Managing Disruptive Physician-Generated Risk in Communication Patterns

the-highwireA physician’s communication style can dramatically increase the risk of serious error in patient care.  Simple adjustments in style can conversely reduce risk and liability.  The One Minute Manager by Ken Blanchard and Spencer Johnson written in 1981 has sold millions of copies. It is still a gold standard of manageable ways to reduce work stress, empower workmates, improve efficiency and manage good communication.
 
One minute is the time it takes, according to Blanchard and Johnson, to do effective completion of many tasks, give praise to workmates and give reprimands when appropriate. In 60 seconds, a busy and harried physician can conceivably clear a piece of paperwork from his path by handling it only once and attending to it when it is first picked up.  This technique works for several reasons.  The paperwork does not pile up into a seemingly insurmountable and tedious task; quickly disposing of that obligation eliminates having that and other similar tasks brewing on the backburner to distract and ‘haunt’ you through the workday and if you have the inclination and time to pick up a piece of paper to inspect it in the first place, chances are you also can spare 60 seconds to process it so you don’t have to touch it again.
This philosophy is easily translated into improving communication, improving work relationships and de-stressing as you go through the typical workday or answer call.
 
Another technique described by Blanchard and Johnson is the one-minute praising.  Ending an exchange with workmates with 60 seconds (or less!) of appreciation for their contribution is a fantastic investment with high return.  Giving the details of why you appreciate them, and/or the current interaction, builds a supportive and cooperative work alliance that will, over time, become a valuable resource in further supporting you.
 
These 60 seconds also become ‘training’ for team members in which you teach how best to communicate with you and what decisions and behaviors of theirs best help you to do your work. Praise boosts morale and empowers others to operate with authority within their scopes of practice so that your own practice is complemented and better empowered.  This small investment will mobilize your available work resources, increase the likelihood that your need-to-know information is readily communicated and reduce risk and liability in patient care.  It is a minute investment for big pay-off’s in professional self-care and a sense of enhanced work related well-being
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The third technique offered by Blanchard and Johnson is the one-minute reprimand.  There are times when reprimands are necessary.  Limiting this exchange to 60 seconds of a clear, calm explanation of the problem, as well as the corrective action needed, will greatly reduce your own stress, contain any emotionality that might rise in lengthier interactions and take that issue off the mental backburner where resentment and potential emotionality will simmer.  Taking 60 seconds immediately to address an error in a professional tone and to suggest a corrective plan again is a small investment in clearing the air, maintaining good working relationships and ‘teaching’.

Keeping in mind that praise is greatly enhanced in its power when an audience is listening and that reprimands are received much more easily and without resentment when care is taken for discretion will make those 60 seconds of communication even more potent, effective and empowering to your work team.

Anger Management Institute of Texas’ Executive Coaching Program is utilized by management of accredited hospital/organizations for physicians displaying disruptive behaviors in the workplace.

For more information please visit http://www.ami-tx.com

“Anger Management Institute of Texas is a certified Anderson & Anderson provider.”

Gregory A. Kyles, M.A., LPC, CEAP, CAMF
Director, Anger Management Institute of Texas
Diplomate, President of Texas Chapter
American Association of Anger Management Providers
http://www.ami-tx.com
https://gregorykyles.wordpress.com
http://www.linkedin.com/in/gregorykyles
http://www.myspace.com/anger_management_expert

Professional Consequences for the Disruptive Physician—the role of other physicians and professional organizations

consequences13Physicians considered “disruptive” in their professional lives are now faced with a greater possibility of administrative interventions due to JCAHO standards.  Interventions could result in loss of facility privileges, limited or lost privileges to practice medicine and even legal proceedings.  Physicians should be aware that administrative agencies could require that a disruptive physician undergo psychological assessment in order to determine fitness for practice and that a disposition of impairment is possible.
 
Such proceedings are distinct from civil or criminal proceedings reactive to malpractice. These are not to examine a case of patient care per se, but are to evaluate a physician’s fitness to continue medical practice. Interventions to address professional disruptive behavior and professional impairment can result in revoked licensure.  While revocation has been appealed in state courts, typically courts defer to the discretion of medical boards.
 
