Presenting a live 100 ‐ minute webinar with interactive Q&A Disruptive Physicians: Disruptive Physicians: From Credentialing to Disciplinary Action Minimizing Liability for Poor Quality of Care, Negligent Credentialing and Physician Lawsuits WEDNES DAY, S EPTEMBER 28, 2011 1pm Eastern | 12pm Central | 11am Mountain | 10am Pacific T d Today’s faculty features: ’ f l f S uzanne A. Fidler, M.D., J.D., CPHRM, S enior Director of Risk Management and Patient S afety Officer, Desert Regional Medical Center , Palm S prings, Calif. Michael R. Callahan, Partner, Katten Muchin Rosenman , Chicago Julian Rivera, Partner, Brown McCarroll , Austin, Texas The audio portion of the conference may be accessed via the telephone or by using your computer's speakers. Please refer to the instructions emailed to registrants for additional information. If you have any questions, please contact Customer Service at 1-800-926-7926 ext. 10 .
Conference Materials If you have not printed the conference materials for this program, please complete the following steps: • Click on the + sign next to “ Conference Materials” in the middle of the left- hand column on your screen hand column on your screen. • Click on the tab labeled “ Handouts” that appears, and there you will see a PDF of the slides for today's program. • Double click on the PDF and a separate page will open. Double click on the PDF and a separate page will open. • Print the slides by clicking on the printer icon.
Continuing Education Credits FOR LIVE EVENT ONLY For CLE purposes, please let us know how many people are listening at your location by completing each of the following steps: • Close the notification box • In the chat box, type (1) your company name and (2) the number of attendees at your location • Click the S END button beside the box
Tips for Optimal Quality S S ound Quality d Q lit If you are listening via your computer speakers, please note that the quality of your sound will vary depending on the speed and quality of your internet connection. If the sound quality is not satisfactory and you are listening via your computer speakers, you may listen via the phone: dial 1-866-871-8924 and enter your PIN when prompted Otherwise please send us a chat or e mail when prompted. Otherwise, please send us a chat or e-mail sound@straffordpub.com immediately so we can address the problem. If you dialed in and have any difficulties during the call, press *0 for assistance. Viewing Qualit y To maximize your screen, press the F11 key on your keyboard. To exit full screen, press the F11 key again press the F11 key again.
The Challenges of Addressing Disruptive Behavior in the Disruptive Behavior in the Community Hospital Setting Suzanne A Fidler M D J D CPHRM Suzanne A. Fidler, M.D., J.D., CPHRM Senior Director of Risk Management Patient Safety Officer 949 ‐ 631 ‐ 0055 drfidler@physicianforlaw.com 5
The Joint Commission (TJC) The Joint Commission (TJC) “Behaviors that undermine a culture of safety” • • All accreditation programs must adopt a code of All accreditation programs must adopt a code of conduct that defines disruptive, unacceptable behaviors. (EP 4) • Leaders create and implement a process for managing disruptive and inappropriate behaviors. (EP 5; Behaviors that Undermine a Culture of Safety, (EP 5; Behaviors that Undermine a Culture of Safety, TJC, Sentinel Event Alert, Issue 40, July 8, 2008) 6
Defining “Disruptive Behavior” fi i “ i i h i ” No clear definition of what constitutes disruptive behavior No clear definition of what constitutes disruptive behavior. • American Medical Association Code of Medical Ethics: • “disruptive behavior” is defined as “personal conduct, whether verbal or physical that negatively affects or whether verbal or physical, that negatively affects or potentially may negatively affect patient care.” Excluded is “criticism that is offered in good faith with the • aim of improving patient care.” 7
One Approach Administration delegates the preparation of the policy to • the Chief of Staff Chief of Staff collaborates with the Medical Staff attorney Chi f f S ff ll b i h h M di l S ff • to draft policy At the General Staff Meeting, the policy is presented to At the General Staff Meeting, the policy is presented to • the medical staff 8
P Problems? bl ? Physicians voice opposition to the policy • Several physicians set up an ad hoc committee to discuss Several physicians set up an ad ‐ hoc committee to discuss • the policy Other physicians bring sample policies from organizations • such as the American Medical Association Some physicians threaten to move their practices • 9
