Stop Labeling Physicians as “Disruptive.” Six Steps to Physician “Success.”
"[W]e never deem the physician “fixed” – because we start with the premise that he or she was never “broken.” We also work from the premise that the ability to develop productive relationships, to carve a successful career path, and to lead effectively, is a never-ending process."
The Call
Because of our reputation for helping physicians to navigate challenging situations, we get calls about “disruptive” physicians. Generally, it’s someone who’s been struggling for some time and an administrator has decided, as a last-ditch effort, to get this person some coaching help.
They’ve tried everything – internal coaching, mentoring, sending the physician away to a week-long program – but they continue to be “disruptive” and if this doesn’t work, they will be terminated.
See Alan Friedman's piece on "The role of Self -Determination in Physician Engagement"
"The physician is assigned the damaging label “disruptive” and becomes a reclamation project – with the stigma that goes along with that designation."
The Term "Disruptive Physician"
A decade ago, hospitals/systems were buying practices. They were creating a large workforce that they didn’t understand. The behavioral or performance issues were previously the purview of the independent medical staff. Now they were an employee issue. The American Medical Association Code of Medical Ethics first defined disruptive behaviors in 2009.
In response, there was a proliferation of education, training, and programs dedicated to “fixing” the disruptive physician. Our observation is that these approaches are not, particularly, effective.
Blog - Does Standardization Contribute to Physician Frustration?
Our Thoughts on the Concept
Really “disruptive”? Too often, the physician labeled “disruptive” is merely a well-intended individual who is dealing with operational frustrations, an un-manageable workload, and a lack of institutional support. No one seeks to understand the frustration or provide real support. The physician is assigned the damaging label “disruptive” and becomes a reclamation project – with the stigma that goes along with that designation.
An Ounce of Prevention…More often than not, the entire situation could have been avoided if the organization really understood the physician’s needs and goals. Did it provide a plan for career success and satisfaction – like we often do with executives in most industries? Because physician success was, historically, not the hospital’s problem, they just don’t think about it. They hire physicians and hope they are successful – that’s the extent of the plan. Maybe the physician finds a productive mentor-mentee relationship. Maybe the physician finds a path via the faculty development office. Often, they don’t.
Who is Responsible for Physician Success? No one is close enough to the situation to identify potential challenges, early. Too often relationships devolve to the point of requiring real work to repair them. In what other part of the organization do we allow this to happen?
Common Interventions Makes No Sense. Wait until the situation is an absolute crisis. Label the physician disruptive and send her away to a disruptive behavior boot-camp of some sort. They get intensive training for a week, perhaps, and are then sent back into their specific situation and expected to no-longer be disruptive…..Want to take a guess at the success rate of this approach? Or think about how the physician feels about this treatment?
"More often than not, the entire situation could have been avoided if the organization really understood the physician’s needs and goals."
A Better Approach
Clarify and Align Goals. Every hospital, system or physician group should develop a process to ensure physician success. What are the new physician’s goals and aspirations? What are his or her expectation regarding daily responsibilities and operational/staffing support? If we don’t get clarity and alignment on these, why are we surprised when the physician is frustrated a year into the new position?
A Plan for Success. Who is tasked with working with and monitoring physician success? Don’t wait until you see low engagement survey scores. Does every physician understand who she can work with on making progress toward established goals? Progressive organizations provide a coach for EVERY new executive. But we bring in a surgeon and pay her $1M a year with no support or plan?
Intervene Early. If someone is monitoring physician success and checking in about relationships/frustrations/progress, you can intervene to prevent real problems. Many physicians have never learned to navigate organizational dynamics or developed the level of emotional intelligence or communication/relationship skills required to deal with these challenges – so get them support BEFORE their behaviors are deemed disruptive.
Look Beyond the Individual. Understand the strategic and operational issues at play, and the relevant organizational dynamics. You cannot give an individual insight and skills in isolation during a “program” and expect them to successfully deploy these in a, unique, highly complex environment. This, of course, requires that their coach needs to have a deep understanding of these challenges.
Assume They Want to Succeed. In our experience, physicians know when they are struggling but don’t know what to do about it or how to ask for help. Like anyone, they need to feel supported. They also need to understand their own behavioral and personality tendencies (heightened self-awareness) as the starting point. They are open to these discussions and this work if, and only if, they feel you really understand their world and their unique challenges.
Accept that it “takes two to tango” ….every relationship is a two-way street. Often the physician’s leaders or team are contributing to challenging dynamics or making the situation worse. It’s not uncommon for our “individual” coaching work to quickly become an effort to coach both the physician and his or her administrator or leader (sometimes the entire department!) – in order to forge more productive relationships.
Establish Behavioral Expectations and Teach People How to Collaborate. Have you done a sufficient job defining what behaviors you expect? Culture is, basically, defined by the behaviors you encourage and discourage. Has your organization clearly communicated, to everyone, at every turn, the professional behaviors that contribute to the culture you aspire to? Have you had frank discussions about how people should function in meetings? How to communicate professionally and effectively? Provided effective training on these topics? If not – is it reasonable to expect people to live up to poorly defined behavioral expectations?
Always Good Advice - "Remain Calm, Be Kind."
Our Success Rate?
We don’t see ourselves as being in the “disruptive physician-fixing” business. We don’t have a specific metric we track in these cases. I’ll say this though- over the past several years, we’ve taken on this type of situation a number of times. Frequently it’s a prominent department chair who was brought in after a wide search, and expectations are high.
We have a team of experts in individual and organizational behavior – who only work with physicians. As we are often working on projects that improve overall department performance, we also have a deep understanding of the complexities, challenges and nuances, that are at play.
In each of these cases, we, collaboratively, made enough progress that the individual stayed with the organization, or only left on their own volition- having overcome their challenges.
In each case, though, we never deemed the physician “fixed” – because we start with the premise that he or she was never “broken.” We also work from the premise that the ability to develop productive relationships, to carve a successful career path, and to lead effectively, is a never-ending process.
