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Thoughts

The sweet spot of disruptive behaviour: is it always such a bad thing?

24-July-2013
24-July-2013 0:00
in General
by Dr. Jenny King

Much has been written about the disruptive behaviour in doctors and other healthcare staff. Disruptive in this context is defined as behaviour which can impair patient care, colleague relationships and the overall work in the organisation.  Lucian Leape (1,2) refers to passive disruption -  persistent lateness, absence, failure to answer bleeps, etc.,  and active disruption – rude, aggressive, undermining behaviour. He points out that both types erode respect and ultimately jeopardise patient care. Few would endorse such behaviour and the tolerance for it is now much less than it was.

 

But recently we have seen a new take on disruptive behaviour.  Cited in the Huffington Post 23 July 2013 is an article for the Times Educational Supplement (3) by Dr Kevin Stannard, who is director of innovation and learning at the Girl's Day School Trust.  Dr Stannard said that "disruptiveness" can be empowering and teach young women skills that they will need to gain university places and perform well in the workplace. "'Disruptiveness isn't, of course, a particularly valued attribute in schools, but it is not so very far from those of resourcefulness, resilience, enterprise, adventurousness, risk-taking, determination, standing up for yourself, leadership and connectivity…….." Dr Stannard said.

Our experience with doctors – especially those who end up being the subject of concern and referred for behavioural assessment – is that many of them show the attributes listed above by Dr Stannard.  The difficulty arises when they lack the interpersonal skills and sensitivity to manage these behaviours. This results in strengths becoming overplayed and becoming self-defeating – what Hogan, the personality theorist, has called “derailers”. Thus the resourceful and enterprising doctor becomes the maverick who ventures outside accepted guidelines, defies protocols or authority, and sails too close to the wind in trying to manage potential conflicts of  Doctors who stand up for themselves or others may lack the influencing or political skills to make their case constructively – they don’t choose their battles and they become as obsessional about their campaign for justice as they are about their clinical performance. What could have been constructive disruption becomes, instead, counter-productive.

 

In business the term disruptive innovation is used to describe an activity that helps to create a new market and goes on to disrupt an existing one, displacing earlier technology. Healthcare is full of such examples. In this context, disruption is a positive force for change. Breaking something apart only works if the pieces can be reconstructed into something better. Doctors who become disruptive break apart the people around them; but with insight, motivation and the right organisational support, there can be reconstruction, often into something better than before.

The majority of doctors we assess for behavioural  issues  have become disruptive because they feel disempowered.  We need to focus on strategies to channel their disruptiveness into behaviour that helps them regain their sense of control . This means putting boundaries in place with clear organisational codes of practice and expectations. Newly appointed consultants who join a department full of new ideas and ambitions try to do too much too soon –  their enthusiasm and push for innovation behaviour quickly becomes labelled as disruptive and difficult. They need help to become more effective influencers and more sensitive at managing the internal politics .  With the right support  and enough insight, disruption can be made to work for everyone.

 

 

References

 

 

  1. Leape, Lucian L. et al.  Perspective: A Culture of Respect, Part 1: The Nature and Causes of Disrespectful Behavior by Physicians . Academic Medicine: July 2012 - Volume 87 - Issue 7 - p 845–852 doi: 10.1097/ACM.0b013e318258338d

 

  1. Leape, Lucian L. et al.  Perspective: A Culture of Respect, Part 2: Creating a Culture of Respect. Academic Medicine, July 2012 - Volume 87 - Issue 7 - p 853–858 doi: 10.1097/ACM.0b013e3182583536

 

http://www.huffingtonpost.co.uk/2013/07/19/schools-encourage-girls-disruptive-success_n_3623380.html?utm_hp_ref=uk-universities-education

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