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DISRUPTIVE PROFESSIONALS

2007 Annual Conference. DISRUPTIVE PROFESSIONALS. Raymond M. Pomm, M.D. Professionals Resource Network. WHAT IT IS NOT. SUBSTANCE RELATED DISORDERS. PSYCHOTIC DISORDERS. MAJOR DEPRESSION. BIPOLAR I / II. WHAT IT IS. A Continuum . Hi Disruptive. Dangerous Disruptive

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DISRUPTIVE PROFESSIONALS

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  1. 2007 Annual Conference DISRUPTIVE PROFESSIONALS Raymond M. Pomm, M.D. Professionals Resource Network

  2. WHAT IT IS NOT... Council on Licensure, Enforcement and Regulation

  3. SUBSTANCE RELATED DISORDERS Council on Licensure, Enforcement and Regulation

  4. PSYCHOTIC DISORDERS Council on Licensure, Enforcement and Regulation

  5. MAJORDEPRESSION Council on Licensure, Enforcement and Regulation

  6. BIPOLAR I / II Council on Licensure, Enforcement and Regulation

  7. WHAT IT IS... Council on Licensure, Enforcement and Regulation

  8. A Continuum Hi Disruptive Dangerous Disruptive Difficult Different Lo Disruptive Council on Licensure, Enforcement and Regulation

  9. Disruptive Professionals are ultimately... Council on Licensure, Enforcement and Regulation

  10. TEAMBUSTERS! Council on Licensure, Enforcement and Regulation

  11. The Underlying Issues... Council on Licensure, Enforcement and Regulation

  12. PredisposingCharacter Hospital Culture Stress Disruptive Incidents       Poor Coping Skills Poor Role Models Council on Licensure, Enforcement and Regulation

  13. PERSONALITY DISORDERS Council on Licensure, Enforcement and Regulation

  14. NARCISSISTIC PERSONALITY DISORDER Council on Licensure, Enforcement and Regulation

  15. THIS IS NO ORDINARY PERSON YOU’RE DEALING WITH! Council on Licensure, Enforcement and Regulation

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  21. Council on Licensure, Enforcement and Regulation

  22. WHAT TO DO... Council on Licensure, Enforcement and Regulation

  23. There is no law that says one cannot be Disruptive Council on Licensure, Enforcement and Regulation

  24. The: -Hospital -Group -Corporation -Leadership holds the hammer Council on Licensure, Enforcement and Regulation

  25. The steps to validate and protect the hammer: Council on Licensure, Enforcement and Regulation

  26. PRN DISRUPTIVE PRACTITIONERPOLICY & PROCEDURE The intent of this policy and procedure is to assist the referral source in utilizing the services of PRN in the management of the disruptive practitioner. The goal of these steps is to determine whether rehabilitation is a viable medical option. Before PRN will accept the referral of a disruptive practitioner, the following protocol must be followed: Slide 1 of 8 Council on Licensure, Enforcement and Regulation

  27. PRN DISRUPTIVE PRACTITIONERPOLICY & PROCEDURE 1) The referral source must document all disruptive behaviors, ramifications of said behaviors and any action taken due to the behaviors. 2) Confidential, one-on-one discussion of the behaviors in question between a “friendly” colleague (representative of the referral source) and the disruptive practitioner. The practitioner will be informed, prior to the discussion, that the confidentiality may be rescinded if the behaviors continue. Slide 2 of 8 Council on Licensure, Enforcement and Regulation

  28. PRN DISRUPTIVE PRACTITIONERPOLICY & PROCEDURE 3) Non-confidential, formal meeting with the admin level representative of the referral source, supervisor (if applicable) and the disruptive practitioner to discuss documented disruptive behaviors that need to be corrected, resulting in a warning that outlines consequences, if not corrected. ** An optional step can be inserted at this point if the referring source has an associated Impaired Practitioner Committee. This committee can be authorized to refer to PRN (step #4 b-e) or a recommendation will be made to the disciplinary body for suspension/termination (step 4a) of the disruptive practitioner. Slide 3 of 8 Council on Licensure, Enforcement and Regulation

  29. PRN DISRUPTIVE PRACTITIONERPOLICY & PROCEDURE 4) Meeting of disciplinary body of the referral source: a) disciplinary body must be ready to suspend/terminate the disruptive practitioner if he/she is unwilling to proceed and comply with the following steps; b) if both parties are in agreement, the disruptive practitioner must contact PRN in order to avoid suspension/termination; c) disruptive practitioner must sign release for PRN to communicate with referral source; Slide4 of 8 Council on Licensure, Enforcement and Regulation

  30. PRN DISRUPTIVE PRACTITIONERPOLICY & PROCEDURE d) phone call made by referral source to PRN in presence of the disruptive practitioner; e) all of the documentation must be faxed to PRN by referral source within five (5) business days of the referral to PRN; f) documentation must be of adequate detail for PRN to take appropriate action; Slide 5of 8 Council on Licensure, Enforcement and Regulation

