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Constructive Discipline: Part 1

Medical Staff Leader Connection, March 19, 2008

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Benjamin Spock taught the baby boomer generation that discipline was punitive, potentially damaging, and non-constructive. He explained that children would only respond to reason when it was presented with love and understanding. This contributed to a generation that reacts against the need to deal directly, constructively, and meaningfully at times when our expectations and our realities fail to mesh.

This has also contributed to a generation of physicians who seldom want to approach colleagues who are struggling to meet expectations. And yet, leadership requires that we help our fellow physicians succeed. If we don't, we have failed in our responsibility to help each other to be the best that we can be.

Is there a way to frame performance oversight/management in a beneficial and constructive way?

The eastern philosophies of Buddhism and Taoism lend some insight; they see discipline not as punitive or disparaging, but as an opportunity to gain enlightenment through self-mastery, self-awareness, and self-discovery. In this re-framing, offering a colleague the opportunity to gain greater understanding and insight in the process of resolving an internal conflict may be seen as an act of grace and generosity. It may be a gift from one colleague to another-not something to be feared and avoided.

Consider the individual who consistently fails to complete his or her medical records. Rather than chastising that individual, a colleague may first seek to understand the individual's conscious or unconscious decision to be an outlier. Is he or she frustrated with an inefficient and unresponsive system or leadership team? Is he or she rebelling against yet another responsibility in an era of heightening expectations and decreasing reimbursement? Also consider that the individual could be frustrated or angry about something that has nothing to do with the professional environment or suffering from depression, alcoholism, marital discord, or burnout.

As St. Francis of Assisi said hundreds of years ago, "In order to be understood, first seek to understand."

All the best,

Jon Burroughs, MD, CMSL
Senior Consultant
The Greeley Company

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