in the OR. Certainly, surgery is not a stress-free profession, and we all know one mistake can result in a bad outcome for the patient.

Potential Problem Areas At one point in my career, I worked with a physician leader who was always engaging in off-color jokes and other explicit conversations. This made some staff uncomfortable and generated com- plaints to the corporate human resources department. Also, patients had reported overhearing the dialogue, and we had some staff threatening to resign. Another scenario I faced involved

a surgeon who routinely arrived late and without any notes pertaining to the patients’ history and physical examina- tions (H&P) on the charts. He would rush the staff in preop and pressure them to send the patient back to the OR with- out the H&P. Staff were intimidated, and in one case, this led to documen- tation not being properly checked and the implantation of a wrong interocular lens (IOL). A third situation I encountered

involved an orthopedic surgeon who was frequently volatile. On one occa- sion, he yelled at patients in the preop area, screamed obscenities in the OR and even threw instruments. The OR staff and the certified registered nurse anesthetist (CRNA) were in tears and refusing to go into the room for the next case.

The fourth scenario might be com-

mon to many of you. A busy surgeon has more than 30 operative reports pending dictation. Staff has made mul- tiple attempts to correct this. Requests for medical records cannot be com- pleted. The center is unable to bill, and the icing on the cake is that the Cen- ters for Medicare & Medicaid Services (CMS) cites the center for not following its own policies and procedures. All these examples have negative consequences. These include adverse clinical events, staff resignations, ver- bal and physical confrontations, culture

You should adopt professional behavior standards whether they are in the form of bylaws, rules and regulations or policies and procedures. Just like excellence should be recognized, bad behavior should be addressed.”

— Rena Courtay, RN, CASC Solutions for Outpatient Surgery Inc.

deterioration, loss of patients from prac- tice, and patient and staff complaints. Further repercussions are more severe and can include disciplinary action, legal action (civil and criminal), Equal Employment Opportunity Commission (EEOC) complaints, loss of staff privi- leges and reports to the Board of Medi- cine and/or National Practitioner Data Bank (NPDB).

Best Practices for Solutions What are some best practices to deal with these types of behavior? Most important of all, you must deal with the problem and learn to address behav- iors as they occur. These things do not usually correct themselves, so you can-

not bury your head in the sand. It is not something that someone will “outgrow.” We all have a responsibility to pro- vide a safe workplace that is free of harassment and discrimination. You should adopt professional behav- ior standards whether they are in the form of bylaws, rules and regulations or policies and procedures. Just like excellence should be recognized, bad behavior should be addressed. Ensure that your team is empowered to have full freedom and support to report inci- dences as well as the confidence that they will be addressed. There are a few important steps to

having a corrective feedback conversa- tion with a physician: ■■

■■ ■■

Inform him/her of the session ahead of time and provide a private, respect- ful atmosphere.

Negotiate an agenda and have all the facts of the issue documented.

If possible, have another physician leader there with you for the con- versation.


Start by asking the physician for his/ her own assessment of the situation being discussed. It is very important to get this perspective before sharing your own observations and findings.

■■ ■■

Then ask the physician for strategies for improvement.

Lastly, review the expected improvements, any monitoring that will occur and the consequences of not improving. These strategies should assist you in confidently handling behavior issues that arise. Most importantly, this approach will enable you to improve the environ- ment at your surgery center and allow you to provide the highest quality of care for the patients that you serve.

Rena Courtay RN, CASC, is the president and chief executive officer of Solutions for Outpatient Surgery Inc. in Plantation, Florida. Write her at


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30