Medical Staff Leadership Responsibilities and the Issue of 'Disruptive Physicians'

In the 2009 white paper titled “Leadership in Healthcare Organizations, A Guide to Joint Commission Leadership Standards,” published by the Governance Institute, the four primary goals of leadership in a health care institution were identified as follows:

1. Quality of care and patient safety; a significant number of sentinel events are linked to ineffective leadership.
2. The financial viability of the health care institution.
3. A decrease in the risks of litigation.
4. Compliance with ethical and legal standards and obligations.

A significant factor that bears upon the issue of leadership in a health care institution and that impacts these cited goals of leadership is that of disruptive physicians and inappropriate behavior. Empirical data shows that disruptive and/or intimidating conduct by physicians can impair the quality of the delivery of patient care services. See “Revisiting Disruptive and Inappropriate Behavior: Five Years After Standards Introduced,” by Ronald M. Wyatt, Medical Director, The Joint Commission (Oct. 2, 2013); “Disruptive Clinician Behavior: A Persistent Threat to Patient Safety,” by Grena Porto and Richard Lauve, psqh.com (July/August 2006). So there is an established nexus between disruptive conduct and negative patient outcomes and medical errors.

The majority of health care providers, including physicians, strive to fully comply with codes of conduct applicable to a health care setting. Unfortunately, however, there are outliers who fail to conform to behavioral norms and who exhibit behavior that is disruptive and that undermines the quality of patient care. Certain departments and settings — for example, the surgical and emergency departments, and the operating room — are generally more susceptible to incidents of disruptive behavior.