Abstract
Disruptive behaviors in health care can have a profound effect on staff relationships that can lead to impaired communication, reduced information transfer, and dysfunctional team collaboration that can negatively impact patient care. Recognizing what disruptive behavior is and what it can do is the first step in enabling organizations to develop appropriate programs and effective strategies to reduce its occurrence. Disruptive behaviors occur across all disciplines, but when physicians are involved, by virtue of their role as captain of the ship, it can set off a chain of events that seriously compromises process and flow. By gaining a better understanding of the forces shaping physician attitudes and behaviors, organizations can then provide the necessary assistance and resource support to enhance behavioral adjustments. The ultimate goal is to not only reduce the incidence of disruptive events, but to also improve overall staff relationships, care efficiency, and instill a positive work atmosphere that increases staff morale, physician engagement, and overall satisfaction.
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References
Advisory Board. When Cleveland clinic staff are troubled they file code lavender advisory board. 2013. https://www.advisory.com/daily-briefing/2013/12/03/when-cleveland-clinic-staff-are-troubled-they-file-code-lavender
Agarwal R, Sands DZ, Schneider JD, Smaltz Detlev H. Quantifying the economic impact of communication inefficiencies in US hospitals. J Healthc Manag. 2010;55(4):265.
Ariely D, Lanier W. Disturbing trends in physician burnout and satisfaction with work-life balance: dealing with the malady among Nation’s leaders. Mayo Clin Proc. 2015;90(12):1593–6.
Beach M, Price E, Gary T, Robinson K, et al. Cultural competency: a systematic review of health care provider educational interventions. Med Care. 2005;43(4):356–73.
Beach M, Roter D, Korthuis P, Epstein R, et al. A multicenter study of physician mindfulness and health care quality. Ann Fam Med. 2013;11(5):421–8.
Beaulieu-Volk D. Poor communication ups risk of malpractice suits, patient non-adherence. FierceHealthcare; 2013. http://www.fiercehealthcare.com/practices/poor-communication-ups-risk-malpractice-suits-patient-nonadherence
Beckman R. The role of medical culture in the journey to resilience. Acad Med. 2015;90(6):710–2.
Beckman H, Wendland M, Mooney C, Krasner M, et al. The impact of a program in mindful communication on primary care physicians. Acad Med. 2012;87(6):1–5.
Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12(6):573–6.
Boothman R. Breaking through dangerous silence to tap an organization’s richest source of information: its own staff. Jt Comm J Qual Patient Saf. 2016;42(4):147–8.
Borges NJ, Manuel RS, Elam CL, Jones BJ. Differences in motives between Millennial and Generation X medical students. Med Educ. 2010;44(6):570–6.
Boyd J. State physician health programs: what you need to know. Quantia MD; 2016. https://quantiamd.com/player/ycnipdwzy?cid=1818
Brock D, Abu-Rish E, Chiu C, Hammer D, et al. Interprofessional education in team communication: working together to improve patient safety. Post Grad Med J. 2013;89(1057):642–51.
Byington M. Hiring for cultural fit at your medical practice. Physicians Practice; 2013. http://www.physicianspractice.com/blog/hiring-cultural-fit-your-medical-practice
Crico Strategies. Malpractice risks in communication failures: 2015 annual benchmark report. Crico Strategies Risk Management Foundation of the Harvard Medical Institutions, Boston, MA; 2015.
Curtis E, Dreachslin J, Sinioris M. Diversity and cultural competence training in health care organizations: hallmarks of success. Health Care Manag. 2007;26(3):255–62.
Dang D, Sung-Heui B, Karlowicz K, Kim M. Do clinician disruptive behaviors make an unsafe environment for patients? J Nurs Care Qual. 2016;31(2):115–24.
Danielson D, Ketterling R, Rosenstein A. M.D physician stress and burnout: causes, effects, and impact on performance and behavior. AMGA Group Pract J. 2013;62(3):38–41.
De Meester K, Verspuy M, Monsieurs K, Van Bogaert P. SBAR improves nurse–physician communication and reduces unexpected death: a pre and post intervention study. Resuscitation. 2013;84(9):1192–6.
