Vice President Operations at Texas Oncology

Mike Marino

In healthcare, the relationship between physician, staff, and patient creates a dynamic that changes lives. The clinical environment sets the mood for the patient experience. In some cases, like oncology, the patients experience fear and anxiety. The physician and office staff work in concert to offset the fear and provide a positive experience for the patient. This helps a patient take control of their disease.

In 2020, the COVID-19 pandemic saw a new hero emerge-the healthcare provider and their staff. These frontline workers have put their lives on the line to care for others. Occasionally, as stressors mount, the physician provider may fall into a pattern of malcontent behavior. When this occurs, the clinical environment can become unfavorable, making it more difficult to mask the discontent. Abusive behavior demonstrated by physicians creates an atmosphere of instability for the clinical staff and translates into patient care. Coined as disruptive physician behavior (DPB) by Alan H. Rosenstein (2002), abusive behavior characterizes any action exhibited by a physician that creates a substandard level of treatment and impedes the organization’s ability to meet its patient care mission. As the clinical staff reacts to DPB, their focus shifts from the patient to the frustration and fear of retaliatory consequences. This anxiety inhibits decision-making abilities and often leads to burnout. Burnout adversely affects employee turnover rates and patient care, creating an environment that lacks continuity of care.

The care team becomes the anchor when the environment is in a perpetual state of change, underscoring the critical nature of civility in the clinic as continuity and constants are challenged daily. A healthcare team must possess the ability to remain agile to navigate the constant state of change. Embracing change must be at the forefront of the healthcare organization and physician provider to adjust to the continual demands of the private and public sectors. An environment of chaos fosters a stressful climate and negatively influences organizational culture. Stressors introduced into the organization erupt into workplace conflict. Physicians have a choice in their reactions and leadership as these stressors arise. Does the clinical environment change in a way that changes the patient experience? Can the collective staff and patient experience predict the clinical environment, precisely the physician’s behavior? The physician’s ability to provide positive leadership becomes more critical as the stressors of healthcare create new challenges every day.

The influence physicians command creates an imbalance in power. The physician’s power position dramatically influences the organizational culture and floor unit. Incivility, such as DPB, leads to undue stress and cultivates dissatisfaction among the support staff.

" The physician’s ability to provide positive leadership becomes more critical as the stressors of healthcare create new challenges every day "

Conflict in a healthcare environment can present unique challenges and can be detrimental to the practice if left unmanaged. Conflict is inevitable and can be both positive and negative. Although it is impossible or advised to eliminate conflict completely, today’s healthcare leaders must have a strategy when confronted with conflict. Healthcare leaders can either inspire a team or impede creativity and engagement.

Toxic leadership leads to low satisfaction rates across the workforce, resulting in increased absenteeism and decreased employee engagement. As leaders of the care team, physicians influence the culture and work environment in the clinic, deterring from or building an environment of instability in healthcare organizations. DPB can contribute to a stressful working environment and negatively influence the organizational structure, leading to increased turnover, compromised patient care, and diminished clinical team dynamics. Incivility, such as DPB, can create an environment that cultivates dissatisfaction among the support staff, resulting in increased staff turnover and lack of continuity of care.

In a quantitative secondary analysis, I looked at disruptive physician behavior’s impact on staff satisfaction and retention rates. Four main themes emerged from this research:

1. There was a significant relationship between DPB and staff satisfaction regarding respectful and open communication aligning with organizational values.

2. As the DPB increased, staff satisfaction decreased.

3. There is a significant relationship between staff turnover rate and the presence of DPB.

4. The overall results of the levels of DPB affecting staff turnover suggested a direct correlation between DPB and staff retention by a 2:1 ratio.

The research results establish the importance of the physician’s role in the healthcare setting. As stakeholders, the physicians, although not always the administrative or operational leaders, wield tremendous influence on the staff and culture. In an era when employee retention and recruitment have become the number one strategic initiative for many organizations, focusing on leadership training for physicians to help influence the trend in leadership behavior may be worthwhile.