A Systems Approach to Disruptive Behavior in Physicians: A Case Study

Abstract

Disruptive behavior in a medical setting has been defined as objectionable or offensive interpersonal behavior that leads to disruptions of professional activities in the workplace. The most frequent approaches to disruptive professionals have largely focused exclusively on the identified physician. This focus has been found to be ineffective for a number of reasons, in particular because of the recurrence of the behavior after a period of time. A new conceptualization of disruptive behavior is offered in this paper. The authors argue such behavior is often instrumental — that is to say the behavior is goal oriented and accomplishes a result sought by the disruptive individual. Starting from this conceptualization, a case is reviewed.The case is analyzed, first to demonstrate the effect of the disruption on team functioning. A significant disruption in team communication is demonstrated through an analysis of the clinical team’s social network. Significant role confusion is found among support professionals in the clinical team. The case is then analyzed to determine the instrumentality (usefulness) of the behavior to the disruptive physician. A system-based intervention is developed and the disruptive behavior is reduced.The authors argue disruptive behavior presents a significant risk to patient safety. They also argue regulatory authorities have a duty to reduce this risk and understanding the impact of this behavior on the team, and the delivery of health care services, will allow authorities to effectively intervene and reduce or eliminate the behavior and its safety risk.