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The Challenge

The Challenge. The spectrum/expectation of individual independence The “collective” personality of the group. Problem Behaviors. Noticed, identified, and discussed The bell is rung Avoid action? Risk Patients Staff Colleagues Regulators. Groups Are Enablers. Rationalize Minimize

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The Challenge

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  1. The Challenge • The spectrum/expectation of individual independence • The “collective” personality of the group

  2. Problem Behaviors • Noticed, identified, and discussed • The bell is rung • Avoid action? Risk • Patients • Staff • Colleagues • Regulators

  3. Groups Are Enablers • Rationalize • Minimize • Compartmentalize • “But he’s a good doctor”

  4. Transient Situational Disorder • Divorce • Financial loss • Life hazards

  5. The Litigation • Risk is real

  6. Profiles • The intellectual bully • Life is too short to be bullied • The passive-aggressive cynic • Difficult to address • The “play by the rules” under-performer • The practice “fast track” to mediocrity

  7. The Intellectual Bully • Senior, experienced • Not compliant with rules • Dismissive to patients/staff • Unresponsive to same • Intimidates; colleagues modify schedules • High-producer

  8. The Passive-Aggressive Cynic • Cynicism elevated to a high art • Right to an opinion, but manner and method • Sub rosa behavior • Hallway and locker room conversation • Will cultivate devotees • Pushes limits without “wrong doing”

  9. The Play-by-the Rules “Under-Performer” • Does the minimum, not a lot more! • Not the fastest nor the slowest • A clock-watcher, schedule analyzer • Does nothing wrong/nothing right • Narcissistic, no organizational conscience • A fast track to mediocrity

  10. Prevention • Recruitment • Values = climate • Culture or “feel” • Hard work, respect, the support • Culture  values = contract • Norms  code of conduct

  11. Walk the Talk • Leaders offer no compromise when values/norms are breached. • No retribution

  12. Intervention • Recognition of a sentinel event • Is there time to analyze, reflect, plan, execute?

  13. Action Plan • Group leadership • Group policies • Who should take action? • Clarify facts; focus on behavior variance • Determine action appropriate to variance • Written prediction and expectations of behavior

  14. Action Plan • Administer the action – face to face • Expectations • Behavior modification • Support, guidance • Counseling

  15. Action Plan • Follow-up • Group Leadership • Accountable • Monitoring closure • Legal Counsel • Documentation • Filing

  16. Group Damage Control • Intimidation • Self correction • Supervisor intervenes • Group intervenes • Diffuse behavior • Reiterate norms at meeting • Activate an educational process

  17. Set the “practice norms,” the contract, put them in writing, and communicate them Make these expectations part of orientation Leadership behavior must be consistent with the norm, or they will not be taken seriously Promptly address variances as they occur Ensure that actions taken are proportional to infractions Follow up and document Use adversity to learn and reinforce normative behavior Consult outside experts and leadership to show the group that the issue is serious Summary

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