#jacr transcript › pb...ruthcarlosmd thu jul 25 9:05:40 pdt 2013 natricer rt @davidnaegermd: happy...

#JACR transcript

Healthcare Social Media Transcript

What is #JACR? Who were the influencers during this time period? #JACR analytics

Healthcare Conference - Healthcare Tweet Chats - Healthcare Analytics

From: Thu Jul 25 9:00:00 PDT 2013To: Thu Jul 25 10:15:00 PDT 2013

change time period

ruthcarlosmd Hello Everyone and Welcome to the #JACR chat! For the next hour we're going to be talking about disruptive behaviors.Thu Jul 25 9:00:30 PDT 2013

PracticalWisdom Great Source for our chat today: http://t.co/dmBN5E1SAE Great Ink Disruptive Behavior this is an important topic. #jacrThu Jul 25 9:01:00 PDT 2013

PracticalWisdom RT @ruthcarlosmd: Hello Everyone and Welcome to the #JACR chat! For the next hour we're going to be talking about disruptive behaviors.Thu Jul 25 9:01:12 PDT 2013

CincyKidsRad RT @ruthcarlosmd: Hello Everyone and Welcome to the #JACR chat! For the next hour we're going to be talking about disruptive behaviors.Thu Jul 25 9:01:28 PDT 2013

NatriceR RT @ruthcarlosmd: Hello Everyone and Welcome to the #JACR chat! For the next hour we're going to be talking about disruptive behaviors.Thu Jul 25 9:01:37 PDT 2013

RadiologyACR A quick note for participants: JACR is planning on archiving these tweets online at a later date. #JACRThu Jul 25 9:01:39 PDT 2013

MarilynGoskeMD It is my pleasure to participate in this discussion that affects many in the radiology field #jacrThu Jul 25 9:01:43 PDT 2013

NatriceR RT @MarilynGoskeMD: Looking forward to a meaningful discussion on this important issue for radiologists and radiology trainees #jacr

of 34#JACR - Healthcare Social Media Transcript

8/8/2013http://hashtags.symplur.com/healthcare-hashtag-transcript.php?hashtag=JACR&fdate=07-2...

Thu Jul 25 9:01:45 PDT 2013

tarheelrad RT @ruthcarlosmd: Hello Everyone and Welcome to the #JACR chat! For the next hour we're going to be talking about disruptive behaviors.Thu Jul 25 9:01:45 PDT 2013

ruthcarlosmd Let's start with introductions #JACRThu Jul 25 9:01:51 PDT 2013

bjh41647 Let me add my welcome as well; a lot of effort on Ruth's part has gone into getting this going #jacrThu Jul 25 9:02:02 PDT 2013

Radsdoc82 RT @ruthcarlosmd: Hello Everyone and Welcome to the #JACR chat! For the next hour we're going to be talking about disruptive behaviors.Thu Jul 25 9:02:08 PDT 2013

RadiologyACR Okay, first topic. T1: How do you define disruptive behavior? #JACRThu Jul 25 9:02:19 PDT 2013

DrGMcGinty #jacr #jacr disruptive behavior is when patient care is placed below physician self interestThu Jul 25 9:02:43 PDT 2013

drmikesevilla RT @PracticalWisdom: I"m going to use http://t.co/6yFcK8qZ77 in 5 minutes when I join our chat! I"m very excited! #jacrThu Jul 25 9:02:43 PDT 2013

ruthcarlosmd Lyndsee is co-moderating @RadiologyACR #JACRThu Jul 25 9:02:51 PDT 2013

PracticalWisdom Hi I"m Lisa @TEDMED & #HCLDR Moderator. Thrilled to be invited to your first Tweet Chat. Lots of friends gathered. #jacrThu Jul 25 9:02:54 PDT 2013

NatriceR #jacr hi all, first time to meet most of u! Retired PSW/p/t family caregiver #specialneeds from OntarioThu Jul 25 9:02:59 PDT 2013

PracticalWisdom RT @NatriceR: #jacr hi all, first time to meet most of u! Retired PSW/p/t family caregiver #specialneeds from OntarioThu Jul 25 9:03:12 PDT 2013

ruthcarlosmd Shout out to the #JACR Twitter Team @KristinaHoque @DavidNaeger@MattHawkins @Jim_Rawson_MDThu Jul 25 9:03:28 PDT 2013



DrGMcGinty RT @ruthcarlosmd: Shout out to the #JACR Twitter Team @KristinaHoque@DavidNaeger @MattHawkins @Jim_Rawson_MDThu Jul 25 9:03:34 PDT 2013

PracticalWisdom RT @ruthcarlosmd: Shout out to the #JACR Twitter Team @KristinaHoque@DavidNaeger @MattHawkins @Jim_Rawson_MDThu Jul 25 9:03:41 PDT 2013

tarheelrad RT @ruthcarlosmd: Shout out to the #JACR Twitter Team @KristinaHoque@DavidNaeger @MattHawkins @Jim_Rawson_MDThu Jul 25 9:03:48 PDT 2013

RadiologyACR A quick note for participants: JACR is planning on archiving these tweets online at a later date. #jacrThu Jul 25 9:03:58 PDT 2013

sdbromd Hi Steve Brown from Boston Children's Hospital #jacrThu Jul 25 9:04:01 PDT 2013

NatriceR RT @ruthcarlosmd: Lyndsee is co-moderating @RadiologyACR #JACRThu Jul 25 9:04:07 PDT 2013

sdbromd A1:Fed State Med Brds: interferes w/ pt care or could reasonably be expected to interfere w/ process of delivering quality care #jacrThu Jul 25 9:04:14 PDT 2013

DavidNaegerMD Happy to be here, everyone. Radiologist at UCSF here. Great topic! #jacrThu Jul 25 9:04:26 PDT 2013

PracticalWisdom Great to see Healthcare Leader #HCLDR Community Members gather for their first chat. @MattHawkins @Jim_Rawson_MD @ruthcarlosmd #jacrThu Jul 25 9:05:08 PDT 2013

NatriceR RT @ruthcarlosmd: Shout out to the #JACR Twitter Team @KristinaHoque@DavidNaeger @MattHawkins @Jim_Rawson_MDThu Jul 25 9:05:13 PDT 2013

NatriceR RT @RadiologyACR: A quick note for participants: JACR is planning on archiving these tweets online at a later date. #jacrThu Jul 25 9:05:19 PDT 2013

RadiologyACR Excited to have everyone join in! Here's the first topic again. T1: How do you define disruptive behavior? #JACR #jacrThu Jul 25 9:05:33 PDT 2013

