What are effective strategies for managing physicians who do not adhere to patient care standards?

"Do No Harm" is one of the foundational tenants of ethics and client care services across many paradigms/careers. By not following patient care standards, a physician can delay, stifle, and potentially harm a person's recovery process. I believe in teachable moments and kindly sharing the importance of adhering to codes of ethics, conduct, safety, and patient care standards. Seeking to integrate patient care/ethical standards into the professional fabric of who we are is important to not only providing excellent case management services, but it overlaps into every other service and outcome a person will experience and can be instrumental in their growth and recovery.

As they say, "You can't judge a tree's strength by the size of its leaves, but by the depth of its roots." We had a talented psychiatrist on our team who was consistently falling short in providing follow-up care for patients. We knew it wasn't a knowledge or skills issue, but we wanted to be sure. After a thorough assessment, we discovered that she was going through a difficult personal situation: her son had been diagnosed with a life-threatening cancer. This experience taught us that it's important to look beyond the surface when someone is struggling.

I have experience with rolling out new protocols that require physician engagement and compliance. It is essential for physicians to understand the “why” and evidence to support these changes. There then needs to be accountability through team feedback and auditing. When poor compliance is identified, the physician needs to approached and allowed to explain their perspective and decision-making. An assessment must be done to ensure the physician has enough education on the changes to comply. They must also be guided to understand the impact of the non-compliance on the patient outcomes and/or team. When the physician then performs well, the successful outcomes should be identified and recognized.

When physicians do not adhere to care standards, understanding root causes is key to constructive resolution. Rather than making assumptions, we must inquire gently through empathy and listening without judgment. Burnout impacts many in caring roles. Through open communication, barriers and needs can be uncovered, not differing opinions. Our shared goal is patient well-being, so we lift each other when challenges arise. No single path suits all, as we are all individuals. Standards are crucial, yet flexibility is warranted where lives intersect complexly. We must make space for each other's motivations in serving patients. With compassion we can address any concerns cooperatively to continually strengthen quality as a team united in care.

One thing that I found, crucial and important, whenever engaging a colleague, or subordinate, who is falling short of patient care standard, is not only to identify the root cause, but pulling that individual aside and discussing such concerns with empathy, lack of judgment, and respect. Of these, respect is most important. Health professionals are human and have egos. You will lose any opportunity to make significant change in behavior by being disrespectful or condescending or bruising their ego by embarrassing them in front of their peers.

Communication is the key to successful “case management”, which we do with mental health and Substance Use Disorder clients, families and corporations. Our team Psychiatrist is an incredible communicator and is constantly educating himself as well as teaching new med students.

Communication is the key to resolving all sorts of conflicts and try communicating with physician's the need to follow the norms

"A tree does not grow stronger by cutting off its branches, but by nurturing its roots." Similarly, physicians can thrive when we address the root causes rather than merely addressing the symptoms of non-compliance.

In my experience, it is often helpful to involve peer physicians to participate in the conversations when coaching physicians.

I find that entering these types of conversations work best when I come from a place of curiosity rather than correction. It is important to understand why the behavior occurred before attempting to correct it. Individuals will not share the true root cause of their behaviors if leaders do not create safety and trust!

When standards diverge, feedback with support can realign approaches. Through open discussion, offer perspective on strengths and tailored skill development assistance via coaching and resources. Monitor progress dialogically rather than judgmentally, recognizing achievements encouragingly. Examine serving patients while respecting all experience and challenges, as none are flawless yet excellence grows within through understanding. Differences teach as harmony balances complexity; compassion empowers where rules divide. Uplifting guidance prosperity brings to lives and callings united in wellbeing.

I would focus first on developing standard work, training to the standard, and creating standard processes to ensure consistency. It is important to remember to be critical about the process and kind to the people when making and reinforcing standards.

A n?o aderência é consequente de pouco tempo de consulta, péssimo local de trabalho, valores de remunera??o aviltantes, sendo quest?o de tempo o desligamento por parte do médico.

The performance reviews, are one of the ways to monitor and evaluate progress together with the physician. The performance reviews or the expectations of the review, are shared with the physician so that they know what is expected of them at each year, quarter, month etc...in every area of their professional duties.

All of this assumes that some breach of a standard has been verified, and that there is a consensus about such an occurrence. It also implies that formal peer review has been instituted, which carries a number of legal obligations to ensure fairness and due process. Unfortunately these days it is not uncommon for health care entities to target physicians who may be outliers or even whistleblowers, using trumped up allegations of various breaches in order to create grounds for dismissal or even career derailment. This may be especially common in the case of resident physicians, who have limited resources to fight back.

Healthcare is all about providing standard and recommended medical care by every Physician who is qualified and takes a Hippocratic oath. This isn't just a professional obligation but a medicolegal compulsion to save oneself from the perils of negligence and compensation.Inspite of knowing this many physicians don't adopt standard care and act at their own discretion which isn't just a deviation from the standard practice,but which dents on the aspects of medical care and clinical Outcomes.The institution should have a stringent policy for every aspect of clinical care and all such pathways should be upheld and followed by every professional.This should become a non negotiable rule, and should be inducted at the time of recruitment.

