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Constructive discipline--An oxymoron?

Medical Staff Leader Connection, March 26, 2008

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Many of us fear and avoid dealing directly, constructively, and meaningfully with our colleagues when they fail to meet common expectations. But, as I discussed last week, discipline can actually provide us with opportunities to better understand each other as individuals and professionals. 

Consider last week's example of the physician who persistently fails to complete his or her medical records. I suggested that instead of chastising this individual, a colleague should first seek to understand the reason this individual is not meeting expectations.

Does this physician understand the unintended consequences of not completing records or imparting critical clinical information to colleagues in a timely manner? Does he or she understand that the inability to code and bill ties up large sums of money that could be used to improve care and provide services? Does he or she understand that billing for a service that is not documented raises the potential for fraud and abuse? It is difficult to stimulate change without first helping others understand the unintended impact of an action (or inaction), no matter how seemingly benign.

A helpful approach is to engage in mutual problem solving, or as Fisher and Urey demonstrated in their popular book Getting to Yes, inventing options for mutual gain. Can the hospital implement e-signature with Internet access, electronic access to records through remote portals, or other innovative ways that will save physicians and the organization both time and money?

As Charles Dwyer of The Wharton School of Business pointed out, "Never expect anyone to engage in behavior that serves your values unless you have given that person adequate reason to do so." This statement begs the question, "What is adequate reason?" Is it professional esteem, money, security, pride, or any other fundamental motivations that drive our behaviors? Coming to a mutual awareness of what is important to your colleague is a powerful way to inspire change.

Understanding our colleagues' motivations does not obviate the need to hold them mutually accountable for their actions or inactions. It also doesn't mean we can never engage in progressive discipline on rare occasions when an individual is unwilling or unable to comply with mutually agreed-upon expectations.

Thus, a seemingly trivial matter of dealing with a performance issue takes on a deeper and more useful approach: the opportunity to engage in mutual problem solving and awareness. Accountability becomes a shared responsibility and the interaction may lead to something far more significant than the issue itself.

All the best,
Jon Burroughs, MD, CMSL
Senior Consultant
The Greeley Company

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