July 21, 2025 • 20 mins
In this MGMA podcast episode, host Daniel Williams talks with Dr. Christopher Kodama, MD, MBA, founder of EverSpark, about managing disruptive physician behavior. They define what disruptive behavior looks like in healthcare settings, discuss its impact on practice culture, and outline actionable strategies for addressing it—covering preparation, conversation techniques, and follow-up. Dr. Kodama also previews his upcoming session at the MGMA Leaders Conference in Orlando.
Main Points:
00:50 – Introduction and Guest Welcome
01:38 – Dr. Kodama's Background and Career Journey
05:13 – Understanding Disruptive Physician Behavior
06:36 – Defining Disruptive Behavior
08:20 – Identifying Disruptive Dynamics in Practice
11:53 – Approaching the Difficult Conversation
17:44 – Follow-Up and Mitigating Risk
20:23 – Conclusion and Upcoming Conference Details
Additional Resources:
Email us at dwilliams@mgma.com if you would like to appear on an episode. If you have a question about your practice that you would like us to answer, send an email to advisor@mgma.com. Don't forget to subscribe to our network wherever you get your podcasts.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Daniel Williams (00:02):
Hi, everyone. Daniel Williams here with the
MGMA podcast. Today, we'retackling a topic that keeps a
lot of practice leaders up atnight, disruptive physician
behavior. We have the rightperson here, an expert on this
topic, doctor ChristopherKadama. He's an MD, an MBA, a
(00:24):
former company CEO, and nowfounder of Everspark.
And also, doctor Kadama is goingto be speaking at our MGMA
Leaders Conference this fall inOrlando, and we're really
excited about that. So, doctorKadama, first of all, welcome to
the show.
Dr. Christopher Kodama: Danielle, it's a pleasure to be (00:43):
undefined
here. Thank you so much forhaving me on.
Daniel Williams (00:48):
Yeah. So let's first start by getting to know
you a little bit better. As Imentioned, some of our listeners
may be able to meet you inperson in Orlando coming up here
in the fall. But, for those whomight not, or just are
interested in who you are, tellus a little bit about your
healthcare background, somehighlights there you might want
to share.
Dr. Christopher Kodama (01:08):
Sure. I am a pediatric hospitalist by
background, and my attraction topediatrics originally was really
spawned through a passion aroundadvocating for others,
populations that don'tnecessarily have the voice or
agency to do so themselves. Andthat's what attracted me to
pediatrics ultimately. What Ifound is that I was gravitating
(01:29):
more towards a complex morecomplex level of care for that
patient population. And inretrospect, I believe it had to
do with the fact that I reallyenjoy creating clarity out of
chaos and putting my interestsaround how to connect seemingly
disparate dots into acomprehensive cohesive plan.
(01:50):
And hospitalist medicine isessentially encompasses a lot of
those interests. On any givenday, you may be juggling a
variety of inputs fromspecialists, parents and
caregivers, care managers,nurses, etcetera, the patient if
they're old enough toparticipate. And then you have
to weave that together into aplan that everybody can get
(02:10):
behind and operate off of. Andso as a result of that, I
through circumstances, theopportunity to step into an
administrative role presenteditself. And what I found in that
work was it was very much thesame skill sets in some regards
or foundational skills andultimately ended up pursuing a
(02:31):
career in executive management,went back to business school, as
you noted earlier, so that Icould enhance my fluency and
understanding of concepts tobetter collaborate with my
nonphysician businesscolleagues.
Through the course of that work,every now and then you would
come across these quote, unquoteHR situations. And you mentioned
(02:55):
very graciously that I'm anexpert in this topic. I don't
know that anybody truly aspiresto be an expert, and I'm not
sure that I am one. It's aconstant learning journey. But
oftentimes, these things come upfrom time to time, and they
range in degree of severity andintensity.
And with time, repetition,intention, learning from
failures, that's what gets mehere today to this conversation
(03:18):
so that if there's anything thatI can share with either audience
members on the podcast or at theleaders conference later this
year that helps make their livesa little easier or accelerates
the learning curve for them, I'mhappy to do it because I wish I
had those types of resources andmore intentional guidance. I
(03:39):
will say, just as a quickcaveat, disruptive behavior is
disruptive behavior, whetheryou've got an MD or a DO after
your name or not. So some ofthis practice also incorporates
managing nonphysician disruptivebehavior as well. I do believe,
however, for a variety ofreasons, we do look at
(03:59):
physicians differently in theworkplace, particularly when it
comes to matters such as perhapsperceived real or unreal
dynamics around power dynamics,around hierarchy, etcetera, that
can make this very intimidating,particularly for a practice
manager who may not be aphysician or particularly
(04:19):
comfortable in this area.