The AMA stands firm that all physicians are responsible for maintaining health and wellness in order to be fit for medical practice.  The following is from the AMA Ethics Policy E-9.0305 Physician Health and Wellness:

“To preserve the quality of their performance, physicians have a responsibility to maintain health and wellness, construed broadly as preventing or treating acute of chronic diseases, including mental illness, disabilities, and occupational stress.  When health or wellness is compromised, so may the safety and effectiveness of the medical care provided.  When physical or mental health reaches the point of interfering with a physician’s ability to engage safely in professional activities, the physician is said to be impaired.

In addition to maintaining healthy lifestyle habits, every physician should have a personal physician whose objectivity is not compromised.  Physicians whose health or wellness is compromised should take measures to mitigate the problem, seek appropriate help and engage in an honest self-assessment of their ability to continue practicing.”

The AMA Code of Medical Ethics states that a “physician shall respect the rights of patients, colleagues, and other health professionals” and that a “physician shall…report physicians deficient in character or competence…to appropriate entities.”

Hospitals mandated by JCAHO to develop policies to address disruptive physicians may make decisions about their own organization’s relationship with a physician against whom allegations of disruption are made.  They may also, based upon the results of an investigation, involve the state medical society’s impaired physicians’ health service program. 

Confidentiality is guarded in treatment and supervision of impaired physicians; however, some states do have disclosure laws that mandate certain types of information be reported.  Discovery of past serious misconduct and patient harm, or potential patient harm, are reported to the state medical board.
Additionally, some state medical boards will post findings of misconduct in print and/or electronically.  The National Practitioner Data Bank will also post allegations and findings that come to medical boards for review.

Anger Management Institute of Texas’ Executive Coaching Program is utilized by management of accredited hospital/organizations for physicians displaying disruptive behaviors in the workplace.

For more information please visit http://www.ami-tx.com

“Anger Management Institute of Texas is a certified Anderson & Anderson provider.”

Gregory A. Kyles, M.A., LPC, CEAP, CAMF
Director, Anger Management Institute of Texas
Diplomate, President of Texas Chapter
American Association of Anger Management Providers
http://www.ami-tx.com
https://gregorykyles.wordpress.com
http://www.linkedin.com/in/gregorykyles
http://www.myspace.com/anger_management_expert

Anger Management Executive Coaching Services for Physicians in Houston, Texas


Anger Management Institute of Texas’ Executive Coaching Program for Disruptive Physicians is experiencing a dramatic increase in referrals from Texas, and Louisiana.
 

All of the referrals have been made by management of accredited hospital/organizations as a result of JCAHO Sentinel Event Alert Issue 40, July 9, 2008 which became effective January 1, 2009 regarding physicians displaying disruptive behaviors in the workplace.

Our Anger Management Executive Coaching 10 Hour program is available for clients who would prefer a private setting or are not appropriate for mixed or open groups. Such individuals may include, but are not limited to, high profile individuals, physicians, attorneys, judges, faculty, law enforcement, and high-level management.
 
The program is designed to improve stress and anger management, communication, empathy, and emotional intelligence. Initially, a confidential Anger Management Map, and Emotional Intelligence Profile assessment is utilized to determine your current level of functioning in the following areas:
 
1. Interpersonal Aggression
2. Interpersonal Assertion
3. Interpersonal Deference
4. Interpersonal Awareness
5. Self-Esteem
6. Empathy
7. Drive Strength/Motivation
8. Decision Making
9. Time Management
10. Leadership
11. Commitment Ethic
12. Stress Management
13. Physical Wellness
14. Personal Change Orientation
 
Based on the results of the assessments, our Executive Coaching clients are provided with an individualized plan of action that includes exercises and behavior logging tools to facilitate the learning process. Sessions concludes with a review and a summary. If at all possible these classes should be completed in a timely manner; evening and weekend hours are available.
 The weekend program schedule is:
 
• Friday   6 – 8 PM   Assessment and review
• Saturday 1 – 5 PM  Executive Coaching
• Sunday    8 – 12 Noon   Executive Coaching
   
Note:  We provide optional 30 Day, 60 Day, and 90 Day 30 minutes (telephone or in-person) follow-ups.

Gregory A. Kyles, M.A., LPC, CEAP, CAMF
Director, Anger Management Institute of Texas
Diplomate, President of Texas Chapter
American Association of Anger Management Providers
http://www.ami-tx.com

http://www.ami-tx.org
https://gregorykyles.wordpress.com
http://www.linkedin.com/in/gregorykyles
http://www.myspace.com/anger_management_expert