The College of Physicians and Surgeons of Saskatchewan

Definition Of Disruptive Workplace Behavior

Behavior, either verbal or non-verbal, which by its nature may:

·Demonstrate disrespect to others in the workplace.

·Affect or have the potential to affect adversely the care provided to patients.

·Reflect a misuse of a power imbalance between the parties

The quality of health care workplaces is enhanced when all health care personnel cooperate with one another and treat one another with respect and courtesy.

Conversely, the quality of health care workplaces is eroded when any health care personnel exhibit disruptive behavior and/or are disrespectful or discourteous in their interactions with one another.

Disruptive, discourteous, or disrespectful workplace behavior by any health care personnel should not be tolerated.

All personnel who govern, manage, or work at the frontlines of the health care system should strive to foster a positive workplace environment and to prevent behavior that may poison that environment.

When disruptive workplace behavior occurs, the perpetrator of such behavior ought to be held accountable and steps ought to be taken to prevent future recurrence of such behavior.

Disruptive workplace behavior is less likely to become entrenched if appropriate interventions are made promptly when such behavior is first manifested.

It is very strongly recommended that every Regional Health Authority in Saskatchewan should have strategies for preventing disruptive workplace behavior and strategies to deal effectively with such behavior when it occurs.

In respect to all personnel who are employees of RHAs or who work under contract with RHAs, the human resource department of each RHA should have in place mechanisms and protocol for prevention and response to disruptive workplace behavior that are as consistent as practical in a variety of employment circumstances. However, it is recognized that employment circumstances, unionized or non-unionized, contract, salary or self-employment will impact the mechanisms and protocol for response.

Some of the mechanisms could be:

·Clear policies in respect to workplace behavior that is inappropriate and will not be tolerated.

·Programs to raise awareness of workplace behavior expectations among all workers.

·Mechanisms for reporting disruptive behavior without fear of retaliation.

·Mechanisms for non-adversarial resolution of workplace conflict.

·Awareness of and referral access to educational programs designed to achieve behavioral change and personnel who exhibit disruptive workplace behavior.

·Application of progressive discipline to personnel who exhibit significant and persistent disruptive behavior and are refractory to non-punitive measures.

·A willingness to terminate the employment or contractual engagement of personnel who are persistently disruptive and are refractory to lesser sanctions.

SPECIFIC INFORMATION ABOUT DISRUPTIVE PHYSICIAN WORKPLACE BEHAVIOR

To the extent that it is possible, policies and strategies for prevention and early response to disruptive physician workplace behavior should be the same as those that apply to all other personnel.

However such policies and strategies may require some modification for the following reasons:

·There may be a real or perceived power gradient between physicians and other health care personnel that may make such personnel less inclined to:

·Directly challenge a physician who exhibits disruptive workplace behavior; and

·Report a physician who exhibits disruptive workplace behavior.

·Most physicians are not employees of RHAs or engaged under personal services contracts. For that reason, the disciplinary mechanisms pertaining to physicians may vary from those pertaining to employees and contractees.

The agencies that have served as members of the SAHO Committee on Disruptive Physician Workplace Behavior offer the following guidelines for preventing and addressing disruptive physician workplace behavior.

GUIDELINES FOR REGIONAL HEALTH AUTHORITIES FOR PREVENTION OF AND RESPONSE TO DISRUPTIVE PHYSICIAN WORKPLACE BEHAVIOR

·Physicians should be included in all RHA initiatives directed toward prevention of disruptive workplace behavior and the fostering of positive workplace environments.

·RHAs should ensure that all members of the RHA medical staff are informed about expected workplace behaviors and which behaviors will not be tolerated.

·RHA non-physician and physician personnel ought to be assured of protection from physician retaliation if they report disruptive physicians. A protocol for dealing with retaliation should be established.

·When disruptive physician workplace behavior is first identified, the most senior physician executive in the RHA should be notified and he or she shall determine the appropriate intervention including who works collaboratively with the RHA’s administrative personnel to address the problem. The problem should be addressed so far as is practical in the same manner as they would respond to disruptive workplace behavior by non-physician personnel (i.e. Alternative Dispute Resolution, behavior modification education, etc.).

·If disruptive physician workplace behavior recurs in spite of non-punitive interventions, the RHA should invoke and effectively apply the disciplinary processes described in its Medical Staff Bylaws.

·In its application of its Medical Staff Bylaws, RHAs should follow the principles of progressive discipline as they would in respect to any other health care personnel who exhibit disruptive workplace behavior.

·If any RHA finds itself unable to deal effectively with disruptive physician workplace behavior, it should formally refer such matters to the attention of the College of Physicians and Surgeons.

ADVISORY AND SUPPORT SERVICES FOR RHAs IN DEALING WITH DISRUPTIVE PHYSICIAN WORKPLACE BEHAVIOR

The SAHO Committee on Disruptive Physician Workplace Behavior has assembled helpful resource materials on this issue. These resource materials include:

·Many articles from the published literature that describe the phenomenon of disruptive workplace behavior and approaches taken by health agencies to prevent and respond to this phenomenon.

·Information about an assessment program that may accept referral of physicians who demonstrate persistent disruptive workplace behavior.

·Information in respect to an educational resource that may be helpful in modifying patterns of disruptive physician workplace behavior.

RHAs are welcome to contact SAHO to access any of these resource materials.

RHAs are also welcome to contact the Registrar, Deputy Registrar or Associate Registrar of the College of Physicians and Surgeons for informal advice and guidance in the course of dealing with a physician who exhibits disruptive workplace behavior.