Daniel Williams (04:21):
Yeah. Thank you for sharing that. So we're gonna
get deep into this topic ofdisruptive physician and just
disruptive, perhaps, employee aswell. First, though, you are
currently with Everspark. Talkabout that organization just so
we have an idea of whatEverspark does.
Sure. So about a year and a
Dr. Christopher Kodama (04:43):
half ago, almost two years now that I
think about it, I decided it wastime to strike out on my own and
learn and grow in a differentway than I had within a large
corporate environment. And overthe course of my clinical and
administrative career, I'vealways been a bit of a
generalist, touching a lot ofdifferent things, which speaks
(05:04):
to another interest of mine,which is lifelong learning.
Independent consulting, which iswhat Spark is, was a vehicle for
me to be able to exercise thoseskills, share them with others,
and continue to learn in adifferent way. What I do ranges
from working with organizationsto help them hone in on
strategic plans. One of theareas that I'm particularly
(05:26):
passionate about is transformingthose plans and ideas into
action.
So I work on a fair amount ofimplementation activity as well
as optimizing existingprocesses. And then public
speaking and group facilitation.Those are the grand tour of
things that I do at Everspark.
Daniel Williams (05:43):
Okay. Great. So let's get to this issue. It's
the phrase disruptive physician.That's what we're gonna be
talking about here.
It can mean a lot of things. Soin 2025, as you are, I called
you an expert, maybe you'resomeone who studies this topic
who offers advice about thistopic. With that in mind, just
(06:06):
define what, disruptivephysician means in 2025.
Dr. Christopher Kodama (06:12):
Sure. I typically look at the broad
definition of disruption. Andwhat was interesting when I
first started doing this work isthere's a fair amount of
resource and general guidancethrough the American Medical
Association on this very topic.In the beginning, I didn't
realize that, so I was operatingin a vacuum off of my own
definitions. Over time, itappears that there's actually
(06:35):
quite a bit of overlap betweenhow I define disruptive
physician behavior and how theAMA defines it through their
work.
And in essence, disruptivebehavior is any conduct in the
workplace that distracts othersto the extent that it interferes
with their ability to do theirjob optimally. And one of the
nuances I was alluding toearlier, Daniel, about sometimes
(06:58):
the stakes are a little bit morespecific when physicians are the
ones exhibiting the disruptivebehavior. The impacting others'
ability to do their joboptimally begins to move into
the areas of patient safety andquality, which is why I think
this is such an important topicfor us to collectively
(07:20):
understand and lean into withgrace and fairness and respect
rather than taking the easierpath sometimes, which is to turn
a blind eye.
Daniel Williams (07:30):
Let's talk about some of those first
signals then. If someone were towalk into a practice or a
service line that's having someissues, what is the disruptive
dynamic? What culturally, whatdoes it look like? What is going
on in the hallways? The maybedata points show up.
What else is going on there thatsomeone could go, okay. I see
(07:52):
it.
Dr. Christopher Kodama (07:52):
So based on my experience, I would say
it's something this might sounda little hokey, but you can
sense. It's almost like a darkaura that's hovering over the
environment. And the way that ittends to manifest in my
experience has been when you areencountering staff that are
pretty cynical, seemingly burntout, disengaged, disengaged,
(08:18):
meaning things like barely doingtheir job or resenting when
they're asked to do something,even if it is within their scope
of practice or job. What you'llfind is a very polished exterior
with a lot of chaos underneath.So people who are putting on the
brave face because they believethat's what they need to do for
(08:39):
the benefit of their colleaguesand their patients.
A lot of times, single wordanswers to questions like how
are things going today? Oh, it'sfine. Everything's fine. It's
almost as though these folkshave been so used in more
dramatic instances of disruptivebehavior if it's chronic and
indolent. It's as though thesepeople have figured out ways to
(09:03):
cope and rationalize almost inan abusive situation.
I don't know that there's anymagical hallmark of this other
than you're more likely to senseit. And then asking probative
questions and learning over timehas been helpful for me because
I think sometimes people are soused to suffering through this.
