Disruptive Healthcare Provider Behavior

Disruptive Healthcare Provider Behavior

Rade B. Vukmir Disruptive Healthcare Provider Behavior An Evidence-Based Guide

Rade B. Vukmir, MD, JD President Critical Care Medicine Associates Sewickley, PA, USA Professor Adjunct Emergency Medicine Temple University School of Medicine Clinical Campus Pittsburgh, PA, USA ISBN 978-3-319-27922-0 DOI 10.1007/978-3-319-27924-4 ISBN 978-3-319-27924-4 (ebook) Library of Congress Control Number: 2016930304 Springer Cham Heidelberg New York Dordrecht London Springer International Publishing Switzerland 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper Springer International Publishing AG Switzerland is part of Springer Science+Business Media (www.springer.com)

Preface Disruptive provider behavior is perhaps one of the most complicated areas of medical practice management and hospital administration. The scope of research into this topic has expanded considerably to involve all members of the healthcare team, including providers and administrators. The analysis has begun to focus on patient care and quality of life in the health-care workplace, rather than just the effects on an individual or group. As such, approaches toward intervention have shifted from corrective actions targeting the individual to education and proactive intervention that strives to improve the overall system. This book addresses the theory of disruptive behavior theory, how this behavior is experienced, at-risk groups and situations, regulatory influence, and strategies directed at intervention and improvement. Finally, a set of illustrative case scenarios, including situational analysis and action plans, is presented. Sewickley, PA, USA Rade B. Vukmir v

Executive Summary The study of disruptive behavior among health-care providers is based on a multidisciplinary approach emphasizing a comprehensive identification, education, and remediation strategy. The search identified approximately 90 articles published over the past 35 years that reported substantive qualitative and quantitative scientific data and recommendations on this topic. Here, disruptive provider behavior is defined, its etiology is explored, and it is profiled according to location and specialty correlates. The complex nursing interface and residency training correlates also are analyzed. Most importantly, the effects on patient safety and care quality are reported. In addition, the impact of policies on the economic and legal aspects of the health-care delivery process is evaluated. Lastly, the management interface, interventional strategies, and educational approaches regarding the disruptive behavior dilemma are discussed. Disruptive provider behavior is a complex, multifaceted problem whose solution requires cooperation among physicians, nurses, and administrators to ensure care quality and patient safety. At the same time, investment of time and effort in a facility s staff has direct benefits in reducing absenteeism and employee turnover, as well as indirect benefits that accrue directly to the patient, as staff performance is improved as well. vii

Contents 1 Introduction... 1 2 Scope of the Problem... 5 3 Organizational Approach... 9 4 Maturation of the Analysis... 17 5 Profile of the Behavior... 23 6 Location at Risk... 33 6.1 Operating Suite... 33 6.2 Labor and Delivery... 34 6.3 Intensive Care/Critical Care Unit... 34 6.4 Emergency Department... 35 7 Specialty at Risk... 37 7.1 General Surgery... 37 7.2 Obstetrics/Gynecology... 40 7.3 Orthopedic Surgery... 42 8 Physicians in Training... 45 9 Etiology... 49 10 Nursing Interface... 55 11 Patient Safety... 59 12 Policy and Guidelines... 65 13 Economic Issues... 69 14 Legal Interface... 75 ix

x Contents 15 Regulatory Interventions... 81 16 Strategies for Improvement... 85 17 Educational Process... 95 18 Management s Responsibility... 101 19 Conclusion... 111 Appendix: Situational Analysis and Approach to Case Scenarios... 117 Index... 145