We assume that all tweets are your own and not those of your employer unless stated otherwise #JACR



ruthcarlosmd Thu Jul 25 9:05:40 PDT 2013

NatriceR RT @DavidNaegerMD: Happy to be here, everyone. Radiologist at UCSF here. Great topic! #jacrThu Jul 25 9:05:41 PDT 2013

ruthcarlosmd There are 3 topics for discussion: T1 T2 and T3. Please try to place these in your tweets to make the transcript easier to read. #JACRThu Jul 25 9:05:45 PDT 2013

PracticalWisdom T1: “interferes with patient care or could reasonably be expected to interfere with the process of delivering quality care” #jacrThu Jul 25 9:05:52 PDT 2013

ruthcarlosmd If you modify someone else's tweet, please use "MT" so that we know it has been changed. Thank you! #JACRThu Jul 25 9:05:55 PDT 2013

ruthcarlosmd We assume that all tweets are your own and not those of your employer unless stated otherwise#JACRThu Jul 25 9:06:06 PDT 2013

tarheelrad Disruptive behaviors can stem from a failure to create a culture of respect http://t.co/xihSCtPEyS #jacrThu Jul 25 9:06:15 PDT 2013

Radsdoc82 @DrGMcGinty or when physician self interest is placed above any dept goals including education, quality, research #jacrThu Jul 25 9:06:22 PDT 2013

CincyKidsRad T1: disruptive behavior doesn't always involve patients. Can also involve co-workers #jacrThu Jul 25 9:06:26 PDT 2013

DavidNaegerMD T1 Disruptive behaviors are not necessarily selfish. People are human and stressed. #jacrThu Jul 25 9:06:28 PDT 2013

DrGMcGinty RT @Radsdoc82: @DrGMcGinty or when physician self interest is placed above any dept goals including education, quality, research #jacrThu Jul 25 9:06:31 PDT 2013

OPCErgo RT @DavidNaegerMD: Happy to be here, everyone. Radiologist at UCSF here. Great topic! #jacrThu Jul 25 9:06:31 PDT 2013



sdbromd Jnt Comm: interferes w/ others’ ability to effectively carry out duties or undermines pt’s confidence in hospital or healthcare team #jacrThu Jul 25 9:06:34 PDT 2013

NatriceR RT @RadiologyACR: Excited to have everyone join in! Here's the first topic again. T1: How do you define disruptive behavior? #JACR #jacrThu Jul 25 9:06:42 PDT 2013

KristinaHoque @RadiologyACR #JACR welcome everyone to the first tweet chat for JACR!Thu Jul 25 9:06:53 PDT 2013

PracticalWisdom T1: Disruptive behavior in any workplace poses considerable challenges for coworkers, managers, subordinates, and patients. #jacrThu Jul 25 9:06:54 PDT 2013

sdbromd most important consequences are breakdown in communication, information transfer, teamwork, relationships leads to compromised safety #jacrThu Jul 25 9:07:23 PDT 2013

NatriceR @RadiologyACR #jacr patient viewpt anything that affects team/ pt care negativelyThu Jul 25 9:07:26 PDT 2013

MarilynGoskeMD All impaired behavior is not necessarily disruptive but the two are often thought of as synonymous #jacrThu Jul 25 9:07:30 PDT 2013

NatriceR RT @ruthcarlosmd: We assume that all tweets are your own and not those of your employer unless stated otherwise #JACRThu Jul 25 9:07:32 PDT 2013

ElinSilveous “@RadiologyACR: Excited to have everyone join in! Here's the first topic again. T1: How do you define disruptive behavior? #JACR #jacr”Thu Jul 25 9:07:34 PDT 2013

NatriceR RT @ruthcarlosmd: If you modify someone else's tweet, please use "MT" so that we know it has been changed. Thank you! #JACRThu Jul 25 9:07:43 PDT 2013

NatriceR RT @Radsdoc82: @DrGMcGinty or when physician self interest is placed above any dept goals including education, quality, research #jacrThu Jul 25 9:07:51 PDT 2013

bjh41647 There are instances where obvious (if it quacks...); other times not so obvious; concerns for false accusations #jacrThu Jul 25 9:07:59 PDT 2013

RT @Radsdoc82: @DrGMcGinty or when physician self interest is placed above any



PracticalWisdom dept goals including education, quality, research #jacrThu Jul 25 9:08:01 PDT 2013

Radsdoc82 @PracticalWisdom and it sets a bad example for others especially when there are impressionable people around #jacrThu Jul 25 9:08:11 PDT 2013

DrGMcGinty #jacr #jacr doctors surprisingly unwilling to call out bad behaviourThu Jul 25 9:08:20 PDT 2013

DavidNaegerMD @MarilynGoskeMD Great point. Impaired behavior very important, but not synonymous. #JACRThu Jul 25 9:08:23 PDT 2013

NatriceR RT @MarilynGoskeMD: All impaired behavior is not necessarily disruptive but the two are often thought of as synonymous #jacrThu Jul 25 9:08:27 PDT 2013

NatriceR RT @KristinaHoque: @RadiologyACR #JACR welcome everyone to the first tweet chat for JACR!Thu Jul 25 9:08:38 PDT 2013

TirathPatelMD T1 Disruptive behavior is sometimes not clear cut. One may think of said behavior negatively; others may not. #JACRThu Jul 25 9:08:41 PDT 2013

RadiologyACR RT @MarilynGoskeMD: All impaired behavior is not necessarily disruptive but the two are often thought of as synonymous #jacrThu Jul 25 9:08:46 PDT 2013

ElinSilveous T1. Behavior that threatens the well-being of oneself or another, or the environment in which people are being care for. #JACRThu Jul 25 9:08:57 PDT 2013

DrGMcGinty RT @MarilynGoskeMD: All impaired behavior is not necessarily disruptive but the two are often thought of as synonymous #jacrThu Jul 25 9:08:58 PDT 2013

sdbromd Acting in self interest not necessarily disruptive, even if at times unprofessional. #jacrThu Jul 25 9:09:00 PDT 2013

MarilynGoskeMD It is fascinating that disruptive behavior has received so little attention in the radiology field yet it is so common. #jacrThu Jul 25 9:09:10 PDT 2013

RT @bjh41647: There are instances where obvious (if it quacks...); other times not so obvious; concerns for false accusations #jacr



NatriceR Thu Jul 25 9:09:12 PDT 2013

sdbromd familiar examples: angry outbursts, physical threats, throwing things, Profane/ disrespectful language, sexual comments or innuendo #jacrThu Jul 25 9:09:20 PDT 2013