Ph Physicians’ Perspective i i ’ P ti Medical staff is self ‐ governing • Physicians are not the only offenders Physicians are not the only offenders • Peer Review as a tool by those in positions of power • Competition, economic tool Competition, economic tool • Recredentialing process • Outspoken or unpopular physicians may be perceived as • “disruptive” 10
P Protections Offered t ti Off d Establish a clear channel to report disruptive behavior • Objective data collection Objective data collection • Ensure code of conduct is incorporated into the medical • staff rules and bylaws Focus on rehabilitation rather than discipline • Hospital maintains a culture that is supportive and • inculcates a positive collaborative culture of safety f f 11
Focus on Rehabilitation, Focus on Rehabilitation, Not Discipline Adopt a standardized mechanism to investigate and • document disruptive behavior p Establish an informal review process • Collegial intervention should be established • Administration provides education and training d d d d • Appropriate referral process for physicians requiring • evaluation, diagnosis, and treatment g Monitoring procedure for the physicians and safety of • patients 12
D Dr. Hart H t Dr. Hart is an electrophysiologist who is well trained from • a distinguished medical program. He moved to the community to establish a private H d h i bli h i • electrophysiology cardiology practice. Dr. Hart typically gets irritated if he is paged and the Dr. Hart typically gets irritated if he is paged and the • nurses cannot answer questions such as the interpretation of the rhythm strips, the current vital signs, and test results and test results. 13
P ti Patient Tom t T Patient Tom is a 55 ‐ year ‐ old executive with a long history • of smoking hypertension and obesity of smoking, hypertension, and obesity. He is at risk for heart disease and has been admitted for • further cardiac testing. Dr. Hart plans to perform an electrophysiology study in • the morning if the patient has no further chest pain. 14
N Nurse Jane J Nurse Jane is a recent graduate from a local nursing • school and this is her third month working the night shift. g g The nurses are instructed that due to the recent CPOE • (computer provider order entry) implementation, no verbal orders from physicians will be accepted verbal orders from physicians will be accepted. Around 9 p.m., patient Tom complains of chest pain. • Nurse Jane checks Tom’s vital signs, listens to his heart, • and follows the cardiac protocol by administering f nitroglycerin. After 10 minutes, patient Tom states that his chest pain , p p • has not improved. 15
P Paging Dr. Hart i D H t Nurse Jane places a call to Dr. Hart’s exchange. • Dr. Hart does not call back within 15 minutes and patient Dr Hart does not call back within 15 minutes and patient • Tom still has chest pain. Nurse Jane places a second call to Dr. Hart’s exchange. • Dr. Hart does not call back, so Nurse Jane places a third • call to Dr. Hart. 16
D Dr. Hart’s Call H t’ C ll Dr. Hart calls back and Nurse Jane begins to present to Dr. • Hart the purpose of her call using SBAR for effective p p g communication per the hospital’s standards. Dr. Hart interrupts her and demands to know why she did • not give patient Tom additional nitroglycerin not give patient Tom additional nitroglycerin. Before Nurse Jane can answer, Dr. Hart barks the • following orders: stat EKG, start a nitroglycerin, cardiac enzymes blood gas then call with the results enzymes, blood gas, then call with the results. He hangs up before Nurse Jane explains that he will have • to enter the orders per hospital policy and she is not able to read back his orders. 17
R Results Return lt R t Nurse Jane receives the results and places a call back to • Dr. Hart. Dr. Hart returns the call and asks Nurse Jane to read the • results. As Nurse Jane starts to read back the results Dr Hart As Nurse Jane starts to read back the results, Dr. Hart • interrupts her and asks her to read the blood gas. Nurse Jane did not recall that Dr. Hart had ordered the • blood gas. 18
I t Interaction ti Dr. Hart begins to raise his voice at Nurse Jane, calling her • an “idiot” and demanding that he speak to the charge nurse. Nurse Jane becomes tearful and gets her charge nurse. • In the meantime, Dr. Hart hangs up. g p • The charge nurse pages Dr. Hart who calls back again • demeaning the nurse for not ordering the blood gas. The charge nurse tries to explain that CPOE policy g p p y • requires that he enter the orders but Dr. Hart hangs up. Nurse Jane enters an incident report into the hospital • computer system. p y 19
Recommend
More recommend
