University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA.
Ariadne Labs, Boston, Massachusetts, USA.
BMJ Lead. 2023 Jun;7(2):128-132. doi: 10.1136/leader-2022-000615. Epub 2022 Aug 19.
As health systems continue to consolidate at a rapid pace, many physicians are stepping into roles that involve managing other physicians. While more physicians are thrust into these positions each year, the managerial training they receive is highly variable and often insufficient for dealing with the challenges they will face, notably disruptive behaviour. Broadly defined, disruptive behaviour includes any actions that affect a team's ability to effectively care for patients, and can even threaten patient and provider health. New physician managers--who typically have little prior experience in management roles--need specific supports to address this uniquely daunting challenge.Over our management careers, we have spoken with dozens of new and experienced physician managers to understand how they manage disruptive behaviour in the workplace and to collect their advice for future physician managers. In this paper, we reflect on those conversations and distill them into a three-part approach for diagnosing, treating and preventing disruptive behaviour in the workplace. We describe how the right management approach depends on a thorough assessment of the most likely drivers of the disruptive behaviour. Second, we present strategies for treating the behaviour focusing on the physician leader's communication skills and available institutional resources. Finally, we advocate for system-level changes that institutions or departments can implement both to prevent disruptive behaviour and to better prepare new managers to address it.
随着医疗体系的快速整合，越来越多的医生开始承担管理其他医生的职责。尽管每年都有更多的医生被推到这些岗位上，但他们接受的管理培训差异很大，而且往往不足以应对他们将面临的挑战，尤其是破坏性行为。广义上讲，破坏性行为包括任何影响团队有效照顾患者能力的行为，甚至会威胁到患者和医务人员的健康。新的医师管理者——他们通常在管理角色方面几乎没有经验——需要特定的支持来应对这一独特的艰巨挑战。在我们的管理生涯中，我们与数十名新老医师管理者进行了交谈，以了解他们如何在工作场所管理破坏性行为，并为未来的医师管理者收集他们的建议。在本文中，我们反思了这些对话，并将其提炼为诊断、治疗和预防工作场所破坏性行为的三部分方法。我们描述了正确的管理方法取决于对破坏性行为最可能驱动因素的彻底评估。其次，我们提出了针对该行为的治疗策略，重点关注医师领导者的沟通技巧和可用的机构资源。最后，我们提倡机构或部门可以实施的系统层面的变革，以防止破坏性行为的发生，并更好地为新管理者应对这一行为做好准备。
