Disruptive Healthcare Provider Behavior: An Evidence-Based Guide

147 Pages·2016·1.745 MB·English

by  Rade B. Vukmir (auth.)

Rade B. Vukmir
Disruptive Healthcare
Provider Behavior
An Evidence-Based Guide
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Disruptive Healthcare
Provider Behavior

Rade B. Vukmir
Disruptive Healthcare
Provider Behavior
An Evidence-Based Guide
Rade B. Vukmir, MD, JD
President
Critical Care Medicine Associates
Sewickley , PA , USA
Professor Adjunct
Emergency Medicine
Temple University School of Medicine
Clinical Campus
Pittsburgh, PA, USA
ISBN 978-3-319-27922-0 ISBN 978-3-319-27924-4 (eBook)
DOI 10.1007/978-3-319-27924-4
Library of Congress Control Number: 2016930304
Springer Cham Heidelberg New York Dordrecht London
© Springer International Publishing Switzerland 2016
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Pref ace
D isruptive provider behavior is perhaps one of the most
complicated areas of medical practice management and hos-
pital administration. The scope of research into this topic has
expanded considerably to involve all members of the health-
care team, including providers and administrators. The analy-
sis has begun to focus on patient care and quality of life in the
health-care workplace, rather than just the effects on an
individual or group. As such, approaches toward intervention
have shifted from corrective actions targeting the individual
to education and proactive intervention that strives to
improve the overall system.
This book addresses the theory of disruptive behavior
theory, how this behavior is experienced, at-risk groups and
situations, regulatory influence, and strategies directed at
intervention and improvement. Finally, a set of illustrative
case scenarios, including situational analysis and action plans,
is presented.
Sewickley, PA, USA Rade B. Vukmir
v

Executive Summary
The study of disruptive behavior among health-care provid-
ers is based on a multidisciplinary approach emphasizing a
comprehensive identification, education, and remediation
strategy. The search identified approximately 90 articles pub-
lished over the past 35 years that reported substantive quali-
tative and quantitative scientific data and recommendations
on this topic.
Here, disruptive provider behavior is defined, its etiology
is explored, and it is profiled according to location and spe-
cialty correlates. The complex nursing interface and residency
training correlates also are analyzed. Most importantly, the
effects on patient safety and care quality are reported. In
addition, the impact of policies on the economic and legal
aspects of the health-care delivery process is evaluated.
Lastly, the management interface, interventional strategies,
and educational approaches regarding the disruptive behav-
ior dilemma are discussed.
D isruptive provider behavior is a complex, multifaceted
problem whose solution requires cooperation among physi-
cians, nurses, and administrators to ensure care quality and
patient safety. At the same time, investment of time and effort
in a facility’s staff has direct benefits in reducing absenteeism
and employee turnover, as well as indirect benefits that accrue
directly to the patient, as staff performance is improved as well.
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Contents
1 Introduction.................................................................. 1
2 Scope of the Problem .................................................. 5
3 Organizational Approach ........................................... 9
4 Maturation of the Analysis ......................................... 17
5 Profile of the Behavior ............................................... 23
6 Location at Risk .......................................................... 33
6.1 Operating Suite ................................................... 33
6.2 Labor and Delivery ............................................ 34
6.3 Intensive Care/Critical Care Unit .................... 34
6.4 Emergency Department .................................... 35
7 Specialty at Risk .......................................................... 37
7.1 General Surgery .................................................. 37
7.2 Obstetrics/Gynecology ....................................... 40
7.3 Orthopedic Surgery ............................................ 42
8 Physicians in Training ................................................. 45
9 Etiology ......................................................................... 49
10 Nursing Interface ......................................................... 55
11 Patient Safety ............................................................... 59
12 Policy and Guidelines ................................................. 65
13 Economic Issues .......................................................... 69
14 Legal Interface ............................................................. 75
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