Tips to discuss performance issues with physicians

Dear medical staff leaders:

One of the major responsibilities of the medical staff is to monitor and improve physician performance. This means that from time to time we must meet individually with physicians to discuss their performance.

Most of the time physicians are willing to sit down and discuss data or findings about their performance. But since this may not always be true, the medical staff bylaws should include a section that requires physicians to meet when requested to do so by medical staff officers such as the chief of staff, department chair, MEC or medical staff quality committee.

Here are some tips for holding these meetings:

• Carefully select who will attend the meeting. A collegial first meeting may only require one medical staff leader. This will often be the department chair. If the meeting is a second meeting, or if you expect resistance by the physician, at least two leaders should be present. Others involved may be the section chief, chief of staff, or chair of the quality committee.
• The meeting should begin with a reminder to the physician that he or she is a valued member of the medical staff. Separate the physician and his or her overall practice from the problem you wish to discuss.
• Be specific to the problem you wish to discuss. Talking in generalities may avoid confrontation but it will not improve performance. In order to improve, the physician has to know exactly what needs attention.
• Constantly refer to the data. It is not advisable to discuss performance improvement unless you have reliable and valid data about the issue under discussion.
• Be persistent. Physicians often are unwilling to accept a need for change. It may be necessary to bring the conversation back to the issue and the data supporting it. Many physicians divert attention from themselves by criticizing other physicians, the data, or others in the meeting.
• Limit the meeting time. The meeting should be scheduled for 30 or 45 minutes, or before a key time such as OR time or office hours. This is helpful if the physician has a history of inappropriate responses to performance or behavior issues. If the planned time ends before all parties resolve the issue, you may need another meeting for further discussion.

All for now,

Barbara LeTourneau, MD, MBA
The Greeley Company