Is your process for ID'ing disruptive docs complete?
What your peer review process should contain
Organizations are taking a close look at their policies for addressing disruptive physicians, in order to comply with new Joint Commission standards for 2009 that will require accredited health care organizations to create a code of conduct and formal process for managing unacceptable behavior.
In addition, a Sentinel Event Alert was just issued by The Joint Commission to call attention to this topic. Rude language and hostile behavior among health care professionals can threaten patient safety and quality of care, warns the alert.
The alert recommends organizations educate all health care team members about professional behavior, develop a system to detect and report unprofessional behavior, and take a comprehensive approach to intimidating and disruptive behaviors that includes a "zero tolerance" policy and strong support from physician leadership.
Your peer review process for a disruptive provider should include the following, says Douglas L. Elden, chairman of the Northbrook, IL-based National Peer Review Corp.:
- A review of the hospital records relating to the professional conduct of the physician, including the credentialing file, staff complaints, and records of investigation, committee minutes, and other relevant information. The investigation should not be limited to the latest incident or incidents.
- An on-site investigation to gather information on the physician's professional conduct through interviews with the physician's peers, patient care professionals, managers, administrators, and technical and support personnel.
- The information gathered from the records and site visit should coalesce to create a solid record detailing any disruptive conduct incidents, as well as their causes, targets, and the circumstances surrounding these incidents.
- The information should then be analyzed to determine the impact of the physician's conduct on patient care.
- A report should be generated setting forth the unbiased conclusions and recommendations necessary for the hospital to determine if peer review action is appropriate.
- If the hospital and medical staff are concerned about a physician's clinical competence, as well as disruptive conduct, the peer review activities for each issue should be conducted as two separate tracts.
"Hospital decision makers often hesitate to initiate a review of a disruptive physician," says Elden.
In addition to internal political considerations, this reluctance arises, in many instances, because the evidentiary basis for the review may appear too subjective to support a peer review action.
Alice Gosfield, a Philadelphia-based attorney and consultant specializing in quality improvement, points to a case involving a complaint of the patient against the hospital for failure to take definitive action when complaints were made against the physician (Copithorne v. Framingham, Supreme Ct. MA 1988).
"Despite concerns, a hospital cannot ignore its legal obligation to take action to protect the safety of patients and the hospital staff from the disruptive conduct of a physician," says Elden.
Organizations are taking a close look at their policies for addressing disruptive physicians, in order to comply with new Joint Commission standards for 2009 that will require accredited health care organizations to create a code of conduct and formal process for managing unacceptable behavior.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content