In recent years there has been more emphasis on the actions of medical personnel associated with a disruptive behavior of physicians.

In the past, many hospitals do not have policies, procedures or guidelines to help them when they are faced with the unprofessional conduct of a certain physician – especially if such behavior does not directly affect the quality care in the context.

Too often, the decision on whether disciplinary action should be taken against a particular doctor depend on factors such as the doctor if she has contributed significantly to the performance of the hospital end result of a year or so the doctor had a special relationship with the hospital administration.

With the intention of hospitals actively and appropriately to the issue of physician unprofessional conduct, the Joint Commission now requires that health care organizations accredited to the policies and procedures for determining physician behavior that disrupts the work address.

Although all health professionals would agree that such policies and procedures would be beneficial to the clinic, the language of politics by a hospital and a hospital’s Executive Committee (MEC) has measured that violence can be avoided. You need two hospitals and physicians with staff of a fair and reasonable to correct for the possible prevention of behavioral problems.

From his statements, it is clear that the Joint Committee considers that a clear policy is disruptive behavior by physicians address required if the hospital implicitly promoting “disruptive behavior”.

However, the Joint Commission did not define or determine what would be “unacceptable” or are “disruptive behavior.”

Without further indication of the Joint Commission, the doctors are concerned and involved in preparing the hospital policies and procedures for managing such behavior in order to protect physicians from unnecessary negative actions against staff privileges.

This concern was echoed by the American Medical Association regarding the broad definition of “not acceptable” or “disruptive behavior” which, if not defined, could lead to arbitrary enforcement of these standards.

The implementation of the new policy requires a measured approach

To avoid scenarios, for example, where the action of a hospital can lead to discipline a physician with whom the hospital has one of political or economic differences solely on the basis that the doctor had raised his voice to a nurse a tense hospital MEC should use language in a careful and measured policy to fight against disruptive physician behavior.

If everyone agreed that the hospital can not tolerate flagrant disruptive behavior as an attack against a colleague, have adopted standards and related measures will be measured to really achieve the policy objective is to make a productive environment and healthy workplace.

A measured approach to provide greater safety for the physician and the hospital say how to achieve the objective of the above policy. We believe that such a policy should first give a definition of the types of practices to which policies that address.

For example, “disruptive behavior” by a medical staff member is a behavior that interferes with the hospital’s capacity to achieve its goals and defined, but not necessarily limited to the following actions towards colleagues, hospital staff, patients or visitors

* Hostile, angry voice and aggressive, confrontational or body language;

* Attacks (verbal or physical) that exceed the limits of fair rules of ethics;

* Inappropriate expressions of anger, such as destroying property or throwing objects;

* Sent to abusive language or criticism of the beneficiaries of a ridiculous way to humiliate, intimidate, undermine confidence, or reduce;

* Comments derogatory beyond differences of opinion, that patients or families of patients’ nurses do (this is not intended to prohibit comments that, given a constructive approach to the management load);

* Writing malicious, arbitrary or inappropriate comments / notes in patient records;

* Sexual harassment and discrimination.

The policy should also define procedures for reporting complaints and incidents of alleged disruptive behavior, including the documentation of these issues and reporting.

In addition, policies should address the question of how the report will be reviewed and by whom (eg, the chief of staff or a designated subcommittee of the MEC).

For reports, supported by a preponderance of the evidence, the policy should also step by step process, the notice provides for the physician and provides due process and fairness in the disciplinary action was taken to hospital.

For example, the Chief of Staff will decide whether the matter falls within the definition of conduct “disruptive behavior”. If so, the Chief of Staff will exercise reasonable judge that the conduct subject of a minor nature and is a particular case, means will be directed not necessarily formal, but a short conversation with the doctor or the caregiver if the patient requires conduct remedies.

If the initial complaint or incident is dismissed, is considering a confidential arrangement of the complaint or incident will be maintained in a record time of credentials other than the doctor’s files.

Documentation must be the first such occurrence outside the roster of physicians’ credentials, unless more complaints of similar nature are received. If further complaints are made, should have all relevant documentation and the memorandum and correspondence preserved and stored in files of credentials of the physician.

If the doctor does not solve the problem, and another complaints / occurred, the physician should the opportunity to develop a voluntary program to correct the disruptive behavior of participation are offered. This could take the form of a course in anger management and / or consultant to try to see how a social worker, psychologist or a psychiatrist appointed to the clinic to assess and try to correct the disruptive behavior.

If the doctor refuses to do so voluntarily, if the Chief of Staff to determine if the severity of conduct justifies the subject of a mandatory assessment of mental health.

Finally, if the doctor is the appropriate behavior is not changed since the previous steps, or is such a severe nature, which makes the above steps unreasonable, the hospital may take disciplinary action against the doctor. This must be consistent with procedures established fair trial in the hospital and medical staff carried articles or defense plan – most often the physician to a hearing to defend their behavior.

Such a procedure would protect doctors and the hospital work environment healthy and safe.

However, it should be noted that the above process only a small selection of such provisions to be included in a policy designed to right the hospital might question the physician disruptive behavior, it is not intended to be a comprehensive policy.

Conclusion of unprofessional conduct in May in an adverse report on the results NPDB

The doctors measured by adopting a standard and active policy on disruptive behavior, since the finding of unprofessional conduct is to inform the professional Data Bank (NPDB).

Many doctors mistakenly believe that the only type of incidents are notifiable actions for malpractice or NPDB incidents at the hospital, which directly measures the quality of care available in their context.

However, the NPDB manual specifically states that the hospital should any adverse clinical privilege action against a doctor for malpractice, which has or may have to report a negative impact on a patient. So, if a hospital is authorized to take rapid and uncontrolled disciplinary action against a physician for “disruptive behavior, he may bring in a negative database that could affect the doctor’s head career forever.

For these reasons, it is essential that physicians and staff of the MEC for a measured approach to the definition of “not acceptable” or “disruptive behavior” and adoption of related policies. Otherwise, doctors are allowing the hospital to this new standard to be used as a sword to take arbitrary action against doctors for ulterior motives, rather than promote a productive environment and healthy workplace.

Standard guidelines and limited provided by the Joint Commission

Effect from 1 January 2009, the new management standard LD. 03. 01. 2001 provides in relevant part, that:

* The hospital has a code of conduct that defines acceptable, disruptive and inappropriate behaviors.

* Leaders create and implement a management process, disruptive behavior and inappropriate.

The Joint Commission also conduct medical policies relating to the standard recommended new direction. The new “disruptive behavior” policy should include the following:

* “Zero tolerance” for intimidating and / or disruptive behavior, including crimes such as assault;

* Concepts, bullying behavior of physicians, and complementary activities to support non-physician employees are sent to the address;

* The rules that protect these people report bullying behavior;

* Methods of intervention for patients and / or families who witness these behaviors and

* Characteristics of how and when to begin disciplinary action.

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