(09:27):
They don't trust others orthey've been told before that it
would be taken care of and itwasn't. And so they're less
likely to come forwardinitially. So it takes a bit of
time to understand and learn theculture, what's acceptable and
isn't.
There's also oftentimes a signalwhen you watch how people
interact with one another, howthey treat the patients, how
(09:47):
they talk to one another, thoseoftentimes are subtle cues that
are more tangible that mightgive you an inkling that you
need to dig a little deeper.
Daniel Williams (09:55):
Okay. I wanna go back to the definition then
again, maybe it may notencompass all disruptive
behaviors, but is there achecklist? Is it verbal,
physical, sexual, emotional?What's the checklist of behavior
that fits into this categorythat
Dr. Christopher Kodama (10:13):
would be termed disruptive? Absolutely.
And it's all of the above thatyou listed, Daniel. It may be
verbal abuse, talkingdisrespectfully to others,
demeaning language. It may bephysical, and there have been
situations where I've had tointervene, where there are
allegations that a physician haslaid hands on another
(10:33):
individual, thrown things in theOR is a very common frustration
maneuver that will come up.
There are nonverbal gestures, sothat could be facial
expressions, rolling your eyes.Obviously, there are a lot of
other gestures that somebody canmake nonverbally. And then
there's more of a passive typeof disruption, which is
(10:54):
exclusion, blackballing somebodywho spoke up or spoke out. Those
tend to be the most commoncategories as I
Daniel Williams (11:01):
see them. Thank you so much. One of the things I
saw from your talk that you'regonna have in Orlando is
something called the talk,having the talk. And as it's
described here, many leadersdread that sit down in the
moment, what language or stancekeeps the discussion productive
(11:23):
rather than punitive? So whenyou have to go have the talk
with a disruptive individual,how do you get through that?
How do you approach it? Justwalk us through some of that
just so we get a better idea ofhow to navigate a very difficult
situation.
Dr. Christopher Kodama (11:39):
Sure. And I'm glad you started there,
Daniel, because I think that'sthe natural inclination for all
of us is to go straight to thewhat's that conversation gonna
look like. In the framework thatI'll review in greater detail at
the conference, that is one of ahandful of steps that I have
found consistently. It's morelikely to not only set the
(11:59):
individual you're meeting withup for success to the extent
that you have any control overthat because they have a lot of
say in how this goes down aswell. It helps boost and promote
a healthier culture.
So some of the hallmarks that wewere describing earlier, that's
not a great sign that you've gota thriving practice or business.
(12:19):
So how do you get at that? Andthese are watershed moments
where you have the opportunityto do that. Initially, what I
recommend highly is gather yourfacts and evaluate the situation
because it's an allegation untilproven otherwise. Yeah.
And there may be more sides tothis story than what you're
being told. And that's a commonpitfall I see people kind of
(12:40):
somebody they're really busy.There are a million things
they're dealing with. Somebodycomes into the office. They make
a complaint, and then there'sthis knee jerk reaction.
So an email goes off or a quickphone call to somebody and you
say knock it off, and there'sreally no conversation about it.
And that can be equally damagingfor reasons that I'll go into
greater detail at another time,but understanding the facts and
(13:03):
doing your due diligence isreally important. The second
thing even before theconversation that I recommend is
understanding the dynamics inyour practice. Who are the
individuals and areas of yourpractice or outside your
practice that are involved andto what degree? So there may be
somebody who was directly thetarget of the disruptive
behavior.
(13:24):
Sometimes it's not targeted.Sometimes it's just exhibited
behavior that's very distractingor disruptive to people, like
expressing frustration, verballyshouting, those sorts of things,
but it's not necessarilydirected at any one individual.
But understanding who's impactedby this and why. And everybody
within the sphere of thatphysician is impacted in one way
(13:46):
or another, but probably not thesame. So there may be the people
that are with this individual ona daily basis.
They're gonna be impactedperhaps in a more intense way
than those who are peripheraland don't have a lot of direct
contact with the individual inquestion. However, the latter
group still needs some attentionbecause they're watching,
(14:08):
they're listening, they'rehearing the conversation at the
water cooler, and they wanna seehow this is gonna be handled.
And the manner in which this isrole modeled sets the tone for
interactions that people havewith one another when you're not
around as a leader. And thenthat gets you ready for that
conversation. And I like to planahead and have an outline.
