This document outlines management strategies for addressing physician impairment and misconduct in a constructive, rehabilitative manner. It discusses the importance of developing objective behavioral standards, intervention processes, and ongoing monitoring and support over punishment. The goal is to create a culture of safety by respecting all individuals, empowering staff to speak up, establishing clear behavioral standards, and promoting rehabilitation through education, accountability and a team effort approach.

1. Management StrategiesManagement Strategies
A constructive, proactive,A constructive, proactive,
rehabilitative & effective approachrehabilitative & effective approach

2. The Credentialing FallacyThe Credentialing Fallacy
• “The credentialing process…usually
misses or ignores…those behavioral or
emotional factors that, at some point, may
be a greater determinant of professional
competence than board certification.”
• Daniel A. Lang, M.D.

3. Competence vs. Performance*Competence vs. Performance*
• Competence
– The possession of required skill, knowledge,
qualification, or capacity; adequacy.
• Performance
– The execution or accomplishment of work,
acts, feats, etc.

4. Guiding PrinciplesGuiding Principles
• Respectful at all times
• Completely confidential
• Safe for everyone
– Protect anonymity of staff
• Rehabilitation focus
• Timely & prompt: Must report back
• Based on objective, nonjudgmental data

5. Objective data,Objective data,
Presented non-judgmentallyPresented non-judgmentally
• Investigate thoroughly
• Objective, behavioral descriptions
– Observable behavior (yelled, said “stupid!)
– Times, dates, etc.
– No motives
– Write down
• Present in nonjudgmental terms
– Rehearse

6. Separate the physician from theSeparate the physician from the
problemproblem
• Be “hard” on behavior
• Be “soft” on person
• Always refer to behavior
• Assume good intentions of doctor
• Do not impugn motives

7. Use appropriate consequencesUse appropriate consequences
• Frequently no previous consequences
– Even for bullying
• Consequences promote behavior change
– Good intentions, insight don’t work
• Examples of consequences

8. Follow-Up & MonitoringFollow-Up & Monitoring
• Intervention is only first step
• Chronic conditions often present
• Good monitoring & follow-up relapses
• Provide ongoing mentoring & support

9. Step I: Announce goal ofStep I: Announce goal of
“Culture of Safety”“Culture of Safety”
Get full support from topGet full support from top
Administrative & MedicalAdministrative & Medical
LeadershipLeadership

10. Boldness has genius, power and
magic in it. Begin it now.
--Goethe
(William Hutchinson Murray , MD)

11. Waste ManagementWaste Management
ca. 56 on the job deaths/ yearca. 56 on the job deaths/ year

12. Step II: DevelopStep II: Develop objectiveobjective
Code of BehaviorCode of Behavior
““Principles of Partnership”Principles of Partnership”

13. Step III: Examine Policies,Step III: Examine Policies,
Procedures, BylawsProcedures, Bylaws
Make sure they are up to date andMake sure they are up to date and
SupportSupport rehabilitationrehabilitation of theseof these
physiciansphysicians

14. Step IV: Develop Physicians HealthStep IV: Develop Physicians Health
Committee (non-punitive option)Committee (non-punitive option)
• Group of respected physicians (us. 5-7)
– Wisdom, skills, broadly representative
– Psychiatrist, if possible
– Recovering alcoholic physician, if possible
– Long, renewable terms (3-4 years, renewable)
• Ongoing liaison with OK physicians pgm.
• Train PHC
• Ongoing education programs for doctors

15. V: Develop effectiveV: Develop effective
intervention processintervention process
• Formal meeting with objective goals
• Meaningful people (note plural)
• Present data in way it can be heard
– Objective, observable data
– Nonjudgmental
– Respectful
• Do not allow abusive behavior
– Terminate meeting if abusive

16. Engage physician early in aEngage physician early in a
process of dialogueprocess of dialogue
• Identify and intervene early; be supportive
– “Golden Period”
• Be firm; Use graded responses
• Develop rehabilitation plan together
• Articulate consequences if no change
• Reinforce positive changes
• Follow up, monitor, support, follow up

17. Intervene toIntervene to assessmentassessment whenwhen
appropriateappropriate
• Behavior does not tell us whether
physician is safe to practice
• A comprehensive assessment increases
likelihood of successful rehabilitation
• Assessment more palatable to doctors

18. Monitoring is essentialMonitoring is essential
• Monitoring improves prognosis
– Often long-term proposition
• Does not make problems go away
– Don’t rely on monitoring alone
– Expect physician to address problems
• Monitor compliance with treatment team
– Expect FULL COMPLIANCE
• Monitor progress in behavior change
• Administer appropriate consequences as needed

19. Give nurses, staffGive nurses, staff
permission to speak uppermission to speak up
““I am empowered to tellI am empowered to tell
you that your behavior isyou that your behavior is
unacceptable.”unacceptable.”

20. R E S P E C TR E S P E C T
• R= Respectful treatment of everyone
• E= Empowerment of all
• S= Written Standard of Behavior
• P= Persistence, persistence, persistence
• E=Education (ongoing)
• C= Culture, Confidentiality, Consequences
• T= Team effort