151. Master Your Outreach to Disruptive Physicians With This Proven Leadership Plan Pt1

One of the most difficult assignments for a physician leader is when the senior administration deem one of your colleagues to be disruptive and tell you to go do something about it. I know you've never been taught how to do this, so let me show you our approach that's been successful over the last 15 years in our coaching practice — to help you prepare yourself for that outreach conversation, have the conversation, diagnose where the issue is, and come up with a treatment plan to rehabilitate this doctor's reputation and bring them back into the fold as a valued member of the organization. Check it out.

Dealing with disruptive doctors is a challenging situation and devilishly complex. So what we're going to do here is split this into a two-part podcast. In this first part, I'm going to show you how to prepare yourself for the conversation with the doctor who's been identified as disruptive and how to execute on that conversation.

In the second part, what we're going to do is talk about how their reaction tells you how to proceed. It diagnoses where the issue is and what your treatment plan will be — and then how to construct that plan and execute on it over the following six to nine months.

Dealing with disruptive doctors is an issue that is so important. I’ve stood in front of audiences of hundreds of doctors and said, “Okay, all of you in leadership positions, think about a disruptive doctor. How many disruptive doctors does it take to completely occupy all of your protected administrative time? Hold up the number of fingers for the number of doctors that takes.” And it's always just one.

Just one disruptive doctor can completely destroy your ability to be an effective leader by simply occupying all of your time.

First of all, let's get on the same page. What do we even mean by disruptive physician behavior? What are we talking about? It's words or actions, or both, that cause trouble — behavior that disrupts care with patients and family members, with your staff, or it disrupts the functioning of the organization with the staff or with the leadership team.

Please note: there is a significant distinction between disruptive behavior and suspicions that the physician is impaired. When you're being asked to reach out to disruptive or impaired physicians, you are acting as a member of the leadership team. There are certain things you have to do to maintain the liability protection of the legal umbrella of the organization.

If you are someone who gets asked to reach out to impaired and/or disruptive doctors, it's important that the organization have its ducks in a row so that you are always protected. You must make sure to read the bylaws when you accept your leadership position. Make sure that you have both a disruptive behavior or professionalism set of bylaws, and also a separate policy for dealing with impaired or suspected impaired physicians — including things like an evaluation for impairment, disability treatment, and what to do about the State Medical Board and licensure issues that would happen if you had to report someone.

Now, how do you prevent disruptive behavior in the first place? Well, you make sure that you've got a wellness program that's always looking after the health and wellbeing of the people. You monitor wellbeing and distress. Ideally, your whole leadership team rounds and shadows their people so they know what's going on on the front lines and are getting the sand out of the gears.

In many cases, we know who the disruptive doctors will be — or have been — so regular checkups can prevent blowups that can get them in big trouble. You can see it coming and head it off. Understand what's going on in their practice, in their life, and make some adjustments when their stress level is high so they don't pop.

Now, sometimes you're just checking in with somebody because you heard something on the grapevine. In order to do that, let's go through the structure.

First of all, you want to approach that doctor at a time when nobody can listen to or see you talking to them. And take your hat off — big hand motion — “I'm taking my doctor hat off now, Chuck.” Come from your heart. “I've been watching you and I'm concerned. I've heard some things. How are you doing?”

Heart to heart here. “How are you doing?”

It's an informal conversation. You don't need to document it in any formal record or even in your own diary. “Hey John, you got a moment? First, I'm taking my doctor hat off — now it's just heart to heart, you and me. I'm concerned about you, man. How are you doing?”

You do this because disruptive behavior can be a reaction to burnout. Often it's not, but it can be. So you gotta check. In this situation, you're checking as a friend — this is not a formal outreach.

Also know that disruptive behavior can be caused by other deeper things like trauma and PTSD. They may have emotional intelligence deficits or poor communication skills. They may also be a psychopath — and I'm going to teach you how to tell the difference.

Now, what is your job when you've been delegated the task of dealing with a disruptive doctor? To stop the disruptive behavior. To restore quality care. To restore normal function to the organization and prevent it from recurring — ideally, with the disruptive physician's active cooperation.

It all starts with making sure that the behavior you're being asked to reach out about actually violates your code of conduct or your professionalism statute, and has triggered the disciplinary policy of the organization.

Again, bylaws should cover all these things. If you look for code of conduct or professionalism statute, if you look for an impaired physician policy, or if you look for a disciplinary policy and they're not there in the bylaws — the first step is to ask your senior leaders to get a legal consult and update the bylaws.

Disciplinary conversations as a leader are entirely different conversations than simply informal outreach to your colleagues. You're actually going to put on an entirely different hat — because when you act on behalf of the organization and as an official member of the team, rather than as a friend and a colleague, you're crossing a leadership line.

To maintain the legal cover of your organization, you have to follow all the rules and regulations, policies, procedures, or bylaws on the disciplinary procedure — to the letter.

So I encourage you: when you find the disciplinary policies, print them out. A copy for you and a copy for the person you're going to go talk to. Review them carefully and know your exact responsibilities. If there are holes, ask the CEO to get a legal consult and update the bylaws. Because you've got to cover your legal part — that would be your backside, right?

And remember, documentation will keep you out of court. When that documentation is necessary, file your notes documenting your meetings in accordance with your policy. If things are really weird, I encourage you to keep notes of dates and times when you had really uncomfortable conversations or strange things happened — in your own diary — and maybe even share what happened with somebody else so you have a contemporary witness.

Follow the procedure. Document, document, document. And if you follow all the rules and document well, you're under the organization's legal umbrella. If a lawsuit arises, the organization will be sued — not you.

And I only say this because people who are disruptive tend to hire disruptive lawyers.

Here's the outreach conversation as a leader to a disruptive doctor who's violated the policy.

First of all, squeegee yourself in. Big breath in, and as you exhale, just let go of anything that doesn't need to be here right now.

Get permission. “Hey Chuck, is this a good time to talk?”

Then look at your colleague and tell them — as you put your hand on your head — that you're putting your leadership hat on.

“Chuck, I'm reaching out to you right now as the CMO, on behalf of the medical executive committee, because we have a concern about the way you interacted with Nurse Cheryl yesterday.”

Then give the facts as you know them about the particular interaction. Describe the specific behavior that must stop. Let them know it must stop. Then hand them the printout of the policy that you're carrying with you.

Wrap it up. Take a big breath to clear yourself when you're done. Take your disciplinarian hat off. Then document. If there are formal documents that need to be filed with the committee, write those up and get them filed in the minutes. And if things were really weird, I encourage you to write down a journal entry and maybe tell a friend what happened.

Now, that's how you prepare yourself for the conversation. That's how you structure and deploy the conversation.

In our next podcast, what I'm going to tell you is that what happens next determines what you do in response. It’s what we call “the sorting hat” — like the Sorting Hat at Hogwarts that decided what house you were in. How they respond to what you just did in this conversation will determine your next action. It's pretty simple to understand, and we'll go through it next time.

I'll also show you how, if your colleague is amenable, you can structure a rehabilitation program to get this kerfuffle behind them and restore their place as a valued member of the work team.

Thanks so much for your time and energy here on the podcast. You have a great rest of your week. Until we're together here on the Stop Physician Burnout podcast, keep breathing — and have a great rest of your week.