Pragmatic Systemic Solutions to the Wicked and Persistent Problem of the Unprofessional Disruptive Physician in the Health System.

We have always had and will always have "disruptive" or "dysfunctional" doctors behaving unprofessionally within healthcare institutions. Disruptive physician behaviour (also called "unprofessional behaviour") was described almost 150 years ago, but remains a persistent, wicked problem in healthcare, largely fuelled by systemic inaction. In this Commentary, we aim to explore the following aspects from a systemic lens: (i) the gaps in understanding systemic resistance and difficulty in addressing this issue; and (ii) pragmatic approaches to its management in the healthcare system.

Nurses' perception of disruptive behaviors in emergency department healthcare teams: A qualitative study.

Introduction: In an emergency setting, the occurrence of disruptive behaviors hinders team participation and cooperation. Exploring nurses' perception of disruptive behaviors can lead to a better identification of these behaviors in emergency departments and the provision of better recommendations. This study aimed to explore nurses' perception of disruptive behaviors among emergency healthcare teams in hospitals affiliated to the Hamadan University of Medical Sciences, Hamadan, Iran.

Hospital administration response to physician stress and burnout.

Recent studies have documented the alarming degree of physician stress and burnout that has affected physician attitudes, behaviors, and performance. Growing dissatisfaction, irritability, and frustration has negatively impacted physician ideals and attitudes which can lead to compromised health care relationships with impaired communication, collaboration, and coordination that can adversely affect satisfaction, clinical performance, and patient outcomes of care. For the most part physicians on their own have a difficult time recognizing or admitting that they are working under stress and burnout conditions, and even if they do, are reluctant to do anything about it.

Disruptive Behaviors in an Emergency Department: the Perspective of Physicians and Nurses.

Disruptive behaviors cause many problems in the workplace, especially in the emergency department (ED).This study was conducted to assess the physician's and nurse's perspective toward disruptive behaviors in the emergency department. In this cross-sectional study a total of 45 physicians and 110 nurses working in the emergency department of five general hospitals in Bojnurd participated.

Strategies to Enhance Physician Engagement.

Healthcare reform and other externally driven healthcare initiatives have introduced a number of new healthcare requirements that are restructuring the way we provide healthcare services. With a growing focus on health plan efficiency and accountability for value-based performance metrics extending across the full spectrum of care, healthcare organizations are looking to develop new models of care to meet the needs of today's healthcare environment. Physician alignment and engagement are keys to success.

Physician disruptive behaviors: Five year progress report.

Disruptive behaviors in health care can have a significant adverse effect on staff interactions that can negatively impact staff satisfaction, staff performance, and patient outcomes of care. As referenced in a previously published article, the Obstetrics and Gynecology specialty is one of the service areas where these behaviors occur more frequently. Despite growing evidence of the ill effects of these types of behaviors many organizations are still having a difficult time in addressing these issues in an effective manner.

Taking a new approach to reduce the incidence of physician disruptive behaviors.

Disruptive behaviors continue to play a disturbing role in today's healthcare environment, negatively affecting care relationships that can adversely impact outcomes of patient care. Many organizations have implemented a number of different strategies in an effort to address this important issue with varying degrees of success. New complexities and changing roles, responsibilities and accountabilities for the delivery of appropriate, high-value, high-quality, safe, satisfying care have added increasing pressures on healthcare organizations to better integrate and coordinate healthcare delivery across the entire spectrum of care.

Conflict resolution: unlocking the key to success.

Delivering the best care possible starts with healthcare providers. If we don't get along,what happens to our patients?

Addressing physician stress, burnout, and compassion fatigue: the time has come.

Stress, burnout, and compassion fatigue can have a significant adverse effect of physician well being and patient care. While the frequency and intensity of these negative influences appear to be increasing, there is little help available. We need to raise physician awareness as to the seriousness of this issue and at the same time gain a better understanding of some of the causative factors so we can provide the necessary support services that will enable our physicians to better adjust to the pressures and stresses of our health care environment and re-energize their zest and idealism for medical care.

Addressing disruptive behaviors in the organizational setting: the win-win approach.

Disruptive behaviors can have a significant impact on organizational dynamics and work relationships and a profound negative effect on staff and patient satisfaction, performance efficiency, and patient outcomes. Despite the growing call for action, many organizations still have difficulty in addressing these issues in a consistent, effective manner. Presented below is a model that focuses on causes and barriers and offers solutions designed to promote a "What's in it for me?" win-win approach for improving morale, job satisfaction, and patient care.