Dyrbye AL, Massie F, Eacker A, Harper W, et al. Relationship between burnout and professional conduct and attitudes among U.S. medical students. JAMA. 2010;304(11):1173–80.
Rappleye E. Why Vanderbilt’s medical school is dropping science requirement. Beckers Hospital Review; 2015. http://www.beckershospitalreview.com/hospital-physician-relationships/why-vanderbilt-s-medical-school-is-dropping-science-requirements.html
Epstein R, Krasner M. Physician resilience: what it means, why it matters, and how to promote it. Acad Med. 2013;88(3):301–3.
Executive Dialogue. Executive dialogue: the multigenerational workforce: management implications and best practices. Hospitals and Health Networks; 2013. http://www.hhnmag.com/articles/5899-executive-dialogue-the-multigenerational-workforce
Friedberg M. Relationships between physician professional satisfaction and patient safety. PSNet; 2016. https://psnet.ahrq.gov/perspectives/perspective/193
Frieden R. AMA increases investment in medical education reform. MedpageToday; 2015. http://www.medpagetoday.com/publichealthpolicy/medicaleducation/52852
Gold KJ, Andrew LB, Goldman EB, Schwenk TL. “I would never want to have a mental health diagnosis on my record”: a survey of female physicians on mental health diagnosis, treatment, and reporting. Gen Hosp Psychiatry. 2016;43:51–7.
Goleman D. Emotional intelligence. New York: Bantam Books; 1995.
Gray J. Men are from Mars women are from Venus. New York: Harper Collins Publishers; 2004.
Helfner J, Hilligoss B, Knupp A, Bournique J, et al. Cultural transformation after implementation of crew resource management: is it really possible? Am J Med Qual. 2016;15:1–10. http://ajm.sagepub.com/content/early/2016/07/11/1062860616655424.full.pdf+html
Henson J. Reducing physician burnout through engagement. J Healthc Manag. 2016;61(1):86–9.
Hickson GB, Entman SS. Physician practice behavior and litigation risk: evidence and opportunity. Clin Obstet Gynecol. 2008;51(4):688–99.
Hickson G, Federspiel G, Pichert J, Miller C, et al. Patient complaints and malpractice risks. JAMA. 2002;287(22):2951–7.
Hickson G, Pichert J, Webb L, Gabbe S. A complementary approach to promoting professionalism: identifying, measuring, and addressing unprofessional behaviors. Acad Med. 2007;82(11):1040–8.
Hobson S. Best practices for effective physician on-boarding CHC Community. Hospital Blog; 2016. http://www.communityhospitalcorp.com/community-hospital-blog/~best-practices-for-effective-physician-on-boarding
Holm A, Gorosh M, Brady M, White-Perkins D. Recognizing privilege and bias: an interactive exercise to expand health care providers’ personal awareness. Acad Med. 2017;92:360–4. http://journals.lww.com/academicmedicine/Abstract/publishahead/Recognizing_Privilege_and_Bias___An_Interactive.98457.aspx
MacDonald I. Why hospitals turn a blind eye to misbehaving physicians. FierceHealthcare; 2014. http://www.fiercehealthcare.com/healthcare/why-hospitals-turn-a-blind-eye-to-misbehaving-docs
Jagsi R, Griffin K, Jones R, Perumalswami C, et al. Sexual harassment and discrimination experiences of an academic facility. JAMA. 2015;6:555–6.
Joshi N. Doctor, shut up and listen. New York Times; 2015. http://www.nytimes.com/2015/01/05/opinion/doctor-shut-up-and-listen.html?_r=0
Judson TJ, Volpp KG, Detsky AS. Harnessing the right combination of extrinsic and intrinsic motivation to change physician behavior. JAMA. 2015;314:2233–4.
O’Reilly K. Stressed physicians reluctant to seek support. amednews.com; 2012. http:www.amednews.com/apps/pbcs.dll/personalia?ID=koreilly
Karim S, Duchcherer M. Intimidation and harassment in residency: a review of the literature and results of the 2012 Canadian Association of Interns and Residents National Survey. Canad Med Educ J. 2014;5(1):e50.
Kay M, Mitchell G, Clavarino A, Doust J. Doctors as patients: a systematic review of doctors’ health access and the barriers they experience. Br J Gen Pract. 2008;58(552):501–8.
