QUESTION: We are reviewing an application from a new applicant who has excellent credentials with respect to his education, training, experience and current clinical competence. However, the applicant has had trouble working with others and was even subject to a behavioral performance improvement plan at his last hospital. The Credentials Committee is split over how important behavior really is when a candidate otherwise has excellent credentials. How should we proceed?
ANSWER: This is a question we hear often. You finally find a physician who has excellent credentials, but acts out a little. While everyone has a “bad hair day” once in a while, it is a mistake to bring someone into your organization whose behavior will undermine your culture of safety.
This is the terminology used by The Joint Commission when it issued its 2008 Sentinel Event Alert. According to the Sentinel Event Alert:
“Intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators and managers to seek new positions….All intimidating and disruptive behaviors are unprofessional and should not be tolerated.”
The Sentinel Event Alert was followed by the adoption of a leadership standard that required hospitals to adopt a code of conduct or professionalism policy.
Recognizing the importance of working professionally and respectfully with others, most credentials policies require applicants to demonstrate an “ability to work harmoniously with others, including interpersonal and communication skills sufficient to enable them to maintain professional relationships with patients, families, and other members of health care teams.” The bottom line is that behavior matters in the quality of care you provide in your hospital.
So in credentialing the applicant, get as much information from previous hospitals and past employers about his or her ability to work with others. Ask for a copy of the behavioral performance improvement plan. Ask for a copy of the underlying concerns that led to the adoption of the performance improvement plan. Request a copy of any correspondence that relates to behavioral concerns. And don’t forget to make follow-up phone calls to references and to others who may have worked with the applicant in the past to get a candid evaluation of any problems.
A physician who experienced a problem period because of personal issues, but then improved should not be problematic. A physician with a longstanding pattern of inappropriate and unprofessional behavior is not likely to change when he or she lands at your hospital. Don’t forget the middle option of conditional appointment which can also be useful in laying out expectations and consequences should the inappropriate behavior reoccur.
Please join us in our national program – Credentialing for Excellence – where we discuss this and other credentialing challenges.