How hospitals should deal with disruptive physician behavior

by Mark N. Simon, MD

What can hospital medical staff leaders learn from University of Oregon football coach Chip Kelly? In the morning of September 4th, Kelly had an opportunity to review video tape from the conclusion of his team’s game with Boise State University the night before. What he saw was his senior running back LeGarrette Blount punch an opponent and then lose his cool with the fans in attendance. He also saw that it took a number of individuals to get Blount off the field and into the locker room.

Kelly was now faced with one of the most difficult decisions any leader will face. What was he to do with a valuable member of the team whose behavior was clearly unacceptable? Blount was beginning his senior season with the university. He had been named to the watch list for the Doak Walker Award (the best running back in college) and he was projected to be a 2nd round draft pick in next year’s NFL draft. Blount had set a University of Oregon record with 17 rushing touchdowns in 2008 and had rushed over 1,000 yards that year. Any punishment leveled by Kelly would likely have a significant impact on the team’s offensive production and possibly could result in fewer team wins. Not an easy decision for this first year coach.

Kelly pondered all of these facts, reviewed the evidence, and considered his previous interactions with Blount. Blount had been punished by the coaching staff earlier in the year for previous poor behavior. In the end, Kelly determined that the behavior displayed by Blount was inappropriate and Kelly suspended Blount for the remainder of his senior season. Kelly wants Blount to participate in other football related activities but he will not be allowed to play in any more games. Kelly said, “…he needs to pay for that mistake. But we’re not going to throw LeGarette Blount out on the street.”

How does this translate to the hospital setting? Not infrequently, medical staff leaders are faced with disruptive behavior by physicians. On many occasions, the physicians responsible for these behaviors represent a “great value” to the hospital, and people are reluctant to take significant action for fear of losing business. Kelly recognized that Blount represented a “great value” to the team, and he determined that Blount’s behavior did not meet those expected of member of the team. In addition, Blount had already been subjected to disciplinary action and had been once again reminded of what behaviors were expected. Blount was also aware of the potential consequences of poor behavior.

Hospital leaders should follow these same examples for all members of their teams regardless of perceived value.

* Expected behaviors should be clearly delineated.
* Consequences for divergence from these behaviors should also be delineated.
* The type of punishment should be in line with the severity of the infraction.
* Consequences should increase in a step-wise fashion for repetitive infractions.
* Clear communication should occur at each and every instance.

In the end, medical staff leadership like Chip Kelly must be willing work with disruptive providers while being firm when it comes to expectations. They must not be afraid to suspend or dismiss providers who unable or unwilling to conform to codes of conduct. Medical staff leaders are not only responsible to monitoring the skills of their providers. They are responsible for making sure that the providers adhere to team norms in order to cultivate the best environment for providing quality care to the patients they serve.

Mark N. Simon is an OB-GYN hospitalist.

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