NatriceR RT @Radsdoc82: @PracticalWisdom and it sets a bad example for others especially when there are impressionable people around #jacrThu Jul 25 9:09:38 PDT 2013

sdbromd also quiet uncooperative behavior that undermines team: refusal to perform assigned tasks or answer pages; criticism in front of pt #jacrThu Jul 25 9:09:39 PDT 2013

PracticalWisdom We are all impressionable MT @Radsdoc82 it sets a bad example for others especially when there are impressionable people around #jacrThu Jul 25 9:09:56 PDT 2013

bjh41647 Important to consider motivation - provoked, fatigue, or just a bad actor - repeated episodes important consieration #jacrThu Jul 25 9:10:05 PDT 2013

DavidNaegerMD T1 What about the grey zone? Is "pimping" a form of education or disruptive behavior? When does it cross the line? #JACRThu Jul 25 9:10:22 PDT 2013

TirathPatelMD RT @CincyKidsRad: T1: disruptive behavior doesn't always involve patients. Can also involve co-workers #jacrThu Jul 25 9:10:23 PDT 2013

DrGMcGinty RT @CincyKidsRad: T1: disruptive behavior doesn't always involve patients. Can also involve co-workers #jacrThu Jul 25 9:10:37 PDT 2013

NatriceR RT @bjh41647: Important to consider motivation - provoked, fatigue, or just a bad actor - repeated episodes important consieration #jacrThu Jul 25 9:10:41 PDT 2013

NatriceR RT @DavidNaegerMD: T1 What about the grey zone? Is "pimping" a form of education or disruptive behavior? When does it cross the line? #JACRThu Jul 25 9:10:59 PDT 2013

MarilynGoskeMD often difficult to determine if behavior meets the criteria of being disruptive ! #jacrThu Jul 25 9:11:09 PDT 2013

RT @DavidNaegerMD: T1 What about the grey zone? Is "pimping" a form of



Boundroid education or disruptive behavior? When does it cross the line? #JACRThu Jul 25 9:11:16 PDT 2013

TirathPatelMD RT @KristinaHoque: @RadiologyACR #JACR welcome everyone to the first tweet chat for JACR!Thu Jul 25 9:11:19 PDT 2013

CincyKidsRad What is criteria? @MarilynGoskeMD T1: Frequency of disruptive behavior is importnant #jacrThu Jul 25 9:11:30 PDT 2013

CincyKidsRad What are the criteriaRT @MarilynGoskeMD: often difficult to determine if behavior meets the criteria of being disruptive ! #jacr #jacrThu Jul 25 9:11:59 PDT 2013

PracticalWisdom Appreciate this point. This sometimes is more damaging. MT @sdbromd quiet uncooperative behavior, etc. #jacrThu Jul 25 9:12:21 PDT 2013

tarheelrad Important to identify and address disruptive behaviors especially as medicine continues to move towards being a "team sport" #jacrThu Jul 25 9:12:22 PDT 2013

ruthcarlosmd Reminder to all. please use #JACR in your message so we can follow your thoughts.Thu Jul 25 9:12:24 PDT 2013

DavidNaegerMD @ruthcarlosmd Completely agree! Some "disruptive behavior" may simply being socially daft. That's not just a medicine problem. #JACRThu Jul 25 9:12:37 PDT 2013

bjh41647 Worst case is where physicians use their status to beat down someone who can't fight back #jacrThu Jul 25 9:12:50 PDT 2013

Ihbercha RT @MarilynGoskeMD: All impaired behavior is not necessarily disruptive but the two are often thought of as synonymous #jacrThu Jul 25 9:12:53 PDT 2013

CincyKidsRad How does the frequency of disruptive behavior affect the response? #jacrThu Jul 25 9:13:02 PDT 2013

NatriceR RT @ruthcarlosmd: Reminder to all. please use #JACR in your message so we can follow your thoughts.Thu Jul 25 9:13:03 PDT 2013

Criteria for definition of disruptive behavior is if you think there is disruptive behavior.#jacr



MarilynGoskeMD Thu Jul 25 9:14:01 PDT 2013

NatriceR RT @bjh41647: Worst case is where physicians use their status to beat down someone who can't fight back #jacrThu Jul 25 9:14:01 PDT 2013

DrGMcGinty @DavidNaegerMD @ruthcarlosmd #jacr one person's "socially daft" is another's demeaning and disruptiveThu Jul 25 9:14:04 PDT 2013

ruthcarlosmd RT @bjh41647: Important to consider motivation - provoked, fatigue, or just a bad actor - repeated episodes important consieration #jacrThu Jul 25 9:14:31 PDT 2013

Ihbercha RT @RadiologyACR: Excited to have everyone join in! Here's the first topic again. T1: How do you define disruptive behavior? #JACR #jacrThu Jul 25 9:14:33 PDT 2013

sdbromd @DavidNaegerMD if deleterious to emotional wellbeing of learners, or undermines learning or team cohesion, then yes, disruptive #jacrThu Jul 25 9:14:36 PDT 2013

NatriceR RT @DrGMcGinty: @DavidNaegerMD @ruthcarlosmd #jacr one person's "socially daft" is another's demeaning and disruptiveThu Jul 25 9:14:38 PDT 2013

Ihbercha RT @RadiologyACR: A quick note for participants: JACR is planning on archiving these tweets online at a later date. #jacrThu Jul 25 9:14:43 PDT 2013

PracticalWisdom Could you share more infor. Not sure what you mean=Term MT @DavidNaegerMD Is "pimping" a form of education or disruptive behavior? #jacrThu Jul 25 9:14:56 PDT 2013

ElinSilveous @ruthcarlosmd Thank you. Decades ago I handled PR/Marketing/Physician/Media Relations for 800-bed hospital. #jacrThu Jul 25 9:15:06 PDT 2013

MarilynGoskeMD There should be guidelines and policies within an organization that have criteria that applies to all in that hospital setting #jacrThu Jul 25 9:15:07 PDT 2013

RadiologyACR RT @DrGMcGinty: @DavidNaegerMD @ruthcarlosmd #jacr one person's "socially daft" is another's demeaning and disruptiveThu Jul 25 9:15:10 PDT 2013



TirathPatelMD RT @bjh41647: Important to consider motivation - provoked, fatigue, or just a bad actor - repeated episodes important consieration #jacrThu Jul 25 9:15:12 PDT 2013

NatriceR RT @Ihbercha: Excited to have everyone join in! Here's the first topic again. T1: How do you define disruptive behavior? #JACR #jacrThu Jul 25 9:15:22 PDT 2013

