The "Borderline" Physician:
Managing Performance Improvement for Those Who Can Improve (and Building
the Legal Record for Those Who Can't)
Audio CD
Recorded December 7,
2006
Faculty: Barbara
Blackmond & Phil
Zarone
Do
these scenarios sound familiar?
-
A
physician whose records are chronically incomplete responds to
a final ultimatum and improves; but then starts rounding at midnight...
then responding slowly to pages;....you get the picture! How many
hours must physician leaders spend counseling this physician?
- A physician is an outlier
in complications, and has not responded to progressive collegial efforts.
When the Department Chief tries to get her voluntary agreement to a
monitoring and educational program, she threatens to sue anyone who
might serve as a monitor. How long should you keep trying less formal
steps?
- A
surgeon sees himself at the "cutting edge" of new techniques, and claims
that no one else has the ability to review his work because they're
not as advanced as he is. Nurses are coming to the CMO with concerns
about patients, and even the need for the procedures, but the surgeon's
records reveal no complications. So far, no actual harm, so no need
to do anything?
Dealing
with the clearly problematic physician is hard enough. Even
in the most egregious case, the physician may get an attorney
and try to intimidate physician leaders and disrupt the process
(and today, we're seeing more and more criminal defense attorneys
in these cases!).
So what do you do when the issues are
less clear? Sometimes the most difficult questions are presented
by the mediocre or below average physician who won't or can't
respond to collegial or informal efforts, or who responds
for a time only to slip backwards in the same or a different
way.
Today, with increasing external expectations
(government, news media, community) and internal (board, employees)
and public reporting on quality measures, it is imperative to
strive for excellence. Waiting for a trail of injured patients
is not an option. Yet, without that, hospitals and physician
leaders often worry about the resistance they will face if they
take action.
Join HortySpringer partners, Barb Blackmond
and Phil Zarone, as they explore ideas and strategies for dealing
with the borderline physician:
- Catch
as many issues as possible up front. Don't appoint the problematic
physician. How to spot red flags in the post-Kadlec era.
- Use
a Statement of Expectations to lay the groundwork.
- Consider
the pitfalls and alternatives to addressing the generic
rather than the specific (i.e., reviewing the whole department
rather than only the individual) to avoid the hassle of
appearing to focus on a single physician.
- Use "best practices" approaches
such as benchmarking and feedback reports (you'll need
to do this anyway for JCAHO 2007 standards for more "evidence-based" credentialing
and ongoing professional practice evaluation)
.
- Take
steps that do not rise to the level of "adverse actions." (But
how much leeway do you have for conditional reappointments
and Performance Improvement Plans?)
- Document
actions to build a historical record for future leaders and
a legal record for HCQIA immunity.
- Avoid
allegations of delay by potential "whistleblowers." Keep
them informed without breaching peer review confidentiality.
Audio CD: $225
ORDER
NOW
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