Track and trend behavior issues

Medical staff and hospital leaders often find it difficult to track and trend behavior problems because medical staff members are reluctant to report improper conduct for fear of retribution. To encourage reporting, reporting systems must respect and protect staff members who disclose other physicians’ improper conduct while holding them accountable for reporting incidents in “good faith.” Reporting behavior in good faith means putting the best interests of patients first and discouraging reporting for the sake of retaliating against a provider for alleged wrong doing.

Unfortunately, many hospitals and medical practices have not created an institutional culture that supports the reporting of conduct concerns. Instead, these organizations too often overlook or tolerate disruptive physician behavior. Although some hospitals are officially moving toward zero-tolerance approaches to improper conduct, cultural change commonly lags behind policy change.

Leaders are challenged by the subjective nature of reporting methods that are based on individuals’ perception of a particular behavior. Because medical staff leaders are accustomed to dealing with hard facts when they evaluate data to reach conclusions, they often feel uncomfortable acting on subjective reports.

Behavioral assessments of any kind are considered perception data because they are dependent on what others perceive our behavior to be. Physicians may feel uncomfortable allowing non-physicians to evaluate any part of their performance and become offended when placed in that situation. Unfortunately, there are dimensions of performance, such as interpersonal skills, that are difficult, if not impossible, to assess solely through interaction with peers. Often, a nurse manager or other member of the healthcare team is in a far better position to view day-to-day interactions that may go unnoticed by leadership. This is also a challenging situation due to the inherent hierarchy between physicians, nurses, and other healthcare providers; nurses and other healthcare providers may feel uneasy attempting to communicate with physicians about their behavior issues and vice versa. This tension should be openly discussed with all parties so that every member of the healthcare team feels comfortable interacting with each other when they are asked to assess performance.

If your medical staff implements a behavioral event review committee (BERC) model, each incident report or occurrence of disruptive behavior that involves a physician is reported to the BERC, and a member of the BERC seeks the physician’s side of the story. The physician’s side of the story is factored into the equation before the BERC engages in discussion about or categorizes the incident. The BERC enters its final determination into a database that tracks all information regarding the incident.