(14:28):
I also know that I don't likesurprises, so I'd prefer that
the individual I'm gonna bemeeting with has an
understanding of what we'regonna be talking about when we
schedule the time to gettogether. In other words,
avoiding the ambush tactic.There probably are some rare
instances where that may bewhat's required, but I can't
really think of off the top ofmy head. And I like to be
(14:51):
succinct and focused. So goingthrough a litany or a laundry
list of specific infractions orgrievances, I don't find that to
be particularly helpful.
What I try to do in preparationfor that discussion is if
there's a long list of thosetypes of complaints is more
often than not, there aregeneral themes that are
reflected across those differentinfractions. So looking for what
(15:15):
the one or two primary theme is,it's like, you seem really
angry, and you're taking it outon the staff. It's coming across
in your patient interactions,those sorts of things rather
than data this. Then capturingthat in a way, I'm a big fan of
the SBI feedback framework. So Iprep this in advance, and I
practice it before I go into themeeting.
(15:37):
So a very succinct statement ofa specific situation in which
the disruptive behavioroccurred, a statement of what
the observed behavior was, andthen a description of the impact
that had on those that wereinvolved. And I just roll
through those. I can't think ofa time when I've ever had to
(15:58):
have more than three themescovered in a given interaction.
And I will actually describethis in a brief letter so that
there's documentation that theperson can review after the
conversation. Because sometimesthey're in a bit of shock, and
they're not gonna takeeverything in that they need to.
So having that after you gothrough it together, so you have
(16:20):
a script in a way. You also havesome standardization and
reliability in your approach andframework. And then there's also
a document of what's going onthat both parties can benefit
from having as a reference, Ibelieve. Okay. There's some
nuances about what you put inthat, what you don't.
That's a conversation forwhoever might be advising you
(16:43):
from an HR perspective, butthat's the general approach. And
then finally, the fourth stepreally is about mitigating risk,
following up with impactedparties, so on and so forth.
Daniel Williams (16:53):
Yeah. For our last question, I really wanna
take that a step further thanthat follow-up. So once an
intervention is in motion,depending on the severity of
what the disruptions were, therecould literally be some PTSD or
just people there is some traumainvolved in how do they react?
(17:15):
How do they are they simplykeeping the peace now that the
intervention has been done? Orhow are they feeling?
So what are the measurables? Arethere KPIs? Are there ways to
follow-up with that team to seehow they're doing? Not only how
is that individual doing intheir own behavior, but how is
(17:35):
the team doing? How are theymoving forward?
What can you share with us aboutthat?
Dr. Christopher Kodama: Absolutely. I would say (17:41):
undefined
depending on the severity of theinfraction, there may be a
higher touch approach in certaincircumstances. At a baseline,
regardless of the situation, ifnot already being practiced,
it's a good reminder to practiceessentially leader rounding
where you are spending time evenwhen things are going fine and
(18:01):
there aren't issues, butespecially if you haven't been
doing that and now you have thismoment, using that as a platform
to initiate the leader rounding,you will continue after things
have abated. So standardquestions like asking what's
working well for people. Do theyhave the tools and resources
they need to be successful intheir jobs?
(18:23):
What suggestions or feedbackthey might have for how the
practice can continue to getbetter are standard leader
rounding questions. Now to go instraight with those general
questions after an instance likethat may be a little tone deaf.
So starting out with a littlebit more of a targeted set of
questions that generally adhereto that framework, like how
(18:44):
things changed for you? Are youfeeling a difference? Can you
provide some examples of howthings are different?
Do you feel like you're gettingthe support that you need as we
move through this chapter andset the tone for how we wanna
move forward? And are there anyother concerns or questions that
you have for me? What I havefound is that is important in
(19:05):
those situations to be sensitiveto that. But at some point,
you're gonna know yourconstituency when it's time to
move on because it starts tofeel like beating a dead horse,
especially in circumstanceswhere the disruption was enough
that an intervention wasrequired, but not so much that
you're just gonna dwell on thisforever. There needs to be a
(19:27):
growth mindset where peoplelearn from those stakes and then
move on and not dwell.
Daniel Williams (19:32):
Okay. Alright. Doctor. Kadama, I wanna thank
you for joining us on the MGMApodcast. It's a it's been
Dr. Christopher Kodama (19:40):
a pleasure, Danielle. I really
appreciate the opportunity toshare some ideas and thoughts
with the audience.
