Promoting Professional Conduct

1. Promoting Professional Conduct Module 4: High-Conflict Personalities, Mental Health Issues, and Safety Considerations

2. Professional Conduct Toolkit Overview Module 1 Professional Conduct, Teamwork, and Patient Safety Module 3 Supporting Engagement— Role of Leaders and System Responses Module 2 Responding to Behaviors that Undermine Safe Patient Care Module 4 High-Conflict Personalities, Mental Health Issues and Safety Considerations

3. Introductory Scenario • A third-year medical student has recently rotated to your unit. He seems to be working hard, but staff have been complaining that “he has odd behavior” and that he has mood swings that make him come across as unpredictable. • After rounds one morning, he is heard in the hallway berating one of the housekeepers and loudly blaming the nurses for not keeping him informed of a patient’s transfer.

4. Module 4 Performance Objectives • Describe the link between promoting professional conduct and the safety and personal well being of health professionals. • Identify the traits of high-conflict personalities and strategies for setting limits on unprofessional behavior with them. • Identify the role of well-being committees and other assistance programs. • Identify strategies for supporting those who are impacted by high-conflict personalities and others who negatively impact the work environment.

5. Promoting Professional Conduct • Efforts to address disruptive behavior should be carried out in the context of an organizational commitment to the health and well-being of all staff. • Repeated patterns of unprofessional conduct may be symptoms of underlying disorders.

6. Exercise: Referral Policy Review • Signs indicating referral may be necessary • Review of policy and referral resources • Well-being committee and EAP

7. High-Conflict Personalities • High-conflict people are those individuals who have a life-long pattern of high-conflict behavior and who typically exhibit long-term traits of those with personality disordersand who engage in ongoing high-conflict thinking. Eddy, W. It’s All Your Fault: 12 Tips for Managing People Who Blame Others for Everything. (2008). Janis Publications.

8. Characteristics of High-Conflict People • A majority of high-conflict people have several characteristics in common.

9. Tips for Managing High-Conflict People • Use empathy and create connection repeatedly. • Acknowledge their fears and emotions as real to them without agreeing with their conclusions or beliefs. • Listen openly to their concerns without being taken in by misinformation or inaccurate conclusions. • Consistently set clear limits on behavior and create structures to contain their impact on others.

10. Tips for Managing High-Conflict People • Don’t fall for the drama and don’t adopt high-conflict behavior yourself • Recognize that a single intervention will not be sufficient—they will require continued interventions and limit setting • Do not take their attacks personally or feel you are to blame for the situation

11. Destructive Conflict Behaviors • For high-conflict people, the ability to self-reflect and self-correct is limited or nonexistent. • They default to destructive conflict behaviors and they seem unable to make different choices.

12. Destructive Conflict Behaviors • With most people, our initial reaction in a conflict situation is rarely our final response. • With high-conflict people, their initial reaction often escalates and becomes more rigid rather than becoming less defensive.

13. Exercise: Destructive Conflict Behaviors Scenarios • What patterns do you see common to both scenarios? • What destructive conflict behaviors do you see in each? • What actions can be taken to support those who are impacted by these individuals? • What limits or structures could be initiated to contain the impact of their destructive behavior? • How do you personally create a space to be empathetic with individuals suchas these?

14. Interventions • Once problems are identified, it is important to be responsive and follow the guidelines established by your organization for responding to lapses in professional conduct.

15. Supporting Others • The impact of high-conflict people in the work environment can be devastating, particularly for those who are the target of their dysfunctional behavior. • Providing referral options for those who have been targeted by high-conflict people is an important form of mutual support.

16. Summary • Efforts to address disruptive behavior should be carried out in the context of an organizational commitment to the health and well-being of all. • Managing lapses in professional conduct with high-conflict personalities takes advanced skills and persistent effort. • Supporting those who are impacted by high-conflict people, particularly those with less power or authority, is an essential role of leaders.