Approved: June 25, 2008
Revised: June, 2014
Disruptive behaviour is an enduring pattern of conduct that disturbs the work environment. (Graham & Stacy). A physician whose behaviour is disruptive cannot, or will not, function well with others to the extent that his or her behaviour, by words or actions, interferes with or has the potential to interfere with quality health care delivery. The gravity of disruptive behaviour depends on its nature, the context in which it arises and the consequences which flow from it (CPSA Planning Group 2008).
Policies for dealing with physician disruptive behaviour should be aimed at prevention and early intervention. These policies should also be similar for all members of healthcare teams. However, the College of Physicians and Surgeons of Alberta, hereafter referred to as the College, recognizes that differences do exist for physicians due to a potential power differential in the healthcare system and due to the fact that most physicians are not employees of the health authority and thus disciplinary mechanisms may vary from those related to employees.
In situations where the physician involved in disruptive behaviour is considered an employee or under contract with the health authority. The college recommends the mechanisms to deal with such individuals. These include, but are not limited to:
- clear policies on inappropriate workplace behaviour,
- educational programs to inform all healthcare members of workplace expectations,
- proper methods to report disruptive behaviour which is made available to all members of the healthcare team,
- mechanisms to attempt to resolve disruptive behaviour,
- clear communication with the College for resources and managing such behaviours; and
- a readiness to terminate contracts and employment if the disruptive behaviour does not cease or is deemed severe enough to result in immediate termination of the physicians involvement with the health region.
The College does not tolerate disruptive behaviour. When disruptive behaviour occurs, the perpetrator involved should be held accountable and measures taken to prevent recurrence. Once becoming aware of disruptive behaviour the College must then decide what information needs to be gathered, what assurances are needed to determine fitness to practice and the monitoring required.
Identification of physicians demonstrating disruptive behaviour:
- self report
- report by a colleague
- report by a treating healthcare professional
- identification through a complaint process
Reporting Disruptive Behaviours Any individual who experiences unacceptable conduct or harassment, either personally or as a witness, is entitled and should be enabled to:
- inform the physician that such behaviour is unwelcome;
- seek confidential advice from, or report a complaint to a person in authority with the agency or institution (e.g. hospital, RHA, university, CPSA) (CPSA Planning group 2008).
Information gathering in situations of physician disruptive behaviour.
Regardless of the way in which a physician is identified, the process to determine their fitness to practice will be similar and include the following:
- Additional investigations or requirements.
- Reports of individuals affected by disruptive behaviour.
- Reports from colleagues of work performance.
- Report from health authorities involved in the situation and past physician performance evaluations.
- Additional investigations or requirements.
This information initially may be provided either verbally or in written form. The reporter is entitled to assistance in formatting a written complaint if help is needed. It should include all relevant detail about the individuals involved, the circumstances, and the effect on the reporter and on immediate patient safety (CPSA Planning group 2008).
If there is a serious concern about a physician’s fitness to practice, they can be asked to voluntarily withdraw from practice until all information is gathered or they could be suspended until fitness to practice was determined. This is a serious matter but patient safety must come first and the College will need to ensure that there is not a risk to patients. In both cases, the physician will be reminded to seek legal advice to ensure a fair process.
Additional information may include the following:
- Cognitive assessment and neuropsychological testing to determine ability to practice.
- Physical assessment tailored to the specific problem: i.e.: orthopedic surgeon, neurologist, sleep disorder specialist, internists
- Psychiatric assessment.
Multidisciplinary assessment for complex cases or when there is a direct patient concern involved.Physicians must agree to allow the College access to medical records which confirm their fitness to practice.
- Unfit to practice with no chance of recovery.
- Unfit to practice at the time of assessment but improvements likely.
- Fit to practice with practice limitations or restrictions.
- Fit to practice with no restrictions
- Disruptive behaviour can impair the ability to practice, but in many cases physicians can be rehabilitated. Ongoing monitoring is required to ensure compliance to recommendations of treating experts, to reassess for fitness to practice and to ensure compliance with any practice restrictions or limitations. This can include the following:
- Reports from treating physicians.
- Reports from colleagues or designated practice monitor.
- Reassessment by a third party.
- Practice visits or audits to review their practice.
- Competency assessment.
- Monitoring of billing or medical records to determine compliance to practice restrictions.
Continuing Care Contracts:
These contracts are entered into to ensure compliance to the requirements as a condition of continued practice and using an informal process rather than the complaints process to resolve issues related to disruptive behaviour.