Kendall L. Stewart, M.D. April 19, 2005

1. Doctors Behaving BadlySome Practical Strategies for Dealing with Disruptive PhysiciansA Presentation for Holzer Medical Center Kendall L. Stewart, M.D. April 19, 2005

2. People are often difficult. Bigwigs are particularly difficult. Doctors Are the biggest wigs in the hospital, Sometimes behave badly, and When they do, it causes real problems—including problems with morale and retention. Judging from all the attention this topic receives, we must not manage difficult doctors very well. We could do better. And after this presentation, we will. After mastering the information in this presentation, you will be able to Identify three categories of difficult physician behavior Describe three practical strategies for dealing with disruptive physicians, Explain why those strategies make sense, and Explain how to deploy these strategies successfully in your organization. While only a minority of physicians are truly difficult, these bad actors consume the bulk of the organization’s energy. That’s why this so important. Why is this important?

3. What are some of the categories of difficult physician behavior? • Annoying Doctors • Negative doctors • Selfish doctors • Unreasonable doctors • Whining doctors • Disorganized doctors • Immature doctors • Disruptive Doctors • Angry doctors • Abusive doctors • Dishonest doctors • Arrogant doctors • Felonious doctors • Dangerous Doctors • Marginal doctors • Incompetent doctors • Impaired doctors • Distracted doctors • Careless doctors • Overwhelmed doctors

4. How do disruptive doctors behave? • They are disrespectful. • They berate colleagues publicly. • They use abusive language. • They indulge in condescending behaviors. • They throw temper tantrums. • They intimidate and threaten. • They engage in sexual harassment. • They lie, cheat and steal. • They are insulting. • They are upsetting to patients. • They throw things. • They slam doors and hit walls. • They may even physically assault others.

5. Acknowledge the problem. Make a commitment to manage the problem. Clarify your behavioral expectations. Require physicians to agree to behave. Field the best possible executive team.* Recruit a strong physician executive. Initiate a culture change. Delegate with care. Investigate and document allegations promptly, dispassionately and thoroughly.* Insist on fairness. Confront physicians effectively. Consider all options and choose the best one(s). Propose a reasonable solution and force dissenters to appear unreasonable.* Inform medical staff leaders; do not consult or seek consent. Follow up promptly with staff members. Send resolution letters immediately. Dismiss nuisance complaints quickly. Give your stars the star treatment. What are some strategies for dealing with disruptive physicians?

6. Why should you? This is your first obligation to your organization and your community. These leaders set the tone. Managing disruptive physicians effectively is not possible without a strong executive team in place. Lack of a unified team will invite mischievous physicians to “divide and conquer.” Weak leaders avoid conflict at all costs. When they can’t avoid conflict, they manage it badly. How can you? First, ask yourself whether you have fielded the best possible team of leaders. If you haven’t done it, do it. When you have, ask your boss to do the same. Offer your resignation as evidence of your commitment. Persuade your colleagues to take the same approach. Participate in meaningful succession planning. If you are an executive, remind the CEO that this is her primary obligation to the organization and the community. Field the best possible executive team.

7. Why should you? The “facts” of these incidents evaporate quickly. Everybody else’s emotional arousal distorts their perceptions. Your objectivity immediately establishes you as one who can be trusted. Your patient search for understanding discourages the leap to premature and erroneous conclusions. Your willingness to take meaningful action right away establishes you as the scene commander, reassures the victims and troubles the misbehavers. How can you? Interview witnesses right away. Include their manager in the interview process. Encourage complainants to prepare and sign their own statements. Do not act on undocumented hearsay; invective is usually followed by profound memory loss. Present the documentation to the physician. Document the resulting conversation. Invite the physician to respond in writing. Retain everything in their credentials files for two years. Investigate and document allegations promptly, dispassionately and thoroughly.

8. Why should you? It’s your job. It’s fairly easy to do. But very few leaders in these circumstances can figure this out. Most leaders are so emotionally aroused in these situations that they can’t see the available options. When you offer to take charge of this mess and the resulting fallout, your grateful colleagues will get behind you—way behind you—in a heartbeat. Most leaders are paralyzed by fear that someone won’t like them if they take an unpopular stand. The emergence of a “reasonable” option is just the exit door they were seeking. How can you? Identify every available option. Present the available options to the physician. Rule out the (unreasonable) options the physician prefers firing the staff member who annoyed him or just forgetting the whole thing. Propose the most reasonable option. Offer early adoption of this option as an opportunity to close the book and move on. If you’ve done your work properly, they will usually take their licks and move on. But they will remember and they will be less inclined to touch this hot stove again. Propose a reasonable solution and force dissenters to appear unreasonable.

9. What have we learned? • Disruptive physician behavior is a real problem in most of our hospitals. • Difficult people—including difficult physicians—are here to stay. • But the problem can be managed and minimized—and it must be. • Board commitment is critical. • Effective senior leadership is essential. • Strong physician leaders are the key change agents. • The deployment of the strategies in this presentation will make a difference.

10. Where can you learn more? • Rosenstein, Alan H., et. al., “Disruptive Physician Behavior Contributes to Nursing Shortage,” The Physician Executive, November-December, 2002 • Stewart, Kendall L., et. al. A Portable Mentor for Organizational Leaders, SOMCPress, 2003 • Stewart, Kendall L., “Physician Traps: Some Practical Ways to Avoid Becoming a Miserable Doctor” A SOMCPress White Paper, SOMCPress, July 24, 2002 • Stewart, Kendall L. et. al, “On Being Successful at SOMC: Some Practical Guidelines for New Physicians” A SOMCPress White Paper, SOMCPress, January 2001 • Stewart, Kendall L., “Bigwigs Behaving Badly: Understanding and Coping with Notable Misbehavior” A SOMCPress White Paper, SOMCPress, March 11, 2002 • Stewart, Kendall L., “Relationships: Building and Sustaining the Interpersonal Foundations of Organizational Success” A SOMCPress White Paper, SOMCPress, March 11, 2002 Most of these White Papers can be downloaded from www.KendallLStewartMD.com.

11. How can we contact you? Kendall L. Stewart, M.D. Chief Medical Officer Southern Ohio Medical Center President & CEO The SOMC Medical Care Foundation, Inc. 1805 27th Street Portsmouth, Ohio 45662 740.356.8153 stewartk@somc.org Webmaster@KendallLStewartMD.com www.somc.org www.KendallLStewartMD.com

12. What questions remain? www.somc.org Southern Ohio Medical Center SafetyQualityServiceRelationshipsPerformance 