Daniel Williams (19:45):
You've got it. And I cannot wait to meet you in
person in Orlando. I'll be thereat that session. Looking forward
to that. And so everybodylistening, I want to bring the
information up again.
Doctor. Kadama will talk aboutthis topic in much more detail
in his session, Strategies forManaging Disruptive Physician
Behavior. That's going to beOctober 1 at our MGMA Leaders
(20:09):
Conference. It's going to beheld in Orlando. I am going to
put direct links to that, hissession, and registration for
that so you can be there andmeet us in person in Orlando.
So until then, thank you so mucheveryone for listening to the
MGMA podcast.
Hi, everyone. Daniel Williams here with the
MGMA podcast. Today, we'retackling a topic that keeps a
lot of practice leaders up atnight, disruptive physician
behavior. We have the rightperson here, an expert on this
topic, doctor ChristopherKadama. He's an MD, an MBA, a
(00:24):
former company CEO, and nowfounder of Everspark.
And also, doctor Kadama is goingto be speaking at our MGMA
Leaders Conference this fall inOrlando, and we're really
excited about that. So, doctorKadama, first of all, welcome to
the show.
Dr. Christopher Kodama: Danielle, it's a pleasure to be (00:43):
undefined
here. Thank you so much forhaving me on.
Daniel Williams (00:48):
Yeah. So let's first start by getting to know
you a little bit better. As Imentioned, some of our listeners
may be able to meet you inperson in Orlando coming up here
in the fall. But, for those whomight not, or just are
interested in who you are, tellus a little bit about your
healthcare background, somehighlights there you might want
to share.
Dr. Christopher Kodama (01:08):
Sure. I am a pediatric hospitalist by
background, and my attraction topediatrics originally was really
spawned through a passion aroundadvocating for others,
populations that don'tnecessarily have the voice or
agency to do so themselves. Andthat's what attracted me to
pediatrics ultimately. What Ifound is that I was gravitating
(01:29):
more towards a complex morecomplex level of care for that
patient population. And inretrospect, I believe it had to
do with the fact that I reallyenjoy creating clarity out of
chaos and putting my interestsaround how to connect seemingly
disparate dots into acomprehensive cohesive plan.
(01:50):
And hospitalist medicine isessentially encompasses a lot of
those interests. On any givenday, you may be juggling a
variety of inputs fromspecialists, parents and
caregivers, care managers,nurses, etcetera, the patient if
they're old enough toparticipate. And then you have
to weave that together into aplan that everybody can get
(02:10):
behind and operate off of. Andso as a result of that, I
through circumstances, theopportunity to step into an
administrative role presenteditself. And what I found in that
work was it was very much thesame skill sets in some regards
or foundational skills andultimately ended up pursuing a
(02:31):
career in executive management,went back to business school, as
you noted earlier, so that Icould enhance my fluency and
understanding of concepts tobetter collaborate with my
nonphysician businesscolleagues.
Through the course of that work,every now and then you would
come across these quote, unquoteHR situations. And you mentioned
(02:55):
very graciously that I'm anexpert in this topic. I don't
know that anybody truly aspiresto be an expert, and I'm not
sure that I am one. It's aconstant learning journey. But
oftentimes, these things come upfrom time to time, and they
range in degree of severity andintensity.
And with time, repetition,intention, learning from
failures, that's what gets mehere today to this conversation
(03:18):
so that if there's anything thatI can share with either audience
members on the podcast or at theleaders conference later this
year that helps make their livesa little easier or accelerates
the learning curve for them, I'mhappy to do it because I wish I
had those types of resources andmore intentional guidance. I
(03:39):
will say, just as a quickcaveat, disruptive behavior is
disruptive behavior, whetheryou've got an MD or a DO after
your name or not. So some ofthis practice also incorporates
managing nonphysician disruptivebehavior as well. I do believe,
however, for a variety ofreasons, we do look at
(03:59):
physicians differently in theworkplace, particularly when it
comes to matters such as perhapsperceived real or unreal
dynamics around power dynamics,around hierarchy, etcetera, that
can make this very intimidating,particularly for a practice
manager who may not be aphysician or particularly
(04:19):
comfortable in this area.
Daniel Williams (04:21):
Yeah. Thank you for sharing that. So we're gonna
get deep into this topic ofdisruptive physician and just
disruptive, perhaps, employee aswell. First, though, you are
currently with Everspark. Talkabout that organization just so
we have an idea of whatEverspark does.