Krasner M, Epstein R, Beckman H, Suchman A, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009;302(12):1284–93.
Lemaire JB, Wallace JE, Jovanovic A. Stress and coping: generational and gender similarities and differences. In: Figley C, Huggard P, Rees C, editors. First do no self-harm: understanding and promoting physician stress resilience. New York, NY: Oxford University Press; 2013. p. 216–46.
Lister E, Ledbetter T, Warren A. The engaged physician. Mayo Clin Proc. 2015;90(4):425–7.
Lutfiyya MN, Brandt BF, Cerra F. Reflections from the intersection of health professions education and clinical practice: the state of the science of interprofessional education and collaborative practice. Acad Med. 2016;91(6):766–71.
Mata D, Ramos M, Bansai N, Khan R, et al. Prevalence of depression and depressive symptoms among medical residents: a systematic review and meta-analysis. JAMA. 2015;314(22):2373–83.
McCracken J, Hicks R. Personality traits of a disruptive physician. Physician Exec. 2012;38(5):66–8.
Moss M, Good V, Gozal D, Kleinpell R, et al. An official critical care societies collaborative statement-burnout syndrome in critical care health-care professions: a call for action. Chest. 2016;150(1):17–26.
Muller D. Reforming pre-medical education: out with the old, in with the new. N Engl J Med. 2013;368(17):1567–9.
Patterson K, Grenny J, McMillan R, Switzer AI. Crucial conversations: tools for talking when the stakes are high. New York: McGraw-Hill; 2002.
Privitera M, Rosenstein A, Plessow F, LoCastro T. Physician burnout and occupational stress: an inconvenient truth with unintended consequences. J Hosp Adm. 2014;4(1):27–35.
Rappleye E. 3 in 4 Physicians say their organization is not addressing burnout. Becker Hospital Review; 2016. http://www.beckershospitalreview.com/hospital-physician-relationships/3-in-4-physicians-say-their-organization-is-not-addressing-burnout.html
Ratwani RM, Fairbanks RJ, Hettinger AZ, Benda NC. Electronic health record usability: analysis of the user-centered design processes of eleven electronic health record vendors. J Am Med Inform Assoc. 2015;22(6):1179–82.
Reeves S, Palaganas J, Zierler B. Measuring the impact of interprofessional education on collaborative practice and patient outcomes. Washington, DC: The National Academies Press; 2015.
Roberts DH, Newman LR, Schwartzstein RM. Twelve tips for facilitating Millennials’ learning. Med Teach. 2012;34:274–8.
Rosenstein A. The impact of nurse-physician relationships on nurse satisfaction and retention. Am J Nurs. 2002;102(6):26–34.
Rosenstein A. Physician and nurse behaviors and their impact on communication efficiency and patient care. J Commun Healthc. 2009a;2(4):328–40.
Rosenstein A. Early intervention can help prevent disruptive behavior. Am Coll Physician Exec J. 2009b;37(6):14–5.
Rosenstein A. The economic impact of disruptive behaviors: the risks of non-effective intervention. Am J Med Qual. 2011;26(5):372–9.
Rosenstein A. Physician stress and burnout: what can we do? Physician Exec J. 2012a;38(6):22–30.
Rosenstein A. Physician communication and care management: the good, the bad, and the ugly. Physician Exec J. 2012b;38(4):34–7.
Rosenstein A. Bad medicine: managing the risks of disruptive behaviors in health care settings. Risk Manag. 2013;60(10):38–42.
Rosenstein A. Physician disruptive behaviors: five year progress report. World J Clin Cases. 2015a;3(11):930–4.
Rosenstein A. Taking a new approach to reduce the incidence of physician disruptive behaviors. Hosp Pract. 2015b;43(4):221–5.
Rosenstein A. A multistep approach to improving well –being and purpose. Patient Saf Qual Healthcare. 2015c;12(4):14–7.
Rosenstein A. Meeting the physician’s needs: the road to organizational-physician engagement. Trustee; 2015d. p. 19–22. http://www.trusteemag.com/articles/887-meeting-the-physicians-needs-the-road-to-organization-physician-engagement
Rosenstein A. Strategies to enhance physician engagement. J Med Pract Manag. 2015e;31(2):113–6.