Jim_Rawson_MD T1 #jacr Disrup Behav is any behavior that disrupts patient care or workflow-cause of behavior is a different questionThu Jul 25 9:15:29 PDT 2013

DrGMcGinty RT @Jim_Rawson_MD: T1 #jacr Disrup Behav is any behavior that disrupts patient care or workflow-cause of behavior is a different questionThu Jul 25 9:15:38 PDT 2013

PracticalWisdom RT @Jim_Rawson_MD: T1 #jacr Disrup Behav is any behavior that disrupts patient care or workflow-cause of behavior is a different questionThu Jul 25 9:15:40 PDT 2013

DavidNaegerMD RT @TirathPatelMD @KristinaHoque Agree. Everything from poor teaching to inter-generation interaction may be considered "disruptive" #JACR.Thu Jul 25 9:15:47 PDT 2013

bjh41647 The definition of disruptive behavior depends on who is bears the brunt and who must deal with repeated offenses #jacrThu Jul 25 9:15:55 PDT 2013

NatriceR RT @ElinSilveous: @ruthcarlosmd Thank you. Decades ago I handled PR/Marketing/Physician/Media Relations for 800-bed hospital. #jacrThu Jul 25 9:15:55 PDT 2013

ElinSilveous Hospitals and independent diagnostic/treatment centers would be wise to have this spelled out in the HR/Personnel manuals. #JACRThu Jul 25 9:16:19 PDT 2013

tarheelrad RT @bjh41647: The definition of disruptive behavior depends on who is bears the brunt and who must deal with repeated offenses #jacrThu Jul 25 9:16:24 PDT 2013

sdbromd @bjh41647 #jacr true that motivation important, many drivers of disruptive behaviors, but still disruptive even if from fatigue or illnessThu Jul 25 9:16:45 PDT 2013

ruthcarlosmd Hi @NatriceR Thanks for joining as a part-time caregiver full time caring person. #JACRThu Jul 25 9:16:59 PDT 2013



Ihbercha @RadiologyACR If somebody interferes with whatever I am doing, in any shape, way or form....THAT IS THE DISRUPTOR..... #JACRThu Jul 25 9:17:03 PDT 2013

PracticalWisdom T1: “interferes with pt or could reasonably be expected to interfere w/ the process of delivering quality care” http://t.co/dmBN5E1SAE #jacrThu Jul 25 9:17:29 PDT 2013

ruthcarlosmd RT @Jim_Rawson_MD: T1 #jacr Disrup Behav is any behavior that disrupts patient care or workflow-cause of behavior is a different questionThu Jul 25 9:17:30 PDT 2013

NatriceR RT @ruthcarlosmd: Hi @NatriceR Thanks for joining as a part-time caregiver full time caring person. #JACRThu Jul 25 9:17:30 PDT 2013

CincyKidsRad @Ihbercha but by that definition, some disruptive behavior is good ie - giving more information on a patient #jacrThu Jul 25 9:18:01 PDT 2013

ruthcarlosmd @MarilynGoskeMD Guidelines do exist, but can be rarely applied, due to the institutional culture #JACRThu Jul 25 9:18:21 PDT 2013

DavidNaegerMD Disr Bhvs may ultimately need to be treated like sexual harassment training in the work place. #JACRThu Jul 25 9:18:23 PDT 2013

Colin_Hung T1: Dr. Hickson at Vandy has created a whole org around predicting/preventing phys disruptive behavior http://t.co/9DLMaCFDTL #JACRThu Jul 25 9:18:46 PDT 2013

Jim_Rawson_MD RT @bjh41647: Important to consider motivation - provoked, fatigue, or just a bad actor - repeated episodes important consieration #jacrThu Jul 25 9:18:49 PDT 2013

sdbromd @bjh41647 #jacr Rosenstein, O’Daniel, Joint Comm Journal on Quality and Patient Safety, 2008Thu Jul 25 9:18:49 PDT 2013

bjh41647 no question motivation or cause is separate, but cause related to frequency and responsibility for disposition #jacrThu Jul 25 9:18:51 PDT 2013

TirathPatelMD #JACR "Disruptive behavior" not always clear cut. What one may find disruptive, another in a similar position may not.Thu Jul 25 9:19:17 PDT 2013



Jim_Rawson_MD RT @ruthcarlosmd: Reminder to all. please use #JACR in your message so we can follow your thoughts.Thu Jul 25 9:19:17 PDT 2013

sdbromd @bjh41647 #jacr most important consequences are breakdown in communication, information transfer, teamwork, relationships undermines safetyThu Jul 25 9:19:42 PDT 2013

NatriceR RT @sdbromd: @bjh41647 #jacr Rosenstein, O’Daniel, Joint Comm Journal on Quality and Patient Safety, 2008Thu Jul 25 9:19:49 PDT 2013

ruthcarlosmd @ElinSilveous Also important is a judgment free and repercussion free process that allows ANY one to initiate feedback of disrp behav #JACRThu Jul 25 9:19:52 PDT 2013

DavidNaegerMD Possibly needed: Institutional guidelines (to define), a reporting structure, teaching modules, zero tolerance policies. #JACRThu Jul 25 9:20:01 PDT 2013

Jim_Rawson_MD RT @bjh41647: The definition of disruptive behavior depends on who is bears the brunt and who must deal with repeated offenses #jacrThu Jul 25 9:20:07 PDT 2013

Radsdoc82 @ruthcarlosmd @DrGMcGinty @DavidNaegerMD what about the physician who is too "thorough" #jacrThu Jul 25 9:20:09 PDT 2013

NatriceR RT @DavidNaegerMD: Disr Bhvs may ultimately need to be treated like sexual harassment training in the work place. #JACRThu Jul 25 9:20:22 PDT 2013

MarilynGoskeMD One important thing is that disruptive behavior is at odds with definition of professionalsim #jacrThu Jul 25 9:20:27 PDT 2013

CincyKidsRad RT @MarilynGoskeMD: One important thing is that disruptive behavior is at odds with definition of professionalsim #jacrThu Jul 25 9:20:44 PDT 2013

NatriceR RT @Radsdoc82: @ruthcarlosmd @DrGMcGinty @DavidNaegerMD what about the physician who is too "thorough" #jacrThu Jul 25 9:20:50 PDT 2013

ruthcarlosmd @Colin_Hung Thanks for joining. #hcldr well represented #JACRThu Jul 25 9:20:59 PDT 2013



