WHITE PAPERS FROM TRUE NORTH – LEADERS IN PHYSICIAN COACHING

COACHING: A NON-PUNITIVE, POSITIVE SOLUTION TO HELPING

DISCONNECTED DOCTORS

The Problem

New regulations for hospitals to receive accreditation from the Joint Commission require hospitals to
have policies and procedures in place for disruptive conduct in the workplace. In results from a poll
conducted recently by the American College of Physician Executives (ACPE), 95% of the physician
executive respondents reported encountering disturbing, disruptive, and potentially dangerous behavior
from physicians on a regular basis. Moreover, of those respondents, 70% said it repeatedly involves the
same physician(s). The Joint Commission (JCAHO) standard describes disruptive behavior as those “that
intimidate staff, decrease morale, or increase staff turnover . . . behaviors may be verbal or non-verbal,
and may involve the use of rude language, threatening manners, or even physician abuse.”

Because of mal-adaptive behaviors, these physicians might be referred to a Physician Well Being
Committee, PWBC. About 20 % are not dealt with at all, according to a study published in the July 2006
Journal of the American College of Surgeons. If the physician is not found to be impaired or compromised
by the PWBC, they are often sent back to work with minimal or no intervention. Yet, these mal-adaptive
behaviors can and do continue, thereby increasing the hospital’s risks of lowered patient safety, reduced
patient satisfaction, lowered work morale, increase staff turnover and increased malpractice suits.
Addressing this pressing issue is of utmost importance.

The Solution

Coaching is a non-punitive, non-medical solution to help doctors with disruptive behaviors makes
significant changes. By focusing on the client’s strengths and forward movement, a coach facilitates long-
term changes by helping clients gain insight, keep focused on adaptive behavioral changes, and become
accountable for improving performance. The coaching process typically involves regularly scheduled
meetings, over a short period, and keeps the spotlight on progress rather than past mistakes or history.
This is a highly effective way to hardwire new behaviors, especially so, since most physicians with
disruptive behaviors tend to repeat their mal-adaptive behavior.

The Benefits

December 2006, ACPE published its finding in a report from the first Survey on Physician Morale. Sadly, it
appears that physician morale is at an all time low. Addressing the issue of disruptive behavior in a
positive, strengths based manner has the potential for significant personal, professional and community
benefits. Many are obvious: improved patient safety, greater staff retention, and improved relationships
with patients, staff and administrators. The cost benefits of coaching are great and for corporations in the
US, there is an estimated 600% ROI for coaching.
About Coaching

Coaching as a profession has been around for about 10 years. The International Coach Federation (ICF)
regulates the profession, as well as accredits training and continuing education programs. All members of
the ICF must adhere to a Code of Ethics and meet high professional standards through a stringent
credentialing process.

Its theoretical foundations are based on: 1) Adult Development and Learning, 2) Change Theory, 3)
Positive Psychology; 4) Social Neuroscience, 5) Wellness, 6) Psychology, 7) Management Development, 8)
Ontological Theory; and 9) Systems Theory. An increasing number of institutes of higher education such as
the University of Michigan, Harvard, Stanford, and Georgetown offer graduate degrees in coaching or
coach training through their executive education programs.

One of the more frequent questions asked about coaching is, “How does it compare to other
methodologies?” The chart below gives a brief answers to the question. * Note: All of these methods can
work in conjunction with each other.

Coaching Compared & Contrasted to Other Interventions

Coaching Counselling Training

Future Oriented Digs into past One big dose

Shorter Term Longer Term Over brief period

Developmental Therapeutic Didactic

Professional Focus Personal Focus Topical Focused

Client is Whole Client needs Fixing Gives advice

Elicits Insight Client-Centred Instructor-Centred

Action with accountability Elicits Insight

Highly Individualized Highly Individualized Somewhat Individualized

True North Coaching | www.tncoaching.com

517 292-1261
True North Company LLC ©
COACHING FOR HEALTH CARE INSTITUTIONS
Although executive coaching is commonly adopted in corporate environments, physician coaching in
health care is new. However, its use in health care is beginning to increase.

There are critical factors to consider when implementing a coaching program for physicians exhibiting
disruptive behaviors. Ideally, hospital policies are in place to address what are acceptable and
unacceptable behaviors, reporting mechanisms, and non-retaliation clauses. In addition, the hospital’s
stance on dealing with “special cases,” such as; whistles blowers, high admitters, or highly regarded
specialists needs to be clearly understood by all.

Determining a measurement of success is important. Success indicators could be employee retention,

improved performance, higher patient satisfaction ratings, increased harmony, higher morale, and
engagement.

A process for making referrals must be established. We recommend the hospital to refer as early as
possible rather than allow problems to mount up. The person making the referral can expect resistance
from the physician; therefore creating a safe emotional environment will help. So will educating the
physician, that coaching is a non-medical, non-punitive approach (many times it is a perk) that will focus
on strengths and improving performance. Making a referral demonstrates the hospital values a physician
enough to make substantial efforts to keep them.

