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A physician's disruptive behavior goes unresolved
Poorly managed conflict resurfaces
A hospital CEO received three occurrence reports from a charge nurse on labor and delivery about several problems involving the same physician. Nurses reported feeling intimidated, hurried, and made to feel incompetent due to being berated, sometimes in front of the patient.
The chief of staff and CEO previously had met with the physician to discuss similar concerns. During that meeting, he was defensive, insisting on details and names of his accusers, and was able to surmise who they were by the event descriptions. "For a while, he seemed to get better with his behavior on the unit, but then the problem resurfaced," reports Adele Sullivan, PhD, president of Palm Beach Gardens, FL-based Interventus Inc., a health care consulting firm specializing in conflict management.
In this type of scenario, have the risk manager or other appropriate individual interview the nurses on the unit, ask a series of questions about the physician, and then let him read their anonymous comments, suggests Sullivan. "Tell him that you want to keep this out of the disciplinary process and this is the last attempt to do just that, but that you need for him to hear what others say about him," she says. In addition, the following questions should be considered:
After having collected the information from the nurses, the next step is to meet with the doctor to assess why he behaves this way. Does he feel that this is the only way he will be able to get respect? Does he recognize that a problem exists with his relationship with the nurses? Are there any cultural issues?
Also examine if the staff are in some way creating or perpetuating the problem. "As the previous attempt has shown, you won't be able to solve the problem at the root level by only focusing on one side of the equation," says Sullivan. "If the doctor knows that the nurses will be part of the solution, he may be willing to consider any changes."
In health care, professional roles are interdependent and relationships are ongoing, and working together without good communication has a negative effect on patient care, says Sullivan. "Even though it may be uncomfortable for the nurses involved, ultimately it will be difficult to solve this issue if they cannot come face to face and discuss it, especially since they will have to continue to work together," she says.
Eventually, a mediated meeting between the parties involved could open up communication and make each side understand the possible consequences to patient care. "It may take some time and effort to get to this point, but it is critical," Sullivan says.
This type of conflict should be addressed as early as possible before it has an impact on any more people, says Sullivan. "Even if the other nurses are not directly involved, it is only natural that they form opinions and take sides, drawing them into the web," she says. Staff must know their options when it comes to resolving conflict, confidentiality must be ensured, any form of reprisal should be prohibited, and a neutral person should be available who can guide the process to successful resolution, says Sullivan.
Procedures should also address "what ifs," such as what to do if the supervisor does not see the situation the same way — where does the employee go for assistance?
Sullivan says the question to ask is, "How do we resolve this at the lowest level without bumping it up into counsel's office?" She recommends the use of an employee ombudsman, a hot line, or using a resolution facilitator.
"Making people accountable is essential. But they must have the right tools, know how to use them, and the culture must support them," she says.