Wednesday, August 27, 2014

There's no place for disruptive behavior in healthcare

Why disruptive docs may not be so bad after all

Hospitals need to balance patient satisfaction with outcomes, total experience

Sometimes disruptive behavior can be a good thing.  Not all disruption is due to  technological changes, such as electronic health records.  And some technical disruptions often spur other developments and growth in other industries, perhaps even creating a whole new niche.

Has the healthcare industry gone too far in cracking down on disruptive behavior? Is it okay for doctors to be rude, dismissive and act like jerks if they have superior surgical skills?
Hospitals have long struggled with how to handle disruptive behavior among doctors, sometimes turning a blind eye, other times disciplining or firing them. Getting rid of disruptive docs has become a popular approach as the industry rewards organizations for high patient satisfaction scores.
The biggest problem with disruptive workplace behavior is the negative impact it can have on the patient, FierceHealthcare reported earlier this year. In many instances, the bad behavior distracts the healthcare team, which can lead to medical mistakes.

But aarticle by Becker's Hospital Review calls into question the "zero tolerance" movement and why disruptive docs may not be so bad after all. While some surgeons may be cold and abrasive, they may also be better doctors than their kinder, gentler counterparts, according to the article. Yet the doctors with the better bedside manners are rewarded because they have higher patient satisfaction scores even though they have poor patient outcomes compared to their meaner counterparts.

"In trying to shape our trainees to be all things to everyone ... we run the risk of creating a workforce caught somewhere in the middle, not doing anything well," Shen says.
So how does the industry balance the need for happy patients and skilled clinicians? One way is to recognize that satisfaction--how positive a patient feels about an encounter--is just one part of the patient experience, writes Jason A. Wolf, president of The Beryl Institute, in a blog post for Hospital Impact.

There are divergent opinions as to what effect disruptive behavior can have..

The Joint Commission clearly states,  "disruptive behavior is a sentinel event"

The preceeding quotes are attributable to FIERCEHEALTH

Another point of view, from The Health Care Blog

lawyerdoctor says:
Kudos to Dr. Gunderman for his thoughtful, and analytical evaluation of our current “quality morass.”
We used to have people who were responsible for providing “quality health care.” They were called DOCTORS. If someone didn’t do the right thing, they may or may not have received a butt-chewing. The most powerful incentive for the hospital to provide quality care to the patient was likely the surgeon, whom everyone respected and likely feared a little bit.
One of the most powerful experiences of my medical education was being fortunate enough to spend some time under the tutelage of a small-town general surgeon. He was the most scholarly, genteel, polite, and skilled physician (or person) I think I have ever met. He was so revered and respected in the community that one day he almost made the Director of Nursing break into tears from one simple courteous statement. It was during an operation wherein the staff had forgotten to supply an important surgical tool, and we stood there in sterile scrub, hands folded across chests, for what was about 10 mins (but seemed an hour).
The surgeon said kindly: “Nurse X, you understand that WAITING – is the thing that I do LEAST well.”
I thought the entire nursing staff was going to faint. The item was produced forthwith.

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