Overview: Disruptive activity by practitioners in the hospital takes many forms. When it happens, it is important that the hospital and/or the medical staff take appropriate steps to see that it does not affect patient care or disrupt operations.

Disruptive behavior in a healthcare setting is any conduct by a credentialed practitioner—including physicians, surgeons, advanced practice providers, and others—that intimidates, demeans, or undermines other members of the healthcare team. This behavior is not limited to loud, aggressive outbursts. It often manifests in more subtle, yet equally damaging, ways such as passive-aggressive refusal to cooperate, condescending verbal comments, disrespectful or dismissive body language, and the intentional undermining of clinical decisions. The common thread is that this behavior interferes with the collaborative culture essential for safe and effective patient care. When such activity occurs, it creates a toxic undercurrent that can erode team morale, stifle open communication, and directly compromise patient safety. Therefore, it is a fundamental responsibility of the hospital administration and medical staff leadership to have a proactive, structured, and fair process in place to identify, address, and mitigate these behaviors before they lead to catastrophic outcomes, staff turnover, or legal repercussions. The goal is not merely to punish, but to correct behavior and protect the institution's mission.

Why you should Attend: Hospital executives, medical staff officers, peer review committee members, and support staff should attend to learn how to deal effectively with disruptive practitioners.

Attending a session on this critical topic is not a passive exercise in policy review; it is an active investment in the organization's cultural and clinical resilience. For Hospital Executives (CEO, COO, CNO, CMO), understanding this process is central to their fiduciary and ethical duties. They will learn how tolerating a single disruptive individual, even a highly productive one, can lead to millions of dollars in losses through staff turnover, litigation, and reputational damage, not to mention accreditation issues with bodies like The Joint Commission. For Medical Staff Officers (President, Vice-President, Department Chairs), this training is a practical guide to wielding their authority effectively. They will gain the tools to conduct difficult conversations, implement progressive discipline, and lead their peers with confidence and fairness, thereby upholding the integrity of the self-governing medical staff.

Physicians who serve on Peer Review Committees will learn to expand their focus beyond purely clinical competence to include behavioral standards. They will understand how to evaluate evidence of disruption objectively, separate personality conflicts from genuine patterns of unprofessional behavior, and make sound recommendations that can withstand legal scrutiny. Finally, Medical Support Staff (nurses, therapists, medical staff coordinators) are often the first to witness and be affected by disruptive conduct. Their attendance is crucial to empower them with the knowledge of safe, confidential reporting mechanisms and to assure them that the institution has a robust, trustworthy system to address their concerns without fear of retaliation. This collective understanding across all roles fosters a unified front and a culture of accountability.

You will also learn how to prepare for the day when it becomes necessary to terminate such a practitioner's privileges and medical staff membership.

The termination of a practitioner's privileges is the most severe action a medical staff can take, and it is fraught with legal peril if handled incorrectly. Preparation for this possibility begins long before the final decision is made. Attendees will learn that the foundation for a defensible termination is built on meticulous, continuous documentation. This involves creating an undeniable "pattern and practice" file that demonstrates the behavior is persistent, has been clearly communicated to the practitioner, and has continued despite multiple opportunities and interventions for correction. You will learn the critical importance of linking behavioral standards directly to the criteria for continued membership in the Medical Staff Bylaws, thereby elevating professional conduct to the same level of importance as clinical competence.

Furthermore, the session will cover the intricate procedural steps mandated by the Medical Staff Bylaws for corrective action, which are designed to ensure due process. This includes the proper formation of an investigative committee, the presentation of evidence, and the management of a Fair Hearing if requested by the practitioner. Importantly, you will learn about the mandatory reporting obligations that follow a termination, including the crucial report to the National Practitioner Data Bank (NPDB) and any state-specific licensing board requirements. Understanding this end-game process from the outset ensures that every step taken from the first informal warning is aligned with the ultimate goal of protecting the hospital and its patients in a legally sound manner.

You will also gain an understanding of how to develop provisions in the medical staff bylaws to deal with disruptive practitioners and how to develop a clear and concise policy regarding disruptive behavior.

A hospital's defense against disruptive behavior is only as strong as the documents that form its foundation. This involves two complementary documents: the Medical Staff Bylaws and a standalone Disruptive Behavior Policy. The Medical Staff Bylaws are the constitution of the organized medical staff. To be effective, they must contain explicit language stating that adherence to behavioral standards of professionalism is a mandatory condition for the initial granting and continued enjoyment of medical staff membership and clinical privileges. This provision gives the medical staff leadership the legal authority to take action based on behavior, just as they would for a lapse in clinical skills.