Sure. So about a year and a
Dr. Christopher Kodama (04:43):
half ago, almost two years now that I
think about it, I decided it wastime to strike out on my own and
learn and grow in a differentway than I had within a large
corporate environment. And overthe course of my clinical and
administrative career, I'vealways been a bit of a
generalist, touching a lot ofdifferent things, which speaks
(05:04):
to another interest of mine,which is lifelong learning.
Independent consulting, which iswhat Spark is, was a vehicle for
me to be able to exercise thoseskills, share them with others,
and continue to learn in adifferent way. What I do ranges
from working with organizationsto help them hone in on
strategic plans. One of theareas that I'm particularly
(05:26):
passionate about is transformingthose plans and ideas into
action.
So I work on a fair amount ofimplementation activity as well
as optimizing existingprocesses. And then public
speaking and group facilitation.Those are the grand tour of
things that I do at Everspark.
Daniel Williams (05:43):
Okay. Great. So let's get to this issue. It's
the phrase disruptive physician.That's what we're gonna be
talking about here.
It can mean a lot of things. Soin 2025, as you are, I called
you an expert, maybe you'resomeone who studies this topic
who offers advice about thistopic. With that in mind, just
(06:06):
define what, disruptivephysician means in 2025.
Dr. Christopher Kodama (06:12):
Sure. I typically look at the broad
definition of disruption. Andwhat was interesting when I
first started doing this work isthere's a fair amount of
resource and general guidancethrough the American Medical
Association on this very topic.In the beginning, I didn't
realize that, so I was operatingin a vacuum off of my own
definitions. Over time, itappears that there's actually
(06:35):
quite a bit of overlap betweenhow I define disruptive
physician behavior and how theAMA defines it through their
work.
And in essence, disruptivebehavior is any conduct in the
workplace that distracts othersto the extent that it interferes
with their ability to do theirjob optimally. And one of the
nuances I was alluding toearlier, Daniel, about sometimes
(06:58):
the stakes are a little bit morespecific when physicians are the
ones exhibiting the disruptivebehavior. The impacting others'
ability to do their joboptimally begins to move into
the areas of patient safety andquality, which is why I think
this is such an important topicfor us to collectively
(07:20):
understand and lean into withgrace and fairness and respect
rather than taking the easierpath sometimes, which is to turn
a blind eye.
Daniel Williams (07:30):
Let's talk about some of those first
signals then. If someone were towalk into a practice or a
service line that's having someissues, what is the disruptive
dynamic? What culturally, whatdoes it look like? What is going
on in the hallways? The maybedata points show up.
What else is going on there thatsomeone could go, okay. I see
(07:52):
it.
Dr. Christopher Kodama (07:52):
So based on my experience, I would say
it's something this might sounda little hokey, but you can
sense. It's almost like a darkaura that's hovering over the
environment. And the way that ittends to manifest in my
experience has been when you areencountering staff that are
pretty cynical, seemingly burntout, disengaged, disengaged,
(08:18):
meaning things like barely doingtheir job or resenting when
they're asked to do something,even if it is within their scope
of practice or job. What you'llfind is a very polished exterior
with a lot of chaos underneath.So people who are putting on the
brave face because they believethat's what they need to do for
(08:39):
the benefit of their colleaguesand their patients.
A lot of times, single wordanswers to questions like how
are things going today? Oh, it'sfine. Everything's fine. It's
almost as though these folkshave been so used in more
dramatic instances of disruptivebehavior if it's chronic and
indolent. It's as though thesepeople have figured out ways to
(09:03):
cope and rationalize almost inan abusive situation.
I don't know that there's anymagical hallmark of this other
than you're more likely to senseit. And then asking probative
questions and learning over timehas been helpful for me because
I think sometimes people are soused to suffering through this.
(09:27):
They don't trust others orthey've been told before that it
would be taken care of and itwasn't. And so they're less
likely to come forwardinitially. So it takes a bit of
time to understand and learn theculture, what's acceptable and
isn't.
There's also oftentimes a signalwhen you watch how people
interact with one another, howthey treat the patients, how
(09:47):
they talk to one another, thoseoftentimes are subtle cues that
are more tangible that mightgive you an inkling that you
need to dig a little deeper.
