last week's Tip of the Week, we discussed taking a proactive stance to poor performance. Establishing a series of interventions as soon as a physician's performance appears on the radar screen, although sometimes seen as retribution, can actually help a physician succeed with the help of his or her peers. Unfortunately, few medical staff leaders have been trained to conduct a successful intervention.

When preparing for an intervention, ask yourself the following questions:

What are the goals of the intervention?
For a first intervention, an ideal outcome is that in which the physician acknowledges the behavior causing the incidents, expresses regret, and vows to comply with appropriate behavior going forward. But frequently, physicians will not acknowledge their behavior as having caused a particular event. There are two sides to every story. The best outcome in this case is to have the physician state that he or she will comply with appropriate behavior or follow the accepted policy going forward. This agreement does not require the physician to admit that he or she failed to follow it in the past. At subsequent interventions, the goals are development of an action plan to correct the physician's behavior, and a commitment by the physician to follow that action plan.

What are the physician's likely responses and what will you do if he or she reacts as expected?
If you feel the physician will continue to refute the accusations, come armed with data. If the physician tends to get volatile in these situations and shouts, counter by talking quietly (enforcing the idea that you are not fazed by the physician's yelling) or respond in a forceful way without shouting to show that you are not intimidated. If the physician threatens to leave or call his or her attorney, it is best to fall back on a special appearance policy, which is a policy that states that in these situations, if a physician leaves before the conclusion of the meeting, he or she will automatically undergo temporary suspension of privileges until the meeting is held to completion, without an attorney.

What sources of influence will likely cause a physician to discontinue disruptive behavior?
To determine what sources of influence will likely cause a physician to discontinue disruptive behavior you need to get inside the head of the disruptive physician. What is important to him or her? Is it his or her reputation among peers, is it an appearance in front of the MEC, or is it the threat of loss of privileges or membership? Structure your part of the dialog referencing those points that are most likely to have influence on this particular medical staff member.

What is the backup plan if the physician refuses to change?
If the disruptive physician refuses to commit to changing his or her behavior, sometimes a single intervention may need to occur over multiple meetings. This series of interventions may need to be held in an environment and with people who have greater authority, such as an intervention by the department chair, chief of staff, or chief of staff with the CEO. On occasion, such meetings are necessary to convey the seriousness and importance of the meeting and its discussions.

How will you know whether significant change has occurred?
At your intervention, secure buy-in from the physician that the measurements you will be taking are valid to him or her. This could be validated incidents of inappropriate behavior or the results of patient or staff satisfaction surveys.

How will you document the intervention?
The best way to document an intervention is to write a letter to the physician documenting what was discussed at the meeting, what was agreed upon, and the next steps. Place a copy of this letter in the physician's quality file.

Editor's note:
The above paragraphs were 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. For more information about conducting an intervention, check out the training video for medical staff leaders and general medical staff members, Dealing with Disruptive Physicians: How to End Problem Physician Behavior Now, by clicking here.