Emergency Department Directors Academy Phase I Spring 2020 Difficult Clinicians - Addressing Conflict, Impairment, and Burnout and Creating Resilence and Engagement DESCRIPTION One of the most difficult situations an ED director must confront is the problem physician. You were never taught how to address the practitioner who aggravates staff, patients, and medical staff, is resistant to necessary change, or provides substandard care. Using examples, this course will identify some of the more common types of problem practitioners and describe communication techniques and corrective actions with measurable outcomes and endpoints. List indicators, including methods of identification of the problem physician. OBJECTIVES

• List typical practitioner problems requiring intervention. • Describe effective methods of confronting practitioners (direct, “Cup of Coffee conversation,” private,

with data, etc.) • Discuss counseling techniques (conversations, documentation issues, and when witnesses are

necessary. • Develop corrective actions with measurable outcomes. • Define endpoints, i.e. when terminating the relationship is best for both parties. • Difficult Clinicians - Addressing Conflict, Impairment, and Burnout and Creating Resilence and

Engagement 2/3/2020, 9:45 AM - 10:45 AM FACULTY: Jaime H Hope, MD DISCLOSURE: (+) No significant financial relationships to disclose

Difficult Conversations

Jaime Hope, MDBeaumont Health Level 1 Trauma Tertiary Care Center

Assistant Professor – Oakland Univ Wm Beaumont School of Medicine

Harbor Beach Rural Critical Access Hospital

Disruptive Behavior•Prevent or interfere w/ an individual or group’s work, academic performance, or ability to achieve intended outcomes• Intentionally ignoring questions•Not returning phone calls or pages•Not responding to emails •Public criticism

Vanderbilt University and Medical Center Policy #HH-027, 2010

Disruptive Behavior•Create or have the potential to create an intimidating, hostile, offensive, or potentially unsafe work or academic environment•Verbal abuse• Sexual or other harassment• Threatening or intimidating words•Aggressive or violent actions

Vanderbilt University and Medical Center Policy #HH-027, 2010

Disruptive Behavior•Arriving late/leaving early•Not carrying share of work load• Inappropriate social media posts•Eye rolling and negative body language•Non-work related activities at work• Inappropriate jokes

Cup of Coffee•Reporting the event•Not about control, fixing, counseling•Thankless•Stay neutral and on message•Brief•Single issue focused

Cup of Coffee•“I” > “You” statements•Review incident and specifics•Ask for their point of view

Cup of Coffee•Challenges•Rationalizations•Denial, anger•Requests for help•Going up the chain of command

Cup of Coffee•Are you ok?•We don’t do that here• I was not there, I just wonder why others had that perception• If I had been observed, I would hope you or someone else would bring it to my attention• I know your commitment to excellence and to professionalism, which is why I came to you

Program Efficacy

70%Source: The Patient Advocacy Reporting System: The Tool and Process, July 2012

Program Efficacy

70%Source: The Patient Advocacy Reporting System: The Tool and Process, July 2012

Program Efficacy

70%Source: The Patient Advocacy Reporting System: The Tool and Process, July 2012

Dr. McIntosh

Dr. Sanderson

Dr. Phillips

Dr. Jones

“When you know what is holding someone back,

you can help them find the way forward”

Seek to understand their…•Pain•Fear•Why they think that way•Stressors•Limiting beliefs•Empowering beliefs•Goals/passions/ideas

•Motivators•Mindset (growth vs fixed)•Values•Objections•What makes them feel heard•Self-label/identity

“How we view ourselves

is how we will act”

Intrapersonal Conflict•How would you describe the other person?•How do you think they would describe you?•How does he/she make you feel?•Why do you feel they behave the way they do?•What might you be able to do to alleviate the situation?•What would like the other person to do in return?

“I don’t want you to think this represents the sum total of my view on you.

If we could address this one area, I don’t have other

concerns.”

“He who complies against his will

is of the same opinion still”

(Samuel Butler)

Knowledge

Action=