What I wish I'd known: How experienced physician managers diagnose, treat and prevent disruptive behaviour

As health systems continue to consolidate at a rapid pace, many physicians are stepping into roles that involve managing other physicians. While more physicians are thrust into these positions each year, the managerial training they receive is highly variable and often insufficient for dealing with the challenges they will face, notably disruptive behaviour. Broadly defined, disruptive behaviour includes any actions that affect a team's ability to effectively care for patients, and can even threaten patient and provider health. New physician managers-who typically have little prior experience in management roles-need specific supports to address this uniquely daunting challenge. Over our management careers, we have spoken with dozens of new and experienced physician managers to understand how they manage disruptive behaviour in the workplace and to collect their advice for future physician managers. In this paper, we reflect on those conversations and distill them into a three-part approach for diagnosing, treating and preventing disruptive behaviour in the workplace. We describe how the right management approach depends on a thorough assessment of the most likely drivers of the disruptive behaviour. Second, we present strategies for treating the behaviour focusing on the physician leader's communication skills and available institutional resources. Finally, we advocate for system-level changes that institutions or departments can implement both to prevent disruptive behaviour and to better prepare new managers to address it.