RadiologyACR T2: How do you manage disruptive behavior if you witness it? Is this different from if you hear about the event later? #JACRThu Jul 25 9:21:07 PDT 2013

NatriceR RT @MarilynGoskeMD: One important thing is that disruptive behavior is at odds with definition of professionalsim #jacrThu Jul 25 9:21:08 PDT 2013

Ihbercha When you believe in a thing,believe in it all the way, implicitly & unquestionable.W Disney @Marlothomas ABSOLUTELY! "DO OR DIE" #JACRThu Jul 25 9:21:12 PDT 2013

DavidNaegerMD @Radsdoc82 Perfect comment! Thoroughness is highly chaffing to others but probably NOT disruptive (IMHO). #JACRThu Jul 25 9:21:18 PDT 2013

NatriceR RT @ruthcarlosmd: @Colin_Hung Thanks for joining. #hcldr well represented #JACRThu Jul 25 9:21:28 PDT 2013

PracticalWisdom T1: As Healthcare Leaders it's critical to examine ourselves for any type of Disruptive Behavior. Period #jacrThu Jul 25 9:21:31 PDT 2013

Ihbercha RT @MarilynGoskeMD: One important thing is that disruptive behavior is at odds with definition of professionalsim #jacrThu Jul 25 9:21:50 PDT 2013

Boundroid RT @MarilynGoskeMD: One important thing is that disruptive behavior is at odds with definition of professionalsim #jacrThu Jul 25 9:22:07 PDT 2013

CincyKidsRad Zero tolerance is tough because many people do not know they are being disruptive until it is pointed out to them #jacrThu Jul 25 9:22:20 PDT 2013

MarilynGoskeMD Managing disruptive behavior if you witness it is easier to deal with -direct observation not someone elses word #jacrThu Jul 25 9:22:27 PDT 2013

Colin_Hung RT @PracticalWisdom: T1: As Healthcare Leaders it's critical to examine ourselves for any type of Disruptive Behavior. Period #jacrThu Jul 25 9:22:33 PDT 2013

Ihbercha @RadiologyACR Dont lose your focus... I dont get your second question? #JACRThu Jul 25 9:22:54 PDT 2013

@CincyKidsRad absolutely agree. #JACR



TirathPatelMD Thu Jul 25 9:23:04 PDT 2013

Ihbercha RT @MarilynGoskeMD: Managing disruptive behavior if you witness it is easier to deal with -direct observation not someone elses word #jacrThu Jul 25 9:23:11 PDT 2013

bjh41647 Many folks will be hesitant to report for fear of bringing down the behavior on themselves...or fear of vindictive reporting #jacrThu Jul 25 9:23:14 PDT 2013

NatriceR @CincyKidsRad zero tolerance while in many places still doesn't solve the problems #jacrThu Jul 25 9:23:30 PDT 2013

CincyKidsRad t2: It is important to have some process for discussing disruptive behavior, so that we can learn how to improve #jacrThu Jul 25 9:23:39 PDT 2013

PracticalWisdom T1: Disruptive Behaviors impact Patient Safety. A culture of safety takes disruptive behaviors seriously. The Team must feel safe. #jacrThu Jul 25 9:23:54 PDT 2013

ruthcarlosmd @PracticalWisdom Agree! We choose where we live on the continuum of behavior. Self-awareness key to reduce own disruptive behavior #JACRThu Jul 25 9:24:00 PDT 2013

sdbromd Receptive dept. leadership is key. If dept culture not receptive/responsive, office of clinician support in many institutions #jacrThu Jul 25 9:24:12 PDT 2013

NatriceR RT @PracticalWisdom: T1: As Healthcare Leaders it's critical to examine ourselves for any type of Disruptive Behavior. Period #jacrThu Jul 25 9:24:12 PDT 2013

Ihbercha On thinking in the grand scheme.. "We've got to set our eyes on the horizon." —President Obama @barackobama #JACRThu Jul 25 9:24:18 PDT 2013

CincyKidsRad T2: In a sense, reporting disruptive behavior is similar to peer review. #jacrThu Jul 25 9:24:27 PDT 2013

MarilynGoskeMD Part of managing disruptive behavior is also protecting confidentiality of individual with the behavior #jacrThu Jul 25 9:24:28 PDT 2013

T1: It takes others to tell you how your actions are being perceived before you realize



Colin_Hung you are a source of Disruptive Behaviour #JACRThu Jul 25 9:24:33 PDT 2013

CincyKidsRad RT @MarilynGoskeMD: Part of managing disruptive behavior is also protecting confidentiality of individual with the behavior #jacrThu Jul 25 9:24:46 PDT 2013

ElinSilveous T2. Privately. | “@RadiologyACR: T2: How do you manage disruptive behavior if you witness it? Is this different from if you... #JACR”Thu Jul 25 9:25:01 PDT 2013

ruthcarlosmd Moving to T2: How do you manage disruptive behavior if you witness it? Is this different from if you hear about the event later? #JACRThu Jul 25 9:25:09 PDT 2013

Boundroid RT @PracticalWisdom: T1: As Healthcare Leaders it's critical to examine ourselves for any type of Disruptive Behavior. Period #jacrThu Jul 25 9:25:31 PDT 2013

NatriceR @bjh41647 #jacr also loss of job and more t2Thu Jul 25 9:25:39 PDT 2013

MarilynGoskeMD If there is an individual with disruptive behavior and you witness, best to deal soon and face to face in private #jacrThu Jul 25 9:25:44 PDT 2013

Jim_Rawson_MD RT @PracticalWisdom: T1: As Healthcare Leaders it's critical to examine ourselves for any type of Disruptive Behavior. Period #jacrThu Jul 25 9:25:47 PDT 2013

NatriceR RT @CincyKidsRad: t2: It is important to have some process for discussing disruptive behavior, so that we can learn how to improve #jacrThu Jul 25 9:25:49 PDT 2013

tarheelrad If disruptive behavior is not addressed and dealt with quickly, the whole team suffers. Zero tolerance. #jacrThu Jul 25 9:25:51 PDT 2013

CincyKidsRad and the person reporting it @MarilynGoskeMD: MT: Part of managing behavior is protecting confidentiality of individual w behavior #jacrThu Jul 25 9:26:00 PDT 2013

DavidNaegerMD T2 Big challenge. Misbehaving people are the scariest to report - most likely to retaliate. #JACRThu Jul 25 9:26:04 PDT 2013

@MarilynGoskeMD Then how will you address the problem? #JACR



Ihbercha @RadiologyACRThu Jul 25 9:26:24 PDT 2013

Colin_Hung T2: Cannot confront disruptive behaivor (vs destructive behavior). You have take person aside and have a conversation #JACRThu Jul 25 9:26:34 PDT 2013

