Strengthen your disruptive behavior policy

Dear medical staff leader:
One of the most frequent questions I have heard over the past several months has been how to develop a policy pertaining to disruptive physician behavior. Although ways to address this issue differ from one hospital to another, a solid policy will always have some specific elements.
When writing or revising such a policy consider including the following aspects in your document:

• It should state a general hospital and Board of Trustees intent that all individuals within its facilities are to be treated with courtesy, dignity and respect by all other individuals. Sometimes a policy will discuss who handles the behavior issues of employees and patients or their families/visitors.
• An outline of problems that can occur if disruptive behavior is allowed, such as, interference with hospital operations, a hostile work environment and interference with ability of staff to perform their duties or practice competently.
• It should state who handles the medical staff behavior problems. Many times, the board of trustees is the body charged with this responsibility, but often they delegate initial activities to medical staff officers or the medical executive committee (MEC).
• It should define the types of actions that may lead to immediate termination of employment or privileges, such actions can include assault, stealing, or inappropriate physical behavior.
• The policy should also define what is meant by disruptive. It should clearly state that just because an individual is different in some way, it does not characterize that person as disruptive. Even idiosyncratic behavior is not necessarily disruptive, unless it interferes with others or provides an unreasonable demand that does not contribute to the good of patients. Disruptive behavior is typically characterized as verbal attacks, inappropriate or belittling criticism, and inappropriate remarks in documentation or inappropriate sexual conduct. This section should use a term like "includes but is not limited to".
• A step-by-step procedure on how to report offensive behavior. This should include how to report, to whom the report should go and what information should be included in the report.
• A list of investigative actions to be taken. Those steps can include who will do the investigation and what steps the medical staff will take.

So start working on your disruptive behavior policy. Next month I will review some investigation and disciplinary steps that a medical staff might include in its policy.
 
All for now,
Barbara LeTourneau, MD, MBA
The Greeley Company