Bioethicists "ideally qualified" to help address disruptive behavior
Basic ethics are central to policy development, education
"The problem isn't really that serious." "Some people are just being overly sensitive." "The physician is close to retirement, so there is no need for formal intervention."
Responses such as these serve to deny or rationalize disruptive behavior by physicians who are rude, condescending, or abusive, says ethics consultant and former hospital CEO Paul Hofmann, DrPH, FACHE. Hofmann is president of Hofmann Healthcare Group in Moraga, CA.
"When staff members are intimidated by physicians or others who exhibit threatening behavior, a severe impact on both patient care and staff morale is unavoidable," says Hofmann. He says that hospital leaders must:
- provide training programs concerning this critical topic;
- perform periodic surveys of staff members regarding satisfaction with their working environment;
- monitor compliance with codes of conduct, as well as disruptive behavior policies and procedures;
- address areas of noncompliance;
- have simple, confidential, and convenient means for reporting concerns;
- investigate all allegations promptly and thoroughly;
- give timely feedback on all complaints submitted.
"Having appropriate policies and procedures is obviously not enough," says Hofmann.
Disruptive physician behavior has been the subject of medical staff investigations and sanctions for decades, and hospitals are required by The Joint Commission and other regulatory agencies to address the issue.1,2
Many leaders don't have the courage or know-how to deal with disruptive doctors, however, says John D. Banja, PhD, a medical ethicist at the Center for Ethics at Emory University in Atlanta, GA.
"In many instances, the disruptive doctor knows that his or her clinical skills are valuable to the organization — 'Dr. X is the only neurosurgeon for 100 miles around and we must keep him.' So he gets away with just about anything," says Banja.
Involvement of bioethicists
While most bioethicists lack the requisite training for intervening with disruptive doctors directly, says Banja, they can point out that such disruptiveness is not conducive to organizational goals; can harm employees and even patients; and degrades employee morale.
"The primary reason that disruptive doctors are disruptive is because they are allowed to be disruptive," says Banja. He says the best intervention is an empathic one in which the disruptive doctor is made aware of the consequences of his or her behavior and, it is hoped, becomes impressed with the need to change.
"Bioethicists can and should support efforts to reduce disruptive behavior," according to Hofmann. Bioethicists are certainly well trained in dealing with sensitive issues, including conflict resolution, he adds, so they can make particularly important contributions in policy development and staff education.
"Bioethicists may not have been involved in the past, because many have focused almost exclusively on clinical ethics and devoted less attention to organizational ethics," Hofmann says. "But this subject clearly overlaps both arenas."
Hofmann has found that bioethicists are often underutilized in addressing challenges associated with organizational ethics, including disruptive behavior.
Some executives are hesitant to invite input from bioethicists in administrative matters, such as developing a policy on the solicitation of donations from high net worth patients by their physicians or contributing to the revision of a community benefit plan to reduce health care disparities due to racial, ethnic, and socioeconomic factors.
"By demonstrating organizational insight and credibility when making presentations to employees, physicians, and board members, bioethicists can be increasingly viewed as valuable participants in management and business discussions that have ethical implications," says Hofmann.
However, senior managers don't always recognize when issues have significant ethical dimensions. Hofmann suggests that bioethicists review the American College of Healthcare Executives' Ethics Self-Assessment Survey to familiarize themselves with topics identified as ones requiring attention.
In Hofmann's view, bioethicists are "ideally qualified" to help with policy development and education regarding disruptive behavior because the subject involves many basic ethical principles.
"Concerns related to confidentiality, competing values, avoiding a rush to judgment, the influence of organizational power on reporting problems, and procedural fairness and justice are examples of matters very familiar to bioethicists," he says.
- Rosenstein AH, O'Daniel M. A survey of the impact of disruptive behavior and communication defects on patient safety. The Joint Commission Journal on Quality and Patient Safety 2008;34(8): 464-471.
- The Joint Commission: Behaviors that undermine a culture of safety. Sentinel Event Alert, July 9, 2008:40.