The Disruptive Behavior Policy, often a separate rules and regulations document, must be clear, concise, and actionable. It should start with a strong purpose statement linking professional conduct to patient safety and a healthy work environment. The core of the policy is a detailed definition of disruptive behavior, illustrated with concrete, behavioral examples that leave little room for interpretation (e.g., "berating a nurse during a patient handoff," "refusing to respond to pages for emergent consultation," "using demeaning language"). The policy must also outline safe, confidential, and multi-channel reporting mechanisms that protect reporters from retaliation, and it should clearly reference the progressive disciplinary steps that will follow, from informal coaching to formal corrective action.

We will discuss the elements of an effective policy and the actions that should be taken to develop progressive discipline and/or sanctions that should be taken before taking action under the corrective action procedures.

An effective policy is a roadmap, not just a list of rules. Its key elements include a well-defined scope, a robust definition with examples, guaranteed non-retaliation for reporters, and a clearly articulated progressive discipline pathway. The principle of progressive discipline is central to a fair process. It operates on the concept that the consequences should escalate in response to the severity or persistence of the behavior, starting with the least punitive measures designed to correct the problem.

The first step is often an Informal Intervention, which may involve a private, coaching-style conversation by a department chair or a trusted peer to make the practitioner aware of the perceptions of their behavior. If the behavior continues, a Formal Verbal Warning is documented, signaling the start of the official disciplinary process. This may be followed by a Formal Written Warning placed in the practitioner's file. For persistent issues, more significant sanctions like a Behavioral Contract may be imposed, which can mandate specific remedial actions such as anger management counseling, executive coaching, or communication training. Another powerful tool is a Focused Professional Practice Evaluation (FPPE) focused on behavior, which may involve proctoring or direct observation of the practitioner's interactions. These steps, meticulously documented, demonstrate the hospital's good-faith effort to rehabilitate the practitioner and are essential before escalating to the formal corrective action procedures outlined in the bylaws for suspension or termination.

It is very important to demonstrate that this disruptive behavior is a continuing problem; therefore, appropriate documentation is imperative. You will discover how to create a record of this continuing problem and the efforts taken by the organization to combat the problem.

In the context of disruptive behavior, if an incident is not documented, it effectively did not happen. A handful of vague, anecdotal complaints will not support a significant adverse action. The goal is to build a compelling, evidence-based narrative that demonstrates a "pattern and practice" of unprofessional conduct. This requires moving beyond subjective impressions to objective, factual accounts.

You will learn to implement a standardized incident reporting form that captures specific data: the date, time, and location of the incident; the individuals involved; direct quotes of what was said; a description of the behavior; and, crucially, the impact of that behavior on the team, the reporter, and patient care (e.g., "the nurse was too distraught to properly monitor her other patients," or "the delay in communication led to a 2-hour postponement of the procedure"). Every report, whether from a nurse, a respiratory therapist, or another physician, should be consolidated into a single, confidential file for the practitioner in question. This file must also meticulously document the organization's responsive efforts—copies of warning letters, summaries of coaching conversations, details of the behavioral contract, and reports from any mandated coaches or counselors. This complete record shows a consistent pattern of behavior and the institution's consistent efforts to correct it, creating an indisputable justification for any final actions taken.

Areas Covered in the Session:

Disruptive Practitioner Policies
This segment will provide a deep dive into the anatomy of an effective policy, from the purpose statement and definitions to reporting protocols and integration with the medical staff governance structure.

Corrective Action Procedures
We will break down the formal process as outlined in the Medical Staff Bylaws, explaining the roles of the investigative committee, the Medical Executive Committee, and the Fair Hearing process, ensuring leaders understand how to navigate this legal landscape.

What Constitutes Disruptive Behavior
Moving beyond simple definitions, we will explore the full spectrum of disruptive conduct, from overt verbal aggression to subtle passive-aggressive actions, and discuss how to assess the pattern, frequency, and impact of such behavior.

Steps the Hospital and/or the Medical Staff should take to See that the Disruptive Activity does not affect Patient Care or Disrupt Operations
This practical section will outline the immediate and intermediate actions available, from informal coaching and progressive discipline to the potential for summary suspension in cases of imminent danger, ensuring patient safety remains the priority throughout the entire process.

Who Will Benefit:

• Hospital Executives: To understand their ultimate accountability for culture and the significant legal and financial risks of an unaddressed disruptive practitioner.

• Medical Staff Officers: To gain the practical skills and confidence needed to lead their peers, manage conflict, and enforce professional standards within the medical staff.

• Physicians who serve on Peer Review Committees: To learn how to fairly evaluate behavioral issues alongside clinical ones and contribute to decisions that protect both patients and the integrity of the staff.

• Medical Support Staff: To be empowered as vital guardians of the institutional culture, understanding how and when to report concerns without fear.

• Attorneys Representing Medical Staffs: To gain a comprehensive understanding of the entire process in order to provide proactive legal counsel and effectively defend the medical staff's actions if challenged.