  31. PRN DISRUPTIVE PRACTITIONERPOLICY & PROCEDURE 5) Refer for evaluation, to be arranged by PRN, to a DOH/PRN approved evaluator. The evaluation must be comprehensive. The evaluation must be completed within ten (10) business days of the referral or PRN will recommend the hospital follow through with suspension/termination (unless delay is caused by the evaluator and/or PRN). Slide 6 of 8 Council on Licensure, Enforcement and Regulation

  32. PRN DISRUPTIVE PRACTITIONERPOLICY & PROCEDURE 6) If evaluation is not completed in timely fashion, PRN will make decision whether information is sufficient for referral to Department of Health to compel an evaluation within a certain time frame. 7) If appropriate, contract with PRN under Behavioral Management Contract to include: a) therapeutic recommendations of the evaluator, b) behavioral requirements and consequences as agreed to by the referral source, evaluator and disruptive practitioner, Slide7 of 8 Council on Licensure, Enforcement and Regulation

  33. PRN DISRUPTIVE PRACTITIONERPOLICY & PROCEDURE 8) The disruptive practitioner must execute the contract within ten (10) business days of its receipt. ** PRN is available to the referral source to discuss situation/issues/procedures at any time during this process Slide 8 of 8 Council on Licensure, Enforcement and Regulation

  34. Let’s look at Evaluation/Treatment/Monitoring Process... Council on Licensure, Enforcement and Regulation

  35. Speaker Contact Information Raymond M. Pomm, M.D. Professionals Resource Network P.O. Box 1020 Fernandina Beach, FL 32035 (800) 888 - 8776 Council on Licensure, Enforcement and Regulation

  36. 2007 Annual Conference Disruptive Professionals: New Approaches to Evaluation and Management Larry Harmon, PhD Physicians Development Program

  37. Disruptive Behavior is … … a pattern of conduct which reduces or disrupts the ability of the healthcare (or other) team to do it’s best work Council on Licensure, Enforcement and Regulation

  38. Who are the Disruptive Docs? • MBAs • “Good Doc … Bad Talk” Council on Licensure, Enforcement and Regulation

  39. Clinical Evaluation • Clinical Interview • Extensive Personal History • Psychological & Cognitive Testing • Criminal Background Checks • Drug Testing • “Workplace Behavior Assessment” Council on Licensure, Enforcement and Regulation

  40. Workplace Behavioral Assessment360° P.U.L.S.E. Survey P.hysicians + Professionals U.niversal L.eadership + Teamwork S.kills E.ducation Survey Council on Licensure, Enforcement and Regulation

  41. Workplace Behavioral Assessment • Each physician scores self on survey • Other physicians and healthcare team members give physician survey feedback • Feedback Report is prepared Council on Licensure, Enforcement and Regulation

  42. 3 Types of Assessments • Individual- Continued disruptive pattern despite progressive warnings • Small Group or Section (2-10) • Individual resists • Protect identity of subject • Department or Hospital Program Annual Leadership Feedback Reports Council on Licensure, Enforcement and Regulation

  43. Conducting an Individual Workplace Behavioral Assessment Council on Licensure, Enforcement and Regulation

  44. Phase I:Assessment Step 1: Referral Letter Step 2: Physician Orientation Council on Licensure, Enforcement and Regulation

  45. Step 3. Select “Feedback Groups” Administration Supervisors Colleagues Other Depts. Dr. Disruptive Nurses+ Healthcare Staff Patients* *Patient Pulse survey Support Staff Council on Licensure, Enforcement and Regulation

  46. Step 3. Select “Feedback Groups” Administration “Validator” Adds Any Missing Names(Chief of Staff, CEO, i.e., the “Boss”) Supervisors Colleagues Other Depts. Dr. Disruptive Nurses+ Healthcare Staff Patients* *Patient Pulse survey Support Staff Council on Licensure, Enforcement and Regulation

  47. Step 4. “Self-Rating” Council on Licensure, Enforcement and Regulation

  48. Motivating/Encouraging Dimensions Council on Licensure, Enforcement and Regulation

  49. Disruptive/Discouraging Dimensions Council on Licensure, Enforcement and Regulation

  50. Step 5.Writes Cover Letter TO: My Team Members and Colleagues RE: Invitation for Honest Feedback I am participating in a national Physicians Leadership Development Program, and part of the program is to obtain feedback to help me better understand my workplace interpersonal leadership style and people skills. I have requested the Physicians Development Program to distribute their physician people skills survey, called the “P.U.L.S.E. Leadership Survey,” to my team members, so I can get group feedback. Be honest…survey is anonymous… Dirk Disruptive, MD Council on Licensure, Enforcement and Regulation

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