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Standard Intervention
Research demonstrates the effectiveness of data-driven, peer-based interventions for producing physician behavior change. Therefore, first line 'Standard' steps simply involve making individuals aware of their personal complaint profiles compared with those of their peers, asking those individuals to review the materials and consider devising a plan, and
continuing ongoing assessments. All subsequent decisions regarding the nature and duration of any interventions are up to the Patient Complaint Monitoring Committee, and they are implemented consistent with each institution’s governing policies and procedures. In general, for any given ‘Level 1’ situation, the Committee Chair may decide to 1) do nothing except continue routine analysis;2) ask for additional data; and/or
3) recommend that a particular committee member initiate an intervention. The Committee Chair identifies one of its members whose practice bears some similarity to that of the high complaint doctor. At a minimum, that person will be asked to: 1. Review existing data (rank in total local physician group and rank in specialty on patient complaints); 2. Meet with the high complaint doctor and share his/her Patient Complaint Profile. The general format of the meeting is to:
a) explain the reason for the visit and the nature of the Committee,3. Ask the colleague to develop a plan. In many cases, the best plan will simply be to encourage the colleague to attend to the issues raised by patients. Problems that require resources or structured intervention are referred to the Committee chair. Experience with several hundred 'Level I interventions' reveals that most physicians will willingly participate and the vast majority will respond favorably. When they realize that the medical center has not instituted a witch hunt, most physicians with whom we have used this process to date have responded favorably. Most appreciate being reassured that the process has the support of key members of the medical staff and hospital administration, that the process is confidential, that the allegations are supported by data from a variety of sources, and that they are being invited to participate in the development of a helpful intervention.
b) assure confidentiality,
c) discuss the colleague's view of the problem and potential solutions, and
d) signal that the Committee member will return for a twelve month follow-up visit. In general, no other persons need be involved;
Intensive Interventions
Despite everyone's efforts, non-response and continued high-risk behavior is possible. In such cases, the Committee considers invoking a series of more intensive 'Level II Intervention' steps:
1. Bring in the chief of staff for a 3-way conversation about the nature of the problem, the previous attempt to intervene, and the follow-up data;
2. With the chief's encouragement, require participation in a CME program or other appropriate course or counseling program (e.g., anger management), perhaps accompanied by a Committee member;
3. Consider pairing the High Complaint MD with a role model who observes clinical behavior and provides supportive and corrective feedback;
4. Consider referral to a Physician Wellness Program;
5. Consider an intensive practice evaluation to identify failures of systems of care;
6. Schedule another 3-way appointment within 6-12 months to review follow-up data. While we would like to think the previously described steps will be enough to promote higher quality behavior and patient care in most health professionals, a very small number may require very intensive 'Level III Intervention' steps that the Committee may invoke if necessary:
7. Make referrals for psychological or psychiatric evaluation and, if needed, therapy;
8. Consider initiating the process that might lead to increased malpractice premiums for the department.
9. Revocation of selected privileges and, possibly, termination of privileges.