Rosenstein, A. True physician engagement. Hosp Health Netw Vol.85 No.3 March 2015f p.14
Rosenstein A. Human factors affecting disruptive physician behaviors and its impact on the business of medicine. J Bus Hum Resour Dev. 2016a;2(2):1–10.
Rosenstein A. Understanding the psychology behind physician attitudes, behaviors, and engagement as the pathway to physician well-being. J Psychol Clin Psychiatry. 2016b;5(6):1–4.
Rosenstein A, O’Daniel M. Addressing disruptive nurse-physician behaviors: developing programs and policies to improve relationships that improve outcomes of care. Harv Health Policy Rev. 2005;7(1):86–97.
Rosenstein A, O’Daniel M. Impact and implications of disruptive behavior in the peri-operative arena. JACS. 2006;203(1):96–105.
Rosenstein A, O’Daniel M. A survey of the impact of disruptive behaviors and communication defects on patient safety. Jt Comm J Qual Patient Saf. 2008;34(8):464–71.
Rosenstein A, Privitera M. Recognizing and addressing physician stress and burnout to improve physician satisfaction. AHA Physician Leadership Forum; 2015c. https://ahaphysicianforum.wordpress.com/2015/03/
Rosenstein A, Stark D. Emotional intelligence: a critical tool to understand and improve behaviors that impact patient care. J Psychol Clin Psychiatry. 2015;2(1):1–4.
Rosenstein A, Dinkin S, Munro J. Conflict resolution: unlocking the key to success. Nurs Manag. 2014;45(10):34–9.
Rosenstein A, Karwaki T, Smith K. Legal process and outcome success in addressing disruptive behaviors: getting it right. Physician Leaders J. 2016;3(3):46–51.
Rovner J. Teaching medical teamwork right from the start. Kaiser Health News; 2016. http://khn.org/news/teaching-medical-teamwork-right-from-the-start/
Saddawi-Konefka D, Schumacher D, Baker K, Charnin J, Gollwitzer P. Changing physician behavior with implementation intentions: closing the gap between intentions and actions. Acad Med. 2016;91:211–6.https://www.researchgate.net/publication/299395724_Changing_Physician_Behavior_With_Implementation_Intentions_Closing_the_Gap_Between_Intentions_and_Actions
Salles A, Liebert C, Greco R. Promoting balance in the lives of resident physicians: a call to action. JAMA. 2015;150(7):607–8.
Schultz C, Holmstrom H. The use of medical scribes in health care settings: a systematic review and future directions. J Am Board of Fam Med. 2015;28(3):371–81.
Schwartzstein R. Getting the right medical students: nature versus nurture. N Engl J Med. 2015;372(17):1586–7.
Schwartzstein R, Rosenfeld G, Hilborn R, Oyewole S, et al. Redesigning the MCAT Exam: balancing multiple perspectives. Acad Med. 2013;88(5):560–7.
Schwenk TL, Davis L, Wimsatt LA. Depression, stigma, and suicidal ideation in medical students. JAMA. 2010;304(11):1181–90.
Seipel T. 212 California hospitals fined by state health officials. The Mercury News; 2015. http://www.mercurynews.com/health/ci_28174132/12-california-hospitals-fined-by-state-health-officials
Shanafelt T, Hasan O, Lotte N, Drybye N, et al. Changes in burnout and satisfaction with work-life balance and the general US working population between 2011–2014. Mayo Clin Proc. 2015a;90(12):1600–13.
Shanafelt T, Gorringe G, Menaker R, Storz K, et al. Impact of organizational leadership on physician burnout and satisfaction. Mayo Clin Proc. 2015b;90(4):432–40.
Shanafelt T, Dyrbye L, Sinsky C, Hasan O, et al. Relationship between clerical burden and characteristics of the electronic environment with physician burnout and professional satisfaction. Mayo Clin Proc. 2016;91(7):836–48.
Shapiro J, Galowitz P. Peer support for clinicians: a programmatic approach. Acad Med. 2016;91(9):1–5.
Shapiro J, Whittmore A, Tsen L. Instituting a culture of professionalism: the establishment of a center for professionalism and peer support. Jt Comm J Qual Patient Saf. 2014;40(4):168–78.
