Sample mandatory appearance policy

What is the best way to deal with disruptive behavior? Notice that the question asks about the behavior and not the person. This is the first and most important step in dealing with such physicians, as you are trying from the outset to separate the behavior from the person.

Conduct the initial intervention when medical staff leadership has decided to proceed beyond just providing routine feedback. The first intervention is usually collegial and focused on answering the question “Why is your performance different?” instead of “Why is your performance bad?"

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 inthe past. At subsequent interventions, the goals are to develop an action plan to correct the physician’s behavior and to secure commitment from the physician to follow that action plan.

If you feel that 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 and call his or her attorney, it is best to fall back on a mandatory 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 its completion, without an attorney. Excerpted from The Medical Staff Leader's Practical Guide by William K. Cors, MD, MMM, FAAPL, he following is an example of a mandatory appearance policy.