Ihbercha RT @MarilynGoskeMD: If there is an individual with disruptive behavior and you witness, best to deal soon and face to face in private #jacrThu Jul 25 9:26:36 PDT 2013

bjh41647 what about confidetiality for the one reporting the incident? #jacrThu Jul 25 9:26:40 PDT 2013

NatriceR RT @DavidNaegerMD: T2 Big challenge. Misbehaving people are the scariest to report - most likely to retaliate. #JACRThu Jul 25 9:26:44 PDT 2013

sdbromd relationship/context dependent. Longtime close colleague maybe ask directly. Senior MD? Consult dept leader or hospital resource #jacrThu Jul 25 9:26:45 PDT 2013

PracticalWisdom Colin I'm so glad to see you. Thank you for sharing your time and insight @Colin_Hung Co-moderator #HCLDR #jacrThu Jul 25 9:26:51 PDT 2013

PracticalWisdom RT @Colin_Hung: T2: Cannot confront disruptive behaivor (vs destructive behavior). You have take person aside and have a conversation #JACRThu Jul 25 9:27:10 PDT 2013

ElinSilveous T2. An exception, however, is if there is an immediate threat to oneself, others, or the environment in which care is delivered. #jacrThu Jul 25 9:27:15 PDT 2013

NatriceR @DavidNaegerMD t2 been there done that - misbehaver still employed and continuing #jacrThu Jul 25 9:27:25 PDT 2013

TirathPatelMD T2 managing disruptive behavior requires leaders to educate, but not demean, the disruptor about their actions #JACR #hcldrThu Jul 25 9:27:39 PDT 2013

sdbromd @DavidNaegerMD #jacr maybe some, but may others know they need help -substance abuse, depression, burnoutThu Jul 25 9:27:50 PDT 2013

T2: Dangerous behavior needs to be dealt with immediately. Disruptive behavior can



CincyKidsRad sometimes wait. #jacrThu Jul 25 9:27:58 PDT 2013

MarilynGoskeMD Getting back to how to manage, again need facility policy and procedures #jacrThu Jul 25 9:27:59 PDT 2013

ruthcarlosmd Safety first, of the patient and the team while allowing the disruptive individual to correct behavior @CincyKidsRad @MarilynGoskeMD #JACRThu Jul 25 9:28:01 PDT 2013

ruthcarlosmd RT @NatriceR: @DavidNaegerMD t2 been there done that - misbehaver still employed and continuing #jacrThu Jul 25 9:28:13 PDT 2013

DavidNaegerMD @NatriceR What happened? Lessons learned from the process? #JACRThu Jul 25 9:28:18 PDT 2013

PracticalWisdom T2: Disruptive Behavior is best address by both Official Medical Leaders and Peers can also make a difference. #jacrThu Jul 25 9:28:22 PDT 2013

sdbromd @DavidNaegerMD practice agreements - written before disruptive behavior occurs so all physicians treated equally & consequences clear #jacrThu Jul 25 9:28:26 PDT 2013

bjh41647 Dealing with behavior requires finesse - there is no one way; base treatment on diagnosis #jacrThu Jul 25 9:28:38 PDT 2013

sdbromd significant consequences – including termination – but compassion and understanding re: possible underlying mental health condition. #jacrThu Jul 25 9:28:43 PDT 2013

ruthcarlosmd T2: How would you have resolve this? #JACR @NatriceR @DavidNaegerMDThu Jul 25 9:28:47 PDT 2013

NatriceR RT @DavidNaegerMD: @NatriceR What happened? Lessons learned from the process? #JACRThu Jul 25 9:28:58 PDT 2013

TirathPatelMD RT @bjh41647: Dealing with behavior requires finesse - there is no one way; base treatment on diagnosis #jacrThu Jul 25 9:29:02 PDT 2013

Colin_Hung T2: There are some EXCELLENT resources here http://t.co/GxoG5qylH5 on how to deal with disruptive behavior from @VUMCHealth CPPA #JACR



Thu Jul 25 9:29:07 PDT 2013

Jim_Rawson_MD T2 #jacr Managed disruptive by discussing/defining expectations & holding people accountable.Thu Jul 25 9:29:07 PDT 2013

sdbromd Document problem behaviors, Specific list of do’s and don't’s, Plan for monitoring behavior with timeline, outside clinical assessment #jacrThu Jul 25 9:29:33 PDT 2013

PracticalWisdom Suggestion: I feel more comfortable with using the words Disruptive Behavior vs Misbehaving people. #jacrThu Jul 25 9:29:39 PDT 2013

CincyKidsRad T2: If disruptive behavior is brought on by frustration, discussion may be more fruitful/insightful after person has cooled down #jacrThu Jul 25 9:29:39 PDT 2013

NatriceR @DavidNaegerMD reprimand given, reg staff continued to hunt me- I retired - others in my place take brunt #jacrThu Jul 25 9:29:46 PDT 2013

MarilynGoskeMD Agree @bjh Topic is sensitive and MD with disruptive behavior may not be aware #jacrThu Jul 25 9:29:55 PDT 2013

Colin_Hung Agree w safety first! RT @ruthcarlosmd: Safety first, of the patient & team while allowing disruptive individual to correct behavior #JACRThu Jul 25 9:30:06 PDT 2013

NatriceR RT @bjh41647: Dealing with behavior requires finesse - there is no one way; base treatment on diagnosis #jacrThu Jul 25 9:30:12 PDT 2013

NatriceR RT @PracticalWisdom: T2: Disruptive Behavior is best address by both Official Medical Leaders and Peers can also make a difference. #jacrThu Jul 25 9:30:17 PDT 2013

PracticalWisdom RT @Jim_Rawson_MD: T2 #jacr Managed disruptive by discussing/defining expectations & holding people accountable.Thu Jul 25 9:30:27 PDT 2013

NatriceR RT @PracticalWisdom: Suggestion: I feel more comfortable with using the words Disruptive Behavior vs Misbehaving people. #jacrThu Jul 25 9:30:47 PDT 2013

@Colin_Hung @ruthcarlosmd #jacr safety for disruptive individual as well. They are



sdbromd vulnerableThu Jul 25 9:30:49 PDT 2013

ruthcarlosmd Worst possible outcome and illustrates difficulty in dealing with disruptor #JACR@NatriceR @DavidNaegerMDThu Jul 25 9:31:02 PDT 2013

