How peer reporting helps 'mean' doctors become 'amazing to work with'

Committed leadership is key

Vanderbilt University Medical Center's (VUMC) program that encourages staff to report disruptive physician behavior has yielded results, Lena Weiner reports for HealthLeaders Media.

Disruptive physician behavior can take many forms, from failing to return calls from the nursing station to lashing out at fellow clinicians, says William Cooper, director of the Vanderbilt Center for Patient and Professional Advocacy.

VUMC had already had success with peer-to-peer interventions for clinicians who received the most complaints for patients. Recently, Cooper and his colleagues sought to determine whether a similar program could successfully target those who received the most complaints from VUMC staffers, with the goal of increasing professionalism, quality, and safety. Cooper co-authored a recent study in The Joint Commission Journal on Quality and Patient Safety on the medical center's efforts.

VUMC's peer-to-peer program, called the Co-Worker Observation Reporting System (CORS), includes:

  • Recruiting and training key individuals on how to bring concerns to physicians;
  • Encouraging reporting among staff;
  • Monitoring reports; and
  • "Employing a tiered intervention process to address reported coworker concerns."

Outcomes

The study found that just 3 percent of physicians accounted for nearly 50 percent of complaints from staff. It also found that the program was successful in promoting peer-to-peer interventions: So-called peer messengers followed up with physicians and advanced practitioners who had received staff-reported complaints 84 percent of the time.

Further, researchers found that the interventions appeared to help change behavior. After one year, 71 percent of clinicians who had received a peer intervention based on a staff complaint were not named in any follow-up reports.

The study concluded that systematic "monitoring of documented co-worker observations about unprofessional conduct" is feasible if "co-workers [are] willing and able to share respectful, nonjudgmental, timely feedback."

Cooper says there have been anecdotal examples of success as well. For instance, two nurse managers told VUMC's CNO that a doctor who received an intervention "used to be so mean," but recently has "been just amazing to work with."

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Keys to successful interventions

The key takeaway, according to Cooper, is that "a nonjudgmental conversation with a peer can actually be quite effective in changing behavior." He recommends several steps for staging an effective intervention, including:

  • Using a non-public space;
  • Keeping the discussion relatively short; and
  • Thanking the physician receiving a report for their time.

"What's especially interesting about [the interventions] is that these are sometimes people who have been doing these behaviors for years, and no one has ever told them," he says.

The other part of a successful intervention program, Cooper explains, is empowering staff to speak up. "Team members have to trust that they'll be safe, and that no one is going to retaliate" against them for reporting disruptive physician behavior, he says.

Another critical lesson from Vanderbilt's efforts is the importance of committed leadership. "They have to align with the organization's values," he says, "and you need an intervention model to identify those [best suited to intervene] and train them to give non-judgmental feedback" (Weiner, HealthLeaders Media, 4/11; Webb et al., The Joint Commission Journal on Quality and Patient Safety, April 2016).


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