Daniel Williams (09:55):
Okay. I wanna go back to the definition then
again, maybe it may notencompass all disruptive
behaviors, but is there achecklist? Is it verbal,
physical, sexual, emotional?What's the checklist of behavior
that fits into this categorythat
Dr. Christopher Kodama (10:13):
would be termed disruptive? Absolutely.
And it's all of the above thatyou listed, Daniel. It may be
verbal abuse, talkingdisrespectfully to others,
demeaning language. It may bephysical, and there have been
situations where I've had tointervene, where there are
allegations that a physician haslaid hands on another
(10:33):
individual, thrown things in theOR is a very common frustration
maneuver that will come up.
There are nonverbal gestures, sothat could be facial
expressions, rolling your eyes.Obviously, there are a lot of
other gestures that somebody canmake nonverbally. And then
there's more of a passive typeof disruption, which is
(10:54):
exclusion, blackballing somebodywho spoke up or spoke out. Those
tend to be the most commoncategories as I
Daniel Williams (11:01):
see them. Thank you so much. One of the things I
saw from your talk that you'regonna have in Orlando is
something called the talk,having the talk. And as it's
described here, many leadersdread that sit down in the
moment, what language or stancekeeps the discussion productive
(11:23):
rather than punitive? So whenyou have to go have the talk
with a disruptive individual,how do you get through that?
How do you approach it? Justwalk us through some of that
just so we get a better idea ofhow to navigate a very difficult
situation.
Dr. Christopher Kodama (11:39):
Sure. And I'm glad you started there,
Daniel, because I think that'sthe natural inclination for all
of us is to go straight to thewhat's that conversation gonna
look like. In the framework thatI'll review in greater detail at
the conference, that is one of ahandful of steps that I have
found consistently. It's morelikely to not only set the
(11:59):
individual you're meeting withup for success to the extent
that you have any control overthat because they have a lot of
say in how this goes down aswell. It helps boost and promote
a healthier culture.
So some of the hallmarks that wewere describing earlier, that's
not a great sign that you've gota thriving practice or business.
(12:19):
So how do you get at that? Andthese are watershed moments
where you have the opportunityto do that. Initially, what I
recommend highly is gather yourfacts and evaluate the situation
because it's an allegation untilproven otherwise. Yeah.
And there may be more sides tothis story than what you're
being told. And that's a commonpitfall I see people kind of
(12:40):
somebody they're really busy.There are a million things
they're dealing with. Somebodycomes into the office. They make
a complaint, and then there'sthis knee jerk reaction.
So an email goes off or a quickphone call to somebody and you
say knock it off, and there'sreally no conversation about it.
And that can be equally damagingfor reasons that I'll go into
greater detail at another time,but understanding the facts and
(13:03):
doing your due diligence isreally important. The second
thing even before theconversation that I recommend is
understanding the dynamics inyour practice. Who are the
individuals and areas of yourpractice or outside your
practice that are involved andto what degree? So there may be
somebody who was directly thetarget of the disruptive
behavior.
(13:24):
Sometimes it's not targeted.Sometimes it's just exhibited
behavior that's very distractingor disruptive to people, like
expressing frustration, verballyshouting, those sorts of things,
but it's not necessarilydirected at any one individual.
But understanding who's impactedby this and why. And everybody
within the sphere of thatphysician is impacted in one way
(13:46):
or another, but probably not thesame. So there may be the people
that are with this individual ona daily basis.
They're gonna be impactedperhaps in a more intense way
than those who are peripheraland don't have a lot of direct
contact with the individual inquestion. However, the latter
group still needs some attentionbecause they're watching,
(14:08):
they're listening, they'rehearing the conversation at the
water cooler, and they wanna seehow this is gonna be handled.
And the manner in which this isrole modeled sets the tone for
interactions that people havewith one another when you're not
around as a leader. And thenthat gets you ready for that
conversation. And I like to planahead and have an outline.
(14:28):
I also know that I don't likesurprises, so I'd prefer that
the individual I'm gonna bemeeting with has an
understanding of what we'regonna be talking about when we
schedule the time to gettogether. In other words,
avoiding the ambush tactic.There probably are some rare
instances where that may bewhat's required, but I can't
really think of off the top ofmy head. And I like to be
(14:51):
succinct and focused. So goingthrough a litany or a laundry
list of specific infractions orgrievances, I don't find that to
be particularly helpful.
