The following article was first published on December 18, 2012.
I am currently a medical director of emergency services at a small community hospital, and I have an ongoing problem physician who provides outstanding medical care but can’t keep his mouth shut. He offends nursing staff with his obnoxious, condescending, and judgmental comments, and his patient satisfaction scores are horrific, as you might imagine.
I have talked to him about this issue several times, as has the emergency department director at another hospital. I would rather help him improve than fire him and make him someone else’s problem. How can I confront this problem physician about his rude and disrespectful behavior?
I admire your concern for this “problem physician.” Too often we, as leaders, treat individuals as cogs in the machine—interchangeable parts to be hired and used. Sometimes we use them up, discard them, and hire some more. This is the danger of literally believing the label that people are only “human resources.” Your concern for the individual is an important starting point for solving this problem.
Another common mistake leaders make is to put our concern about individuals above all other people in the organization. We often hold on to problematic individuals or underperformers at the expense of fellow teammates. In your organization, these teammates might include the nursing staff, patients, and other doctors.
When we allow someone to stay in their position and it results in others being abused, team values being sacrificed, and work being inefficient, it’s not compassion, it’s negligence. The difficult challenge of leadership requires balancing our concern for all the stakeholders and working through their often conflicting needs.
At a minimum, direct reports deserve their leader’s honest evaluation of their work. They deserve targeted, behaviorally specific feedback, and improvement suggestions. Anything less shortchanges the individual and undercuts team and organizational effectiveness.
As leaders, we should also provide the resources and means to make the needed improvements. Many leaders assume the problem with poor performers is they lack motivation; therefore, the obvious way to fix the problem is to motivate their employees. However, motivation is only one of three possible causes of poor performance. It is also possible that the employee wants to perform but is unable to do so because of a lack of skills, knowledge, or resources. A third possible cause is a combination of motivation and ability—they are unable to do what’s required and don’t want to do it even if they could. To try and skill up the unmotivated is a waste of time and resources. To motivate the unable only creates depression, not progress.
You describe the physician’s behavior as “offensive, obnoxious, condescending, and judgmental.” You mention that you and others have talked to him several times with no discernible improvement. Has he expressed a willingness to change, then failed to improve? It might be an ability problem. Has he shrugged off your feedback and shown no interest in trying to change? If this is the case, he probably lacks motivation.
Going forward, here’s my recommendation. Have a crucial conversation with the physician. Don’t try to solve the most recent occurrence; rather, use it as an example of the pattern of behavior you want changed. Be specific. Be factual. Compare what you expected with what occurred. Note that you and others have had several talks with him about this subject, with no discernible improvement. Explain that it’s time to take action, then give him two choices. If he is willing to make a heartfelt effort to stop his hurtful behaviors, offer to give him your complete support. This assistance could include training, coaching, counseling, pairing him with a partner, frequent accountability, or feedback sessions to gauge progress and provide support.
If he is willing to try, set behaviorally specific objectives such as, “You will not call anyone in the hospital a ‘fat head.'” Identify how you will measure his progress—such as peer interviews, surveys, key observer reports—and set specific dates and deadlines to review progress as well as make modifications and changes. Set a final date by which he must demonstrate specific changes or explain that termination will result. Make sure all expectations are absolutely clear about deadlines, the behavior to be changed, and how it will be measured. You don’t require perfection, but you do require sustained, significant improvement. If he agrees, follow the plan.
If he does not agree to the development plan you propose and cannot propose an acceptable alternative, initiate the removal process. Allow no more delays or chances.
Responsible leaders care about their people—the one and the many. They don’t callously fire individuals, nor do they allow a single employee to disrespect, abuse, or negatively impact others. They don’t demand change without helping people have the means to change and reasonable time to do it. Responsible leaders give actionable feedback and recognize progress. And they follow through.
I wish you all the best in the difficult and worthwhile effort of leading and serving others.
The ideas expressed in this article are based on the skills and principles taught in Crucial Accountability. Learn more about Crucial Accountability.