The Disruptive Physician

1. Texas Medical Board Irv Zeitler, DO President The Disruptive Physician August 23, 2012

2. Mission Statement “Our mission is to protect and enhance the public’s health, safety and welfare by establishing and maintaining standards of excellence used in regulating the practice of medicine and ensuring quality health care for the citizens of Texas through licensure, discipline and education.”

3. Texas Medical Board Composition Board members Irvin Zeitler, D.O.- President Melinda McMichael, M.D.-Vice President Paulette Southard – Secretary/Treasurer Michael Arambula, M.D. Manuel Guajardo, M.D. Julie Attebury Scott Holliday, D.O. David Baucom Margret McNeese, M.D. Stanley Wang, M.D. Allan Shulkin, M.D. Patrick Crocker, D.O. Wynn Snoots, M.D. Patricia Blackwell Carlos Gallardo John D. Ellis George Willeford, III, M.D. Timothy WebbRoy Smythe, M.D. • 12 Physician members (9 M.D. and 3 D.O.) • 7 Public members (non-physicians) • Appointed by the Governor for 6 year term

4. AMA CODE OF MEDICAL ETHICS Defines disruptive behavior as “personal conduct, whether verbal or physical, that negatively affects or potentially may negatively affect patient care”

5. CULTURE OF RESPECT • Dysfunctional Culture is a barrier to patient safety • Disrespect inhibits cooperation and teamwork • Disrespect cuts off communication and decreases morale

6. PHYSICIAN DISRESPECT • Partially personality characteristics • But mostly… • Learned • Tolerated • Reinforced

7. PHYSICIAN DISRESPECT • Physician ethos of • Status • Privilege • Autonomy • All can lead to disrespectful behavior

8. CMS CONDITIONS OF PARTICIPATION The hospital’s governing body, medical staff and administrative officials are responsible and accountable for ensuring the following: That the hospital-wide quality assessment and performance improvement efforts address priorities for improved patient safety and that all improvement actions are evaluated.

9. JCAHO • LD.03.01.01 • “Leaders create and maintain a culture of safety and quality throughout the hospital.”

10. JCAHO “Behavior that intimidates others and affects morale or staff turnover undermines a culture of safety and can be harmful to patient care.”

11. JCAHO “Leaders must address such behavior in individuals working at all levels of the hospital, including management, clinical and administrative staff, licensed independent practitioners, and governing body members.”

12. TEXAS MEDICAL BOARD • Rule 190.8.2 – Unprofessional Conduct • Engaging in sexually inappropriate behavior or comments • Behaving in an abusive or assaultive manner • Failing to maintain the confidentiality of a patient

13. TEXAS MEDICAL BOARD • Unprofessional Conduct • Behaving in a disruptive manner toward licensees, hospital personnel, patients, family members, or others that interferes with patient care or could be reasonably expected to adversely impact the quality of care rendered to a patient.

14. LESSONS LEARNED Regardless of circumstances, can’t justify behavior Address promptly, lenient policy fosters increasing disruption “Take it to the supervisor”

15. LESSONS LEARNED Two sides to every story Collegial intervention with single non-egregious episode Focus on what is right rather than who is right

16. APPROACH • Medical Staff - Collegial • Medical Staff – Performance Improvement Plan • Coaching • “Charm School” • Regulatory