VITAL WorkLife offers four graduated levels of intervention services ranging from support for informal or Level 1 interventions to disciplinary or Level 4 interventions.
The case studies outlined below both describe Level 3 interventions where serious behavior issues were addressed, but the issues were not so serious that reporting to licensing entities was required.
Case Study 1:The Surgeon Without Appropriate Boundaries
Situation: VITAL WorkLife was approached by a Chief Medical Officer (CMO) who was concerned about an accomplished surgeon who was exhibiting operating room behavior that included:
- Inappropriate communication with staff, including flirtatious interactions with sexual undertones
- Sexual innuendos
- Inappropriate touching
The CMO expressed concerns about the impact of these behaviors on the staff’s ability to focus, concentrate and feel comfortable within the operating room. He was concerned about the impact on patient care and the possibility that a patient might overhear the sexually-related banter.
Assessment: VITAL WorkLife began by gathering information from the organization which was then reviewed by a multi-disciplinary team. The team recommended a Level 3 intervention where the surgeon agreed to participate in an interview and assessment of factors that may have contributed to the organization’s concerns.
During the interviews the surgeon expressed significant remorse related to the inappropriate behaviors identified by the CMO—and embarrassment related to the situation. It emerged that the surgeon, who had recently relocated, had not had time to establish the close ties he’d enjoyed in his last practice and community.
He found that relationships outside of work were a source of stress and difficulty, and that loneliness had jeopardized his judgment in terms of setting clear boundaries between personal and professional interactions.
The surgeon admitted having difficult emotions related to his personal life and past losses, and the team felt he would benefit from counseling.
Recommendation: In the plan presented to the physician and organization, it was recommended that the surgeon:
- Participate in at least ten (10) sessions of face-to-face coaching and counseling with a local psychologist no less than every other week with a focus on establishing appropriate boundaries at work, creating a positive support system, dealing with personal relationships and coping with difficult emotions.
- Identify a trusted local staff member in a position to provide regular feedback to Dr. X on how his communication and behavior was being perceived by others at work.
- Engage in regular communication with the VITAL WorkLife clinical lead on the case for at least one year. It was specified that such communication should occur one month after work with a local psychologist had begun, and then quarterly for one year.
On an organizational level, it was recommended that leadership:
- Provide clear and measurable expectations for Dr. X’s behavior and communication changes at work—with established intervals for reviewing status.
- Document any further complaints and bring them to the immediate attention of the surgeon.
- Engage in regular correspondence with VITAL WorkLife to monitor progress.
VITAL WorkLife was tasked with:
- Coordinating and facilitating referrals for a local psychologist, and follow up to determine effectiveness.
- Following up with the organization and the surgeon for up to one year to provide support and consultation related to recommendations and desired outcomes.
Outcome: The surgeon accepted a referral to a local psychologist and then satisfied the recommendation for counseling. VITAL WorkLife staff consulted with the psychologist and surgeon during the time they worked together, and received positive reports related to the effectiveness and success of the recommendation.
The CMO and the surgeon reported meeting together regularly—and that these meetings were productive. Both the surgeon and the CMO reported satisfaction with progress made toward the original goals.
Case Study 2: An Overwhelmed and Out of Control Specialist
Situation: An HR Director approached VITAL WorkLife for assistance with behavioral and communications concerns related to a specialist that were reported to include:
- Emotional lability
- Intimidation of staff
- Disrespectful communication
Concerns were expressed about the impact of these behaviors on staff retention, on maintaining a culture of respect and safety, on patient care and on overall department functioning. The organization also had concern that his emotional lability might reflect untreated mental health issues, and for that reason planned to request a fitness for duty examination.
Due to the concerns about mental health issues, VITAL WorkLife assisted the organization in setting up a fitness for duty examination for the physician with a local psychologist.
Assessment: No psychological conditions requiring time away from work, medical treatment or medication were identified.
The specialist admitted feelings of being overwhelmed and under stress, and that work was taking over his life. He reported not getting enough sleep, and family difficulties due to time away from work. He reported that the pace at work was causing him a great deal of agitation.
Recommendation: As a result of that assessment, VITAL WorkLife recommended that the specialist cut back on his practice by at least 20 percent—and that he receive assistance from leadership on structuring his workload and workflow in such a way as to maximize his ability to concentrate, maintain energy, and manage stress and frustration. In addition, VITAL WorkLife recommended that the specialist:
- Have regular meetings with leadership to evaluate progress and to obtain feedback on perceptions related to his behavior
- Participate in an “Effective Workplace Interactions” course
- See a cognitive behavioral therapist every two weeks to learn how to handle and manage stress and anger, and improve interpersonal interactions.
On an organizational level, it was recommended that leadership:
- Provide measurable expectations for the specialist’s behavior and communication at work
- Work with Dr. X to create a practice management plan that would include a workload reduction of at least 20%
- Provide support and review of progress. These sessions were also intended to provide support for the specialist around practice issues and staffing concerns.
Outcome: At the end of the year, it was reported that the organization had followed through on reducing the physician’s workload and managing his workflow much more closely. The pace of his work had slowed down significantly. The physician was happier and less stressed, and staff were reporting that they were enjoying working with him.
He reported having benefited from counseling and education and felt much better equipped to manage the challenges of practicing medicine and working cooperatively with his team. He noticed that having more effective communication was leading to improved workflow and cooperation in his clinic, and he appreciated this.
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