Organisational culture determines the behaviour of medical specialists. The reverse also holds true. The way in which doctors deal with quality and safety – and call one another to order regarding behaviour and incident reporting – determines to a large degree the culture of a healthcare institution. This is due to the position held and example shown by the medical specialist within a healthcare institution.
This blog describes the causes and effects of dysfunctional behaviour by medical specialists and how an open culture reduces the risk of this behaviour.
It is important that the culture in healthcare institutions is one in which doctors can report incidents without fear of “blaming and shaming.” This is also known as a just culture. Everybody wants to do their job to the best of their ability, but this can lead to a conflict model between management boards and care professionals. Driving for unity creates a we-culture instead of a we/they culture. It is crucial that values such as compassion, cooperation and carefulness take centre stage. This can help to prevent or reduce potential dysfunctional behaviour.
“Incidents have clearly shown the impact that dysfunctional behaviour by doctors can have on individual patients, on a public sense of security and on the healthcare institution itself.”
Dysfunctional behaviour by medical specialists
More attention is now being paid to the dysfunctional behaviour of medical specialists. Not only in the political arena and in the journalistic community, but also within the professional group of medical specialists itself. The underlying reason for this is a number of incidents that can be attributed to the dysfunctional behaviour of doctors. Devastating case studies have huge impact on the sense of security felt by individual patients, the medical professionals and the healthcare institution itself.
“Alongside their medical know-how and skills, doctors must possess the art of self-reflection, both scientifically and personally, in order to become and remain an excellent doctor.”
Safety and doing the job professionally
It is only logical that the way in which care professionals operate is under the spotlight. For the simple reason that if they do not adhere to the professional standards set, patient safety can be at risk. Moreover, organisational shortcomings can also present a risk to patient safety.
Doctors are trained to be ‘medical experts’ – but competence areas such as communication, cooperation, acting in a socially-acceptable manner, organisational skills and professionalism are just as important. The more work experience doctors have had, the deeper they need to dig into and develop these competences. Education permanent within and outside the area of expertise is an absolute prerequisite. Excessive routine behaviour, rigid adherence to old and outdated procedures or simply too much on their plate can lead to reduced performance in one or more competence areas, despite many years of satisfactory performance.
Risks that can cause dysfunctional behaviour by medical specialists
Research into the origins of dysfunctional behaviour suggests that the risks can be classified as follows:
- Individual factors such as lack of self-reflection, reluctance to accept peer feedback, etc.
- Factors related to the working environment such as organisation/Management Board, practice, pressure of work (too high), long working days, a technically-complex environment, etc. These issues are often coupled to individual factors.
- Factors related to continuous professional development – or a lack thereof – such as insufficient focus on education and training to develop new techniques and new ways of working.
Research by Visser et al.et al. (2003) suggests that 55% of the 2,400 medical specialists interviewed experience high levels of stress and dissatisfaction. Primary factors related to working conditions in combination with individual factors contribute to this sense of stress. High stress levels and dissatisfaction enhance the chance of a burn-out. Doctors suffering from poor psychological and/or physical health – burn-out, physical challenges, depression, addiction and emotional problems within a relationship – are risk factors that can develop into dysfunctional behaviour.
What can contribute to risk prevention under highly-trained professionals?
All hospitals in the Netherlands are required to implement a system that conducts responsible evaluation of individual professional functioning of members of the medical staff (IFMS). Medical specialists request IFMS for peer feedback from subordinates, superiors as well as colleagues at the same level. The medical manager discusses this feedback with the medical specialist. IFMS should be an annual process to ensure that the continuity of feedback discussions is guaranteed.
In the Netherlands, we are familiar with the IFMS system (Individual Functioning of Medical Specialists), and other evaluation systems that map the performance of specialists. The structural character of the IFMS offers the possibility to detect and rectify functional shortcomings (see Box).
Role of management
The Management Board and supervisors are duty-bound to take action when dysfunctional behaviour is detected. It is therefore important that management boards and supervisors are aware of the following:
- Recognition of reduced performance – such as diminishing know-how, skills, cooperation and communication – with the help of the IFMS, for example.
- Timely response to reduced performance is crucially important to prevent the occurrence of safety risks.
- Support during a period of reduced performance should be directed towards situational recovery and safeguarding safety. It is key that the practice or the institution stimulates or facilitates this process.
- An important role for peers, who do not always know what to do. How do you bring instances of reduced performance out into the open?
- Attention should be paid to the development of a culture in which the way care professionals function is discussed openly and, when necessary, is adequately supported.
- The healthcare institution is responsible for the quality and safety of the care provided.
How can TPSC be of assistance?
TPSC Cloud™ software makes it easy for supervisors and care professionals to report incidents and bring them out into the open. Reports can be generated quickly and easily, whereby incidents, risks and trends can be illustrated real time.
Implementation of the PRISMA analysis illustrates the root causes of the origin of an incident, for example, the dysfunctional behaviour of a care professional. In addition, we would like to enter into conversation with you to support your organisation in keeping the Individual Functioning of Medical Specialists (IFMS) system up to date.
Safety Culture Ebook
Would you like to know more about creating a culture of safety that reduces the risk of dysfunctional behaviour by medical specialists? Download the e-book 'Safety is our joint effort!' about creating a healthcare safety culture.
Wendy Rientjes, 2017
Daniels, M. (2013, December). Optimaal functioneren medisch specialisten. Retrieved from http://www.kwaliteitskoepel.nl/assets/structured-files/Optimaal%20functioneren/Optimaal%20functioneren%20van%20medisch%20specialisten.pdf
Wagner, C., Lombarts, K., Mistlaen, P., & Bruijne, de, M. (2015, January). De problematiek van disfunctionerende artsen. KIZ, pp. 23-25. Retrieved from https://website.professionalperformanceonline.nl/wp-content/uploads/2015/05/De-problematiek-van-disfunctionerende-artsen.pdf