TirathPatelMD .@Colin_Hung @VUMChealth talking it over coffee? Simple, yet many times effective. #JACRThu Jul 25 9:31:06 PDT 2013

Boundroid Perhaps executive coaching to "hold up a mirror"? #jacrThu Jul 25 9:31:14 PDT 2013

MarilynGoskeMD @CincyKidsRad Agree Also for some sensitive issues may need todraw in another colleague #jacrThu Jul 25 9:31:20 PDT 2013

NatriceR RT @ruthcarlosmd: Worst possible outcome and illustrates difficulty in dealing with disruptor #JACR @NatriceR @DavidNaegerMDThu Jul 25 9:31:26 PDT 2013

Jim_Rawson_MD T2 #jacr When someone cannot manage their own disruptive behavior, get them additional training/ coaching.Thu Jul 25 9:31:43 PDT 2013

RadiologyACR RT @TirathPatelMD: .@Colin_Hung @VUMChealth talking it over coffee? Simple, yet many times effective. #JACRThu Jul 25 9:31:52 PDT 2013

NatriceR @ruthcarlosmd @DavidNaegerMD #jacr exactly! My worries are about staff/patients a toxic environmentThu Jul 25 9:31:57 PDT 2013

bjh41647 ...but how to negate defensive behavior? almost always the response in my experience #jacrThu Jul 25 9:32:02 PDT 2013

CincyKidsRad RT @Jim_Rawson_MD: T2 #jacr When someone cannot manage their own disruptive behavior, get them additional training/ coaching.Thu Jul 25 9:32:03 PDT 2013

Colin_Hung @TirathPatelMD Yes. Starts in non-confrontational atmosphere. The key is to help ppl recognize they r being disruptive @VUMChealth #JACRThu Jul 25 9:32:08 PDT 2013

@Boundroid #jacr Referral for clinical assessment to an outside group, but with



sdbromd consequences of failing to agreeThu Jul 25 9:32:08 PDT 2013

MarilynGoskeMD We have not address that there may be underlying mental illness #jacrThu Jul 25 9:32:17 PDT 2013

PracticalWisdom RT @Jim_Rawson_MD: T2 #jacr When someone cannot manage their own disruptive behavior, get them additional training/ coaching.Thu Jul 25 9:32:21 PDT 2013

NatriceR RT @Jim_Rawson_MD: T2 #jacr When someone cannot manage their own disruptive behavior, get them additional training/ coaching.Thu Jul 25 9:32:24 PDT 2013

ruthcarlosmd T2: How do patients address disruptive behavior? What is their role in the process? #JACRThu Jul 25 9:32:43 PDT 2013

Colin_Hung @sdbromd Agree. Safety of the disruptor as well...who may not realize the impact they are having on ppl around them #JACR @ruthcarlosmdThu Jul 25 9:32:59 PDT 2013

bjh41647 agree with @Marilyn...especially with repeat offenders, there is often an underlying mental health issue #jacrThu Jul 25 9:33:09 PDT 2013

sdbromd @Jim_Rawson_MD #jacr agreed, confidentiality is important, sensitivity to possible medical, social or psychological issuesThu Jul 25 9:33:10 PDT 2013

CincyKidsRad @bjh41647 defensive behavior is of heightened by frustration. can let people cool off and listen to their frustrations. #jacrThu Jul 25 9:33:13 PDT 2013

PracticalWisdom What if they can't c it RT @Jim_Rawson_MD someone cannot manage their own disruptive behavior, get them additional training/ coaching. #jacrThu Jul 25 9:33:25 PDT 2013

RadiologyACR RT @MarilynGoskeMD: We have not address that there may be underlying mental illness #jacrThu Jul 25 9:33:35 PDT 2013

ruthcarlosmd @MarilynGoskeMD So much baggage with the term that those who want to seek help may not feel free to do so. Perpetuate problem. #JACRThu Jul 25 9:33:36 PDT 2013

TY for #JACR chat. Must go eat that left-over breakfast pizza w/white sauce, broccoli,



ElinSilveous kale, micro-greens and fresh hops flowers. :) Enjoy.Thu Jul 25 9:33:38 PDT 2013

Boundroid @sdbromd #jacr what role, if any, do medical boards play in managing the behavior? #jacrThu Jul 25 9:33:38 PDT 2013

KristinaHoque RT @TirathPatelMD: T2 managing disruptive behavior requires leaders to educate, but not demean, the disruptor about their actions #JACR #hc…Thu Jul 25 9:33:51 PDT 2013

Radsdoc82 @ruthcarlosmd need to consider that many physician role models on tv are heroes for displaying disruptive behavior, like dr house #jacrThu Jul 25 9:33:55 PDT 2013

NatriceR #jacr many great ideas from all participants, grateful - actual exp in workplace very hard to change - glad topic being discussedThu Jul 25 9:33:58 PDT 2013

CincyKidsRad RT @TirathPatelMD: T2 managing disruptive behavior requires leaders to educate, but not demean, the disruptor about their actions #JACR #hc…Thu Jul 25 9:34:05 PDT 2013

NatriceR RT @bjh41647: ...but how to negate defensive behavior? almost always the response in my experience #jacrThu Jul 25 9:34:11 PDT 2013

PracticalWisdom I would hope they would not have to address it. T2: How do patients address disruptive behavior? What is their role in the process? #jacrThu Jul 25 9:34:41 PDT 2013

MarilynGoskeMD I was surposed that 17% of American are depressed. MD slightly less #jacrThu Jul 25 9:34:52 PDT 2013

KristinaHoque @Jim_Rawson_MD agree! Lets make this a constructive process! #jacrThu Jul 25 9:34:55 PDT 2013

Jim_Rawson_MD T2 #jacr When additional training fails to bring someone into acceptable behavior, they are no longer a good fit fit the organization.Thu Jul 25 9:34:59 PDT 2013

NatriceR @PracticalWisdom precisely #jacrThu Jul 25 9:35:11 PDT 2013

PracticalWisdom RT @Jim_Rawson_MD: T2 #jacr When additional training fails to bring someone into acceptable behavior, they are no longer a good fit fit the…



Thu Jul 25 9:35:13 PDT 2013

DrRKSingal Interesting discn going on at #JACR on disruptive behaviour in #healthcareenvironment. #hcsm #meded #hcsmca ++Interesting perspectivesThu Jul 25 9:36:02 PDT 2013

bjh41647 @ruth - House is a great example of misleading the public about what being a good physician means - he'd have been fired day 1 #jacrThu Jul 25 9:36:03 PDT 2013

wilsonjoshm T1 #jacr disruptive isn't inherently bad, can be positive disruptions with aim to improve care, presented at wrong time/way can be dangerousThu Jul 25 9:36:05 PDT 2013

