Rationale and Objectives
In an era of decreased reimbursements and rising expenses, academic health care systems are seeking alternative sources of funding. We hypothesized that the costs associated with disruptive physician behavior represented a source of potential savings and hence a possible financial stream which could be redirected to support other academic activities.
Materials and Methods
To test this hypothesis, we reviewed costs associated with disruptive behavior in clinical and education settings and estimated their savings in academic health care systems.
Results
In a 400 bed hospital, the combined costs for disruptive physician behaviors (due to staff turnover, medication errors and procedural errors) exceed $1 million.
Conclusions
Reducing disruptive physician behavior in academic health care systems is a potential funding stream with the added benefits of improved patient safety, reduced medical errors and improved medical student/resident education.
In 2008, Joint Commission Sentinel Alert No. 40 was released . In this alert, disruptive behavior was linked to medical errors, poor patient satisfaction, preventable adverse outcomes, increased staff turnover, and higher costs of care, including malpractice. The Joint Commission recommended that hospitals establish a formal code of conduct. They also required leadership to create a process for reporting, evaluating, and managing disruptive behavior. The Joint Commission created a new leadership standard (LD.03.01.01) with two elements of performance (EP):
EP 4: The hospital/organization has a code of conduct that defines acceptable and disruptive and inappropriate behaviors.
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Table 1
Disruptive Behaviors.
Anger Outbursts Throwing Demeaning Physical violence Sexual harassment Racial/ethnic jokes Alcohol or drug abuse Chronically late Ignoring pages/calls Ignoring questions, warnings, suggestions Derogatory comments Refusal to follow policy Body language–eye rolling
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Clinical
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Education
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Table 2
Program Director Time Needed to Support Impaired Resident.
Impaired Resident Support Time Spent Discovery phase 12 hours Time investigating complaint 5 hours Time meeting with resident 4 hours Time meeting with others – DIO, CMO, chair, attorneys 3 hours Decision/treatment phase 55 hours Time meeting with resident to plan for treatment 5 hours Time meeting with others – DIO, CMO, chair, attorneys 2 hours Paperwork for school, hospital, medical board 2 hours Redesign of schedule/curriculum for resident absence 8 hours Weekly reports 24 hours Supporting resident, his/her family, and other residents through treatment process 12 hours Return-to-work phase 9 hours Paperwork for school, hospital, medical board, Family Medical Leave Act 2 hours Graduation and future employment 6 hours Paperwork/phone calls for summary residency, fellowship application, practice interview, medical staff application 2 hours Time meeting with resident 2 hours Time meeting with others – DIO, CMO, chair, attorneys 2 hours
CMO, chief medical officer; DIO, designated institutional official.
Get Radiology Tree app to read full this article<
Conclusion
Get Radiology Tree app to read full this article<
References
1. The Joint Commission, Sentinel Event Alert Issue 40, July 9, 2008, Behaviors that undermine a culture of Safety. Available at: http://www.jointcommission.org/assets/1/18/SEA_40.PDF . Accessed November 10, 2012.
2. Setness P.A.: Is it real or is it Memorex? Discerning whether job-related stress or mental illness is causing physician impairment. Postgrad Med 2003; 113: pp. 7-9.
3. Hughes P.H., Brandenburg N., Baldwin D.C., et. al.: Prevalence of substance use among US physicians. [published correction appears in JAMA 1992;268(18):2518] JAMA 1992; 267: pp. 2333-2339.
4. McLellan A.T., Skipper G.S., Campbell M., et. al.: Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. BMJ 2008; 337: pp. a2038.
5. Rosenstein A.H., O’Daniel M.: Disruptive behavior and clinical outcomes: perceptions of nurses and physicians. Am J Nursing 2005; 105: pp. 54-64.
6. Institute for Safe Medication Practices: Survey on workplace intimidation. 2003. Available at: https://ismp.org/Survey/surveyresults/Survey0311.asp . Accessed January 4, 2013.
7. Morrissey J.: Encyclopedia of errors; growing database of medication errors allows hospitals to compare their track records with facilities nationwide in a nonpunitive setting. Mod Healthcare 2003; 33: 40, 42
8. Pearson C.M., Porath C.L.: On the nature, consequences and remedies of workplace incivility: no time for “nice”? Think again. Acad Manage Exec 2005; 19: pp. 7-18.
9. McDonald Owen: Disruptive physician behavior.May 15, 2011.QuantaMD Available at: http://www.quantiamd.com/q-qcp/Disruptive_Physician_Behavior.pdf
10. Rosenstein A.H.: Nurse-Physician Relationships: Impact on Nurse Satisfaction and Retention. American Journal of Nursing 2002; 102: pp. 26-34.
11. Porath C., Pearson C.: The cost of bad behavior.2009.Penguin GroupNew York
12. Bates D.W., Spell N., Cullen D., et. al.: The costs of adverse drug events in hospitalized patients. JAMA 1997; 277: pp. 307-311.
13. 2000.The Advisory Board CompanyWashington, DCpp. 38.
14. Task Force on Healthcare Cost Control. March 2002. As cited in HIMSS Patient Safety Primer and Fact Sheet available at: http://himss.files.cms-plus.com/HIMSSorg/content/files/PT_safety_ROI.pdf Accessed July 15, 2013.
15. Knowles M.S.: The modern practice of adult education: From pedagogy to andragogy.1980.Prentice Hall/CambridgeEnglewood Cliffs
16. Musselman L.J., MacRae H.M., Reznick R.K., et. al.: ‘You learn better under the gun’: intimidation and harassment in surgical education. Med Educ 2005; 39: pp. 926-934.
17. 2011-2012 ACGME resident survey. Available at: https://www.acgme.org/ads/File/DownloadSurveyReport?reportId=46267 . Accessed December 12, 2012.
18. Silver H.K., Duhl Glicken A.: Medical student abuse: incidence, severity, and significance. JAMA 1990; 263: pp. 527-532.
19. Fried J.M., Vermillion M., Parker N.H., et. al.: Eradicating medical student mistreatment: a longitudinal study of one institutions’ efforts. Acad Med 2012; 87: pp. 1191-1198.
20. Brown S.D., Goeske M.J., Johnson C.M.: Beyond substance abuse: stress, burnout, and depression as causes of physician impairment and disruptive behavior. Journal of American College of Radiology 2009; 6: pp. 479-485.