What I try to do in preparationfor that discussion is if
there's a long list of thosetypes of complaints is more
often than not, there aregeneral themes that are
reflected across those differentinfractions. So looking for what
(15:15):
the one or two primary theme is,it's like, you seem really
angry, and you're taking it outon the staff. It's coming across
in your patient interactions,those sorts of things rather
than data this. Then capturingthat in a way, I'm a big fan of
the SBI feedback framework. So Iprep this in advance, and I
practice it before I go into themeeting.
(15:37):
So a very succinct statement ofa specific situation in which
the disruptive behavioroccurred, a statement of what
the observed behavior was, andthen a description of the impact
that had on those that wereinvolved. And I just roll
through those. I can't think ofa time when I've ever had to
(15:58):
have more than three themescovered in a given interaction.
And I will actually describethis in a brief letter so that
there's documentation that theperson can review after the
conversation. Because sometimesthey're in a bit of shock, and
they're not gonna takeeverything in that they need to.
So having that after you gothrough it together, so you have
(16:20):
a script in a way. You also havesome standardization and
reliability in your approach andframework. And then there's also
a document of what's going onthat both parties can benefit
from having as a reference, Ibelieve. Okay. There's some
nuances about what you put inthat, what you don't.
That's a conversation forwhoever might be advising you
(16:43):
from an HR perspective, butthat's the general approach. And
then finally, the fourth stepreally is about mitigating risk,
following up with impactedparties, so on and so forth.
Daniel Williams (16:53):
Yeah. For our last question, I really wanna
take that a step further thanthat follow-up. So once an
intervention is in motion,depending on the severity of
what the disruptions were, therecould literally be some PTSD or
just people there is some traumainvolved in how do they react?
(17:15):
How do they are they simplykeeping the peace now that the
intervention has been done? Orhow are they feeling?
So what are the measurables? Arethere KPIs? Are there ways to
follow-up with that team to seehow they're doing? Not only how
is that individual doing intheir own behavior, but how is
(17:35):
the team doing? How are theymoving forward?
What can you share with us aboutthat?
Dr. Christopher Kodama: Absolutely. I would say (17:41):
undefined
depending on the severity of theinfraction, there may be a
higher touch approach in certaincircumstances. At a baseline,
regardless of the situation, ifnot already being practiced,
it's a good reminder to practiceessentially leader rounding
where you are spending time evenwhen things are going fine and
(18:01):
there aren't issues, butespecially if you haven't been
doing that and now you have thismoment, using that as a platform
to initiate the leader rounding,you will continue after things
have abated. So standardquestions like asking what's
working well for people. Do theyhave the tools and resources
they need to be successful intheir jobs?
(18:23):
What suggestions or feedbackthey might have for how the
practice can continue to getbetter are standard leader
rounding questions. Now to go instraight with those general
questions after an instance likethat may be a little tone deaf.
So starting out with a littlebit more of a targeted set of
questions that generally adhereto that framework, like how
(18:44):
things changed for you? Are youfeeling a difference? Can you
provide some examples of howthings are different?
Do you feel like you're gettingthe support that you need as we
move through this chapter andset the tone for how we wanna
move forward? And are there anyother concerns or questions that
you have for me? What I havefound is that is important in
(19:05):
those situations to be sensitiveto that. But at some point,
you're gonna know yourconstituency when it's time to
move on because it starts tofeel like beating a dead horse,
especially in circumstanceswhere the disruption was enough
that an intervention wasrequired, but not so much that
you're just gonna dwell on thisforever. There needs to be a
(19:27):
growth mindset where peoplelearn from those stakes and then
move on and not dwell.
Daniel Williams (19:32):
Okay. Alright. Doctor. Kadama, I wanna thank
you for joining us on the MGMApodcast. It's a it's been
Dr. Christopher Kodama (19:40):
a pleasure, Danielle. I really
appreciate the opportunity toshare some ideas and thoughts
with the audience.
Daniel Williams (19:45):
You've got it. And I cannot wait to meet you in
person in Orlando. I'll be thereat that session. Looking forward
to that. And so everybodylistening, I want to bring the
information up again.
Doctor. Kadama will talk aboutthis topic in much more detail
in his session, Strategies forManaging Disruptive Physician
Behavior. That's going to beOctober 1 at our MGMA Leaders
(20:09):
Conference. It's going to beheld in Orlando. I am going to
put direct links to that, hissession, and registration for
that so you can be there andmeet us in person in Orlando.
So until then, thank you so mucheveryone for listening to the
MGMA podcast.
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