Shulte B. Time in the bank: a Stanford plan to save doctors from burnout. The Washington Post; 2015. https://www.washingtonpost.com/news/inspired-life/wp/2015/08/20/the-innovative-stanford-program-thats-saving-emergency-room-doctors-from-burnout/
Smith LG. Medical professionalism and the generation gap. Am J Med. 2005;118:439–42.
Spok Inc. Getting right with the Joint Commission: The Hospital Communication Bill of Rights. White paper. Spok Inc; 2013. http://cloud.amcomsoftware.com/WP-AMER-Joint-Commission.pdf.
Stark R, Whitlock D, Cornett D. Addressing satisfaction gaps around cultural fit. Physician Exec J. 2014;40:22–6.
TeamSTEPPS®. TeamSTEPPS®: strategies and tools to enhance performance and patient safety. Agency for Healthcare Research and Quality, Rockville, MD; 2016. http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/index.html
Lindro L. The Talking cure for health care: improving the ways doctors communicate with their patients can lead to better care—and lower costs. The Wall Street Journal; 2013. http://www.wsj.com/articles/SB10001424127887323628804578346223960774296
The Joint Commission. Joint Commission Sentinel Event 40. 2008. dhttp://www.jointcommission.org/assets/1/18/SEA_40.PDF
The Physicians Foundation. Survey of American Physicians. 2016. http://www.physiciansfoundation.org/uploads/default/Biennial_Physician_Survey_2016.pdf
Thew J., Millennials, boomers, gen Xers - can they all get along? HealthLeaders Media; 2015. http://www.healthleadersmedia.com/nurse-leaders/millennials-boomers-gen-xerscan-they-all-get-along
UC San Diego PACE Program. UC San Diego Physician Assessment and Clinical Evaluation (PACE) Program. 2016. http://www.paceprogram.ucsd.edu/Documents/PACE_Program_Detail_Printable.pdf
Vanderbilt University Medical Center. Vanderbilt University Disruptive Behavior and Professional Health Center. 2017. https://www.mc.vanderbilt.edu/root/vumc.php?site=cph&doc=22631
Vassar L. 21 More schools tapped to transform physician training. AMA Wire; 2015. http://www.ama-assn.org/ama/ama-wire/post/20-schools-tapped-transform-physician-training
VITAL WorkLife. Physician Stress and Burnout Survey Cejka Search and VITAL WorkLife; 2014. www.VITALWorkLife.com/survey/Stress
Wagner R. 7 keys to successful doctor on-boarding. Health Care Finance; 2014. http://www.healthcarefinancenews.com/news/7-keys-successful-doctor-onboarding
Wallace J, Lemaire W. Physician wellness: a missing quality indicator. Lancet. 2009;374(9702):1714–21. http://www.thelancet.com/pdfs/journals/lancet/PIIS0140673609614240.pdf
Wen J, Kosowsky J. When doctors don’t listen. New York: Thomas Dunne Books St. Martin’s Press; 2012.
West C, Dyrbye L, Rabatin J, Call T, et al. Intervention to promote physician well-being, job satisfaction, and professionalism: a randomized clinical trial. JAMA Int Med. 2014;174(4):527–33.
West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet. 2016;388:10057.
White RD, Burroughs JH. Credentialing: stopping disruptive behavior at the door (chapter 2). In: A practical guide to managing disruptive and impaired physicians. Danvers, MA: HC Pro; 2010. p. 29–41.
Whitlock DJ, Stark R. Understanding physician engagement--and how to increase it. Physician Leaders J. 2014;1(1):8–13.
Williams D, Wyatt R. Racial bias in health care and health: challenges and opportunities. JAMA. 2016;315(19):2120–1.
Snowbeck C. Minnesota hospitals ramp up efforts to battle physician burnout. Star Tribune; 2016. http://www.startribune.com/minnesota-hospitals-ramp-up-efforts-to-battle-physician-burnout/389385481
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Rosenstein, A. (2017). Disruptive and Unprofessional Behaviors. In: Brower, K., Riba, M. (eds) Physician Mental Health and Well-Being. Integrating Psychiatry and Primary Care. Springer, Cham. https://doi.org/10.1007/978-3-319-55583-6_3
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