Ensinar aos pacientes e fazer com que eles cobrem dos médicos as melhores práticas e desfechos clínicos esperados. Engajamento e compromisso com o paciente e n?o com a organiza??o

Hopefully you identified the true root cause of this provider's behavior and retrained to the standard. While implementing corrective actions maybe a an appropriate action, I first would make sure the organization partnered and provided adequate support. Healthcare organizations face employee/physician retention challenges. These challenges are costly to the organization, its reputation, other staff members.

Consequences of poor reviews are indicated together with the review, so that it is clear for both supervisors and the physician. Whilst outcomes of positive behaviors are also elaborated at individual level for the physician, at team level as well as organizational level so that the physician can see the direct correlation of their behaviors - positive and negative.

I once led a multidisciplinary team in a psychiatry clinic. We had a problem with inconsistent adherence to care standards. Instead of punishing people, we organized regular meetings where everyone could talk openly about the challenges they were facing. By working together to address these challenges, we were able to improve adherence to the standards. Building a culture of accountability and quality in patient care is an investment in the future that will benefit patients for years to com (even if we won't be around to see it).

I find adherence improves when organizations focus on frequent work flow and implementing provider/staff-identified changes that streamline the work flow. Oftentimes, inefficient work flows/processes cause poor adherence.

Ensure that all actions comply with healthcare regulations and legal standards. Sometimes, consulting with legal experts or regulatory bodies may be necessary to manage complex cases of non-adherence appropriately.

To reduce and prevent recurrence, the physician themselves are asked to rate themselves and their patient care, and 360 degree evaluations can also be implemented so that their colleagues and patients alike can evaluate them.

Problemas cujas origens estejam relacionadas com a estrutura e / ou processos, na minha experiência, têm repercuss?o horizontal na opera??o e afetam a todos. Identificar o ponto crítico por vezes n?o é tarefa fácil. Já as situa??es onde as pessoas (profissionais) s?o o problema, o treinamento geralmente resolve, antes de uma eventual substitui??o.

I agree with managing your emotions. What’s critical here is knowing the individual you are addressing from a personal and cultural perspective. The intervention or reprimand in some cases may be best coming from a peer group having a discussion with the individual with clear objectives and expectations. On the other hand, the individual may take that as being “ganged up” on or targeted. Either way, the approach is delicate, and you have to know the individual to be effective with your intervention. And sometimes it doesn’t matter what you do it can blow up in your face and you have to be willing to accept it. You don’t have to deal with that burden alone. This is where your colleagues and workplace policy may help lessen the burden on you.

How to manage your emotions when dealing with challenging situations involving physicians not adhering to patient care standards: Acknowledge Your Emotions Deep Breathing and Relaxation Techniques Mindfulness and Meditation Physical Exercise Talk to Someone Practice Self-Compassion Journaling Set Boundaries Engage in Hobbies and Leisure Activities Seek Professional Help if Needed

Emotions play a very important role for both Physician as well as patient. While the patient should be allowed to express the emotions in a peaceful way, the Physician should not let his emotions revealed. Emotions lead to early judgements and false diagnosis.

When standards aren't followed, it undermines trust and autonomy in care. Preventing gaslighting and empowering patients is vital. Listen fully to understand experiences without dismissal. Repeatedly dismissing concerns without resolution causes distress. Speak with empathy, acknowledging feelings without judgment. Seek respectfully to remedy miscommunication or lack of involvement. Involve advocates if requested to prevent isolation. Accurately document complaints with transparent follow-up. Reports aren't solely about liability - timely responses assure care. Healing relationships require mutual understanding and accountability from all through compassionate collaboration rather than conflict. All deserve caring partnership in wellness.

Discussions with your colleague physicians are easy. The problem often is a directive from someone higher in the chain of command that does not have the whole story and wants actions taken against the physician. Chances are that you have already discussed this with your direct superior and if not, you certainly will be sharing the complex patient situations after this situation happens. Punishment is not justified, but the power from above ends up with a double secret probation that allows your boss to say that they are aware and monitoring this while you continue on. The ultimate solution is to replace or avoid administrators that step outside of their roles. Getting tired of negative hits on physicians from so many directions.

I wonder if the training of physicians doesn’t lend themselves to be anything but a leader. There are several instances I can think of where a physician may not follow patient care standards, one is when they are implementing new protocols, procedures, or practices. Perhaps there is a research study being implemented (especially in large academic centers) and patient care standards may deviate. They deviate for the right reasons- advancing science through clinical trials. Be careful what you label as not following standards. Restrictions placed upon physicians should be carefully considered. If there is gross error and misconduct related to the non adherence of standards then appropriate chain of command and “just cause” should apply.

Seek to understand before wanting to be understood- mantra that helps provide guide ropes in any difficult situation prior to drawing up judgment cards.

Lo más importante es generar consciencia acerca de la responsabilidad que implica el “contrato social” de la medicina y trabajar en el fortalecimiento de competencias inteligentes como escucha activa, comunicación asertiva, resolución de conflictos, compasión, entre otras, que no se desarrollan plenamente hasta que no se inicia el ejercicio profesional.