Predictors of likelihood of speaking up about safety concerns in labour and delivery.

Background: Despite widespread emphasis on promoting 'assertive communication' by care givers as essential to patient-safety-improvement efforts, little is known about when and how clinicians speak up to address safety concerns. In this cross-sectional study, the authors use a new measure of speaking up to begin exploring this issue in maternity care.

Methods: The authors developed a scenario-based measure of clinician's assessment of potential harm and likelihood of speaking up in response to perceived harm.

The quality and economic impact of disruptive behaviors on clinical outcomes of patient care.

Disruptive behaviors have been shown to have a negative impact on work relationships, team collaboration, communication efficiency, and process flow, all of which can adversely affect patient safety and quality of care. Despite the growing recognition of the damage that can be done, there are still pockets of resistance to taking action to address the issue head-on. Given the new call to action from the Joint Commission accreditation standard and the growing public accountability for patient safety, organizations need to recognize the full impact of disruptive behaviors and implement appropriate policies, procedures, and educational programs to raise levels of awareness regarding the seriousness of the issue, hold individuals accountable for their behavior, and provide training and support not only to reduce the incidence and consequences of disruptive events but also to improve efficiency of communication and team collaboration in an effort to improve outcomes of care.

Incidence and impact of physician and nurse disruptive behaviors in the emergency department.

Background: Disruptive behaviors have been shown to have a significant negative impact on staff collaboration and clinical outcomes of patient care. Disruptive episodes are more likely to occur in high stress areas such as the Emergency Department (ED). Having the structure, process, and skills in place to effectively address this issue will lower the likelihood of preventable adverse events.

Managing disruptive behaviors in the health care setting: focus on obstetrics services.

Disruptive behaviors can have a significant negative impact on staff relationships, communication flow, task responsibility, and team collaboration, all of which can adversely impact patient outcomes of care. Addressing disruptive behaviors in a positive manner by emphasizing the benefits of mutual understanding, shared goals and priorities, and adherence to accepted standards of care will enhance communication flow and improve the process and outcomes of care. This is particularly relevant in the obstetrics setting, where care is delivered over a continuum of time, with multiple different members of the health care team playing a vital role as the patient progresses from labor to delivery.

Measuring and managing the economic impact of disruptive behaviors in the hospital.

Disruptive behaviors have been shown to have a significant negative impact on staff relationships, team collaboration, communication flow, and patient outcomes of care. They can be a major factor in contributing to the occurrence of adverse events that compromise quality care and patient safety and can put the patient and organization at increased risk. Whereas organizations generally are not reticent to make system enhancements designed to improve patient safety, they are more reluctant to address human factor issues such as disruptive behaviors for a variety of reasons.

Medicare's value-based payment initiatives: impact on and implications for improving physician documentation and coding.

Medicare has introduced a number of new payment initiatives that will have a profound effect on hospital reimbursement and quality and safety ratings. The new medical severity diagnosis-related group (MS-DRG) payment system adds a number of new DRG categories to more adequately account for patient severity. The new present-on-admission (POA) initiative is designed to withhold additional reimbursement for selected complications that were not recorded as being POA but that occurred during the course of the hospitalization.

CFOs and quality managers: bridging the disconnect.

A survey of hospitals to assess the impact of selected organizational factors on achieving optimal patient outcomes found several barriers. To improve clinical and financial outcomes healthcare organizations should: Perform a self-assessment and discuss different perspectives and perceptions among stakeholders. Redesign structures and processes that support multidisciplinary input and involvement.

A survey of the impact of disruptive behaviors and communication defects on patient safety.

Background: A recent survey was conducted to assess the significance of disruptive behaviors and their effect on communication and collaboration and impact on patient care.

Survey: VHA West Coast administered a 22-question survey instrument--Nurse-Physician: Impact of Disruptive Behavior on Patient Care--to a convenience sample. Of the 388 member hospitals (in four VHA regions) invited, 102 hospitals participated in the survey (26% response rate).

Invited article: Managing disruptive physician behavior: impact on staff relationships and patient care.

Disruptive behavior can have a significant impact on care delivery, which can adversely affect patient safety and quality outcomes of care. Disruptive behavior occurs across all disciplines but is of particular concern when it involves physicians and nurses who have primary responsibility for patient care. There is a higher frequency of disruptive behavior in neurologists compared to most other nonsurgical specialties.