The Physician Health Program phone rings and a physician asks: “Can you tell me how to find an anger management program?”  Without hearing any other details, it’s likely that the caller is trying to cope with issues in the hospital and may even have been told by a Department Head or Chief of Staff that they are “disruptive” and they need to do something about it.

Forms of disruptive behaviour

Disruptive behaviour may be long-standing and legendary.  Conversely it might be more recent in onset, and the subject of quiet concern.  Anger may be expressed in sudden and unpredictable outbursts, or subtly, with persistent verbal abuse that undermines the confidence and respect of co-workers.

Disruptive behaviour may simply take the form of lack of co-operation with others.  Replies to pages may be late or ignored.  Committee or other hospital duties may be neglected – with haughty contempt or passive/aggressive avoidance.  Approach to patient care might be excessively controlling, overly rigid and rejecting of collegial input, opinion or advice.

While the type of behaviour exhibited may vary, what doesn’t tend to vary is the large amount of time and effort spent responding to the complaints and morale problems generated by difficult behaviour.

What Can Be Done?

The Physician Health Program is currently providing some services, namely individual case management and behavioural monitoring of a few physicians. As a trusted and respected service, the Physician Health Program is a credible program skilled to lead the DBP initiative and one which would be most supported by physicians and hospital industry leaders alike.

Bill 168 of the Occupational Health and Safety Act has passed third reading and will be introduced into law in the near future.  This legislation creates a compelling reason for hospital leaders to ensure their workplaces are free from the threat of violence and harassment.  Furthermore, the impact of disruptive behaviour has been demonstrated to negatively impact the quality of patient care/patient outcomes.

Our Goal    

To establish a comprehensive program aimed at reducing the incidence of disruptive behaviour. The program will:

• use a systems approach focussed on supporting changes in both the individual practitioner and the workplace and will consist of  5 areas of focus
• awareness
• prevention
• early intervention
• case response/management
• organizational consulting; systems approach to creating/enhancing respectful workplaces 

Guiding Principles 

The program will:

• not serve to stifle or suppress good faith, respectful advocacy for patient care.
• operate in the best interests of physicians and therefore the patients that they serve.
• welcome all referrals to the program regardless of possible cause(s) but a triage process will be developed to establish bona fide eligibility for program services. 
• be a voluntary service for physicians.
• consider the work place context as well as family context as important contributors to the understanding and management of cases. 
• support hospitals and other health care institutions to develop their own internal infrastructure and expertise to deal with their behavioural issues and concerns.

Progress to date

• The program will be launched in April 1 2010 with an initial emphasis on Case Response (Case Management)

Features of the Case Response Service

• Case Response will be the first of the services to be offered beginning April 1 2010 and will comprise 2 initiatives
• Case response for referred individuals
• A telephone advisory service for Physician Leaders

1.0      Case Response for Referred Individuals

• This service will be delivered  in a collaborative fashion with the PWSP, the referred physician and the hospital all agreeing to the services provided (deliverables)

• It will consist of 3 phases; each phase will be contracted for separately.
• Assessment (3 months)
• Rehabilitation (24 months)
• Long term follow up (36 months)

2.0      Telephone Advisory Service for Physician Leaders

• Physician Leaders will be provided with an opportunity to subscribe to a telephone advisory service.
• This service will provide unlimited telephone advice for managing disruptive behaviour for an annual fee.
• It is anticipated that a service such as this will be more appropriate in the “early intervention” phase.

Other initiatives for 2010

• Forming the PWSP Advisory Committee
• Educational workshops to increase awareness, prevention and early intervention strategies

 

 

 

 

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