Workplace bullying in healthcare II: Vanderbilt U program for doctors

Physicians can be hard driving, high performing individuals whose professional training usually doesn’t involve a lot of interpersonal skills development.  In fact, the process of going through internship and residency may involve a fair amount of harsh treatment, thus modeling behaviors that contribute to an aggressive organizational culture.  It’s not surprising that some doctors bully nurses, hospital workers, and their peers.

Vanderbilt University Medical Center program

From healthcare, here’s one interesting program created specifically to deal with doctors who engage in disruptive behaviors, including bullying.  The Center for Professional Health at the Vanderbilt University Medical Center has instituted a program for identifying, treating, and remediating disruptive behaviors by physicians.  Under the program, complaints lodged by patients and others are used to identify physicians who may be behaving in disruptive ways.  When necessary, a full assessment will evaluate all the circumstances surrounding a physician’s counterproductive behavior.  This will lead to an individually tailored plan of education and counseling.

Strengths

The Vanderbilt program focuses largely on the circumstances and actions of the offending physician.  This makes eminent sense where the conduct has been inappropriate, disruptive, and potentially harmful to co-workers and patients, and the physician appears to be a candidate for whom education and counseling may have a positive remedial effect.  The Vanderbilt program appears well situated to deal with such cases in a fair and responsive manner.  Too many times, discussions about bullying and emotionally abusive conduct dismiss the possibility of working with the offending employee, but here this rehabilitative goal is paramount.

Limitations

However, the Vanderbilt program is not without its limitations.  It implicitly downplays how a negative organizational culture or acts by other individuals may trigger or contribute to behaviors deemed “disruptive” in quite predictable ways.  For example, expressions of anger, derogatory comments about the institution, and various withdrawal strategies may be defensible, or at least understandable, responses to a dysfunctional, hostile, and/or non-inclusive work environment.  Ironically, targets of severe bullying at work may react in just such a manner.

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To learn more

An article fully describing the Vanderbilt program, written by program founder William Swiggart and his colleagues, appears in the Summer 2009 issue of Frontiers of Health Services Management.  Here is the citation: William H. Swiggart, et al., A Plan for Identification, Treatment, and Remediation of Disruptive Behaviors in Physicians, Frontiers of Health Services Management, Vol. 25, No. 4 (Summer 2009).   The article is not freely available online, but a symposium issue of the journal on bullying in healthcare containing the Swiggart piece, another lead article, and two responses (including one that I wrote) may be purchased here.

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Link to the first in this series of posts on bullying in health care, discussing the Joint Commission standards

Link to the third post in the series, discussing tort claims brought against physicians by healthcare workers

Link to the fourth and final post in the series, discussing bullying of nurses and how nurses’ unions can respond

5 responses

  1. Pingback: Workplace bullying in healthcare I: The Joint Commission standards « Minding the Workplace

  2. Pingback: Workplace bullying in healthcare III: A sampling of legal cases « Minding the Workplace

  3. Pingback: Workplace bullying in health care IV: Nurses bullied and responding « Minding the Workplace

  4. Thanks very much for this..I’ve been looking for some program innovation in this area. Are you aware of anyone who has been doing some work that addresses the organzational culture component?

    I’m having some difficult tracking down the article (the site refers me to a Canadian distributor for purchasing), but I think I should be Ok if I can track down the ISBN.

    • Catherine, I don’t know of any coaching/counseling program of this nature that expressly incorporates considerations of organizational culture. Obviously more of the scholarly commentary on bullying at work has been taking into account organizational factors. Griffin and O’Leary-Kelly, The Dark Side of Organizational Behavior (Jossey-Bass 2004) is an example.

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