Feedback loops need to be established. We recommend monthly coaching progress reports to the
hospital and periodic check-ins by the hospital with the client and their supervisor. You can expect
progress to be like an upward spiral, with gradual improvement and possible occasional setbacks. If the
client has a major setback, a meeting with the hospital, client, and coach is optimal. When the meeting is
held as soon as possible after the fact, setbacks are actually ideal learning opportunities.

The hospital, client, and coach relationship

It is critical to the process that a supportive and safe emotional environment be established, where
confidentially is respected and honored by all involved. This is especially important between coach and
client. The client must feel that the coach represents them, not just the hospital. The client must be able
trust the coach and must feel that he or she can openly talk about highly personal matters without fearing
that information will be shared with the hospital.

It is important for the hospital to ask about positive changes the physician is making and to ask what they
need to reinforce their new learning. The physician’s supervisor may need to be educated about the
importance of maintaining confidentially, creating a supportive environment, understanding learning will
take time, and the importance of periodically asking about positive changes they are making. The
supervisor will maximize and encourage the physician’s continued growth by keep focused on the future,
not the past as well as by recognizing and acknowledging positive changes.

True North Coaching | www.tncoaching.com

517 292-1261
True North Company LLC ©
TOP 10 SUCCESS STRATEGIES: WORKING WITH PHYSICIANS WITH
DISRUPTIVE BEHAVIORS

Have you ever had to deal with a physician who was disruptive? If so, you are in the mainstream
of many physician executives. (VPMA, CMO, and COS) We offer this guide so you can start out
on the right foot when dealing with physicians, whose behaviors are disturbing, disruptive and
potentially dangerous.

1. Realize you are in the mainstream. Expect 3 – 5 % of the population in any typical hospital to exhibit
disruptive behaviors. A 2004 poll by the American College of Physician Executives reported that 70 % of
disruptive incidents repeatedly involve the same physician.

2. Institute hospital policies to spell out acceptable and unacceptable behaviors, reporting mechanisms,
and non-retaliation clauses.

3. Be clear on your stance when dealing with “special cases” such as; whistle blowers, high admitters, or
highly regarded specialists.

4. Have all hospital staff sign a “statement of understanding” regarding policies and procedures for
disruptive behaviors. Keep these on file.

5. Create safe environments for reporting with non-retaliation policies and assurances of confidentiality.

6. At the first report of disruptive behavior, discern if this was an unusual off day (bad hair day), an
emerging pattern, or an emergency.

7. When warranted, refer for intervention as early as possible rather than allow problems to mount-up.

8. Consider intervention options and choose one(s) that best match the problem. (Coaching, Training,
Monitoring, Counseling, Psychoanalysis, PWB, State Medical Board)

9. When making a referral to intervention(s), expect resistance. Create a safe emotional environment to
lessen the tension. Convey that a referral demonstrates that the hospital values good physicians enough
to make substantial efforts to keep them.

10. Maximize and encourage the physician’s new learning and continued growth by keeping focused on
the future, not the past. Recognize and acknowledge positive changes. It might be baby steps, but expect
forward movement. Keep all eyes on the prize.

True North Coaching | www.tncoaching.com

517 292-1261
True North Company LLC ©
True North, is a pioneer coaching company in the field of working with physicians labeled as disruptive. It
is the intervention of choice since it is confidential, cost-effective, physician-friendly, non-punitive, and
non-pathological. To meet the challenges True North has developed a highly specialized approach to
addressing disruptive behavior in the healthcare work place. True North’s coaches understand how
people change behaviors and are able to discern if a particular client is coachable. Because of our work
with hospitals around the US, we are a part of making a positive change in healthcare. Our ultimate goal is
increased better patient care.

“Working with physicians who have disruptive behaviors is extremely rewarding and
challenging at the same time. We believe physicians are in the role to be leaders of their
teams. It is incumbent for them to know and utilize leadership skills to promote highly
productive teams. Each physician brings his or her own unique strengths and challenges
into their role as leader. We find many have unrecognized skills, or may need to re-craft
current strengths to become leaders that are more positive.”

Dr. Miller, of True North, the “go to” coach for hospitals

Sara Miller, EdD is a credentialed coach with 8-plus years of coaching

executives and physicians in healthcare institutions. Dr. Miller is a
recognized leader and pioneer in the field of working with physicians who
have disruptive behavior. Her background includes over 20 years of broad
experience in university teaching, research, and program development in
the arena of human relationships. She is a graduate of the prestigious
Authentic Happiness Program, taught by Martin Seligman at the
University of Pennsylvania, and served on the Ethics and Standard
Committee of the International Coach Federation.

Her client list includes physicians, healthcare institutions and training

universities; such as: Yale University Medical School, University of
Dr. Sara Miller President Rochester Medical Center, Heartland Regional Health Systems, Trinity
Health Systems of Michigan, Henry Ford Hospital, Detroit Medical Centers
of Michigan, SSM Health Care – St. Louis, Wayne State University Physician Group, South Carolina
Licensing Board, Swedish Medical Center, Emergency Physician Medical Group, and Gunter School of
Medicine, India.

True North Coaching | www.tncoaching.com

517 292-1261
True North Company LLC ©