Bullies Throwing Tantrums
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The document discusses disruptive surgeon behavior in the perioperative environment. It begins with objectives to describe conditions that foster disruptive behavior, identify coping strategies, and define negative consequences. The presentation then characterizes categories of disruptive behaviors, conditions that foster them like situational stressors and cultural norms, and how those impacted cope, such as avoiding the surgeon or reporting the behavior. Negative consequences are outlined, including shifting focus from patients and deterring employment in surgery. The presentation concludes with recommendations for practices to address disruptive behavior through training, clear reporting systems, and individual accountability programs.
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Bullies Throwing Tantrums
- 1. BULLIES THROWING TANTRUMS: DISRUPTIVE SURGEON BEHAVIOR IN THE PERIOPERATIVE ENVIRONMENT Amalia Cochran, MD, FACS, FCCM Associate Professor of Surgery Vice Chair of Education and Professionalism University of Utah @AmaliaCochranMD
- 2. Disclosures ⢠Content author and editor for UptoDate ⢠Web and Social Media Editor for JAMASurgery
- 3. Objectives ⢠At the conclusion of this talk, attendees will be able to: ⢠Describe conditions that foster disruptive surgeon behavior ⢠Identify common coping strategies used in response to disruptive surgeon events ⢠Define negative consequences resulting from disruptive surgeon behavior @AmaliaCochranMD
- 4. But first⌠A brief story @AmaliaCochranMD
- 5. Medical Students Before the clerkship After the clerkship @AmaliaCochranMD
- 6. An epiphany ⢠If mistreatment is a problem for medical students- our next generation and those most âlikeâ us- how are we behaving towards everyone else? @AmaliaCochranMD
- 7. Wisdom from JFK âThose who dare to fail miserably can achieve greatly.â @AmaliaCochranMD
- 9. WHAT IS DISRUPTIVE PHYSICIAN BEHAVIOR? @AmaliaCochranMD
- 10. AMA Definition ⢠âConduct, whether verbal or physical, that negatively affects or that potentially may negatively affect patient care is considered disruptive behavior.â @AmaliaCochranMD
- 11. TJC Definition ⢠Moved away from âdisruptive physicianâ terminology (too vague) ⢠Replaced with âbehaviors that undermine a culture of safety.â ⢠Described both overt and subtle behaviors @AmaliaCochranMD
- 16. Or maybe this guy had it right⌠@AmaliaCochranMD
- 18. My Research Objective(s) ⢠To develop a unified conceptual model of disruptive surgeon behavior ⢠To define the negative consequences of disruptive behavior using the perspective of those most impacted by it ⢠To identify coping strategies employed in response to episodes of disruptive surgeon behavior ⢠Develop a programmatic response based upon findings @AmaliaCochranMD
- 19. Two questions ⢠âCan you tell me about a time when you saw a surgeon demonstrate disruptive behavior? â ⢠âPlease explain why you believe the surgeon behaved in this way.â @AmaliaCochranMD
- 20. Participants
- 21. What grounded theory looks like @AmaliaCochranMD
- 22. HOW IS DISRUPTIVE BEHAVIOR CHARACTERIZED? @AmaliaCochranMD
- 24. WHAT CONDITIONS FOSTER DISRUPTIVE BEHAVIOR? @AmaliaCochranMD
- 29. HOW DO THOSE SUBJECT TO DISRUPTIVE BEHAVIORS COPE? @AmaliaCochranMD
- 31. WHAT NEGATIVE CONSEQUENCES OCCUR FROM DISRUPTIVE BEHAVIORS? @AmaliaCochranMD
- 33. Disruptive Surgeon Behavior Coping Strategies Talk to colleagues Externalization of the behavior Avoidance Warn others Identify areas of personal development Redirect the surgeon to the patient Report the behavior Negative Consequences Shifts focus from patient to surgeon Increased mistakes Deterred from employment in surgery Loss of respect for surgeons Feelings of powerlessness Interrupted learning Reluctance to provide additional support @AmaliaCochranMD
- 34. WHERE DO WE GO FROM HERE? @AmaliaCochranMD
- 35. Beneficial practices ⢠Inter-professional activities ⢠Creation of stable teams ⢠Conflict management training for surgeons ⢠Remediation plans for trainees and staff ⢠Clear reporting system and clear code of conduct ⢠Encourage reporting- good and bad! ⢠?360s ⢠Follow throughâŚincluding termination ⢠Zero tolerance @AmaliaCochranMD
- 36. Apparent pattern Single âunprofessional" incident Promoting Professionalism Pyramid "Informal" Cup of Coffee Intervention Level 1 "Awarenessâ Level 2 âGuidedâ Level 3 "Disciplinaryâ Pattern persists No â Vast majority of professionals - no issues - provide feedback on progress Adapted from Hickson GB, Pichert JW, Webb LE, Gabbe SG, Acad Med, Nov, 2007 Mandated Reviews Mandated @AmaliaCochranMD
- 37. UP3- A local solution ⢠Interdisciplinary group ⢠Surgeons, including a division chief ⢠Anesthesiologist ⢠Housestaff ⢠Student advocate ⢠Nurse managers ⢠Perioperative nurses ⢠Risk management ⢠Psychiatrist ⢠HR project manager @AmaliaCochranMD
- 38. UP3 Timeline Phase1 Establish Council Standard Development Carrots & Sticks Reporting and adjudication mechanism Phase2 UP3 Roll-out Educational activities Individual accountability program Phase3 Full implementation Ongoing education programs Assessment of efficacy by Council @AmaliaCochranMD
- 39. MY CHALLENGE TO EACH OF YOU @AmaliaCochranMD
- 40. Do hard things *especially those that scare you @AmaliaCochranMD