NatriceR MT @KristinaHoque: T2 managing disruptive behavior requires leaders to educate but not demean the disruptor about their actions #JACR #hcldrThu Jul 25 9:36:05 PDT 2013

sdbromd @Jim_Rawson_MD #jacr agreed. put into place a supportive process, but if not effective, termination or retirement may be necessary.Thu Jul 25 9:36:06 PDT 2013

Colin_Hung T2: Quote Dr. Gerald Hickson "The key to dealing with disruptive behavior is to talk ABOUT each other not AT each other". #JACR @VUMCHealthThu Jul 25 9:36:13 PDT 2013

PracticalWisdom MT @Jim_Rawson_MD When additional training fails to bring someone into acceptable behavior= no longer a good fit fit the organization. #jacrThu Jul 25 9:36:15 PDT 2013

DrGMcGinty RT @Jim_Rawson_MD: T2 #jacr When someone cannot manage their own disruptive behavior, get them additional training/ coaching.Thu Jul 25 9:36:25 PDT 2013

NatriceR RT @KristinaHoque: @Jim_Rawson_MD agree! Lets make this a constructive process! #jacrThu Jul 25 9:36:33 PDT 2013

MarilynGoskeMD Sometime underlying mental illness needs to be addressed before MD can be successful in workplace #jacrThu Jul 25 9:36:36 PDT 2013

Radsdoc82 @Jim_Rawson_MD prob not a good fit elsewhere either. What responsibility do we all have being in the same profession? #jacrThu Jul 25 9:37:00 PDT 2013

@PracticalWisdom Patients see different kind of disruptive behavior, passivity that



ruthcarlosmd interferes w/ the care process rather than active.#JACRThu Jul 25 9:37:16 PDT 2013

Colin_Hung RT @Jim_Rawson_MD: T2 #jacr When someone cannot manage their own disruptive behavior, get them additional training/ coaching.Thu Jul 25 9:37:25 PDT 2013

nursefriendly @wilsonjoshm #jacr if you define #disruptive as simply interrupting the #StatusQuo, it can be extremely beneficial :)Thu Jul 25 9:37:29 PDT 2013

NatriceR RT @MarilynGoskeMD: Sometime underlying mental illness needs to be addressed before MD can be successful in workplace #jacrThu Jul 25 9:37:47 PDT 2013

PracticalWisdom It's concerning how many patients/colleagues can be impacted by 1 person who is displaying disruptive behavior @Jim_Rawson_MD #jacrThu Jul 25 9:37:50 PDT 2013

ruthcarlosmd RT @wilsonjoshm: T1 #jacr disruptive isn't inherently bad, can be positive disruptions with aim to improve care, presented at wrong time/wa…Thu Jul 25 9:37:53 PDT 2013

NatriceR RT @nursefriendly: @wilsonjoshm #jacr if you define #disruptive as simply interrupting the #StatusQuo, it can be extremely beneficial :)Thu Jul 25 9:38:05 PDT 2013

NatriceR @nursefriendly @wilsonjoshm hello Andrew;) #jacrThu Jul 25 9:38:19 PDT 2013

MarilynGoskeMD We have not talked about disruptive behavior and how to manage in trainees #jacrThu Jul 25 9:38:21 PDT 2013

NatriceR @PracticalWisdom @Jim_Rawson_MD yes concerning - #jacrThu Jul 25 9:39:03 PDT 2013

NatriceR RT @MarilynGoskeMD: We have not talked about disruptive behavior and how to manage in trainees #jacrThu Jul 25 9:39:13 PDT 2013

CincyKidsRad .@MarilynGoskeMD probably should be a similar process for trainees as for faculty #jacrThu Jul 25 9:39:32 PDT 2013

RadiologyACR T3: How do we educate trainees and clinicians on recognizing and reacting appropriately to disruptive behavior? #JACR



Thu Jul 25 9:39:40 PDT 2013

brainbanker #JACR coaching needs to have clear shared goals, otherwise difficult to assess its effectivenessThu Jul 25 9:39:47 PDT 2013

PracticalWisdom Disruptive Behavior is like Pollution: It's Ugly and it spreads. Agree w/@Jim_Rawson_MD coach but sometimes we must let them go. #jacrThu Jul 25 9:40:02 PDT 2013

sdbromd @MarilynGoskeMD #jacr not so different. gentle firmness, clear expectations, offers of support, outside counseling, consequencesThu Jul 25 9:40:08 PDT 2013

DrGMcGinty RT @brainbanker: #JACR coaching needs to have clear shared goals, otherwise difficult to assess its effectivenessThu Jul 25 9:40:10 PDT 2013

DavidNaegerMD T2 Interesting thought: difficult to address issues in those above you AND below you in the "medicine hierarchy". #JACRThu Jul 25 9:40:20 PDT 2013

TirathPatelMD @nursefriendly @wilsonjoshm Even if the #DisruptiveBehavior has positive goals, the execution may have negative outcomes. #JACRThu Jul 25 9:40:32 PDT 2013

DrGMcGinty #jacr organizational culture can be influential and not always in a good wayThu Jul 25 9:40:35 PDT 2013

CincyKidsRad Harder part is trainees feeling comfortable enough to report faculty disruptive behavior. they may get the brunt of the disruption #jacrThu Jul 25 9:40:38 PDT 2013

NatriceR RT @RadiologyACR: T3: How do we educate trainees and clinicians on recognizing and reacting appropriately to disruptive behavior? #JACRThu Jul 25 9:40:45 PDT 2013

nursefriendly @ruthcarlosmd @wilsonjoshm #jacr Anyone can play #MondayMorningQuarterback, it takes conviction to go against the grain in the first place.Thu Jul 25 9:40:47 PDT 2013

NatriceR RT @brainbanker: #JACR coaching needs to have clear shared goals, otherwise difficult to assess its effectivenessThu Jul 25 9:40:59 PDT 2013

PracticalWisdom RT @RadiologyACR: T3: How do we educate trainees and clinicians on recognizing and reacting appropriately to disruptive behavior? #JACR



Thu Jul 25 9:41:01 PDT 2013

NatriceR RT @DavidNaegerMD: T2 Interesting thought: difficult to address issues in those above you AND below you in the "medicine hierarchy". #JACRThu Jul 25 9:41:11 PDT 2013

DavidNaegerMD @sdbromd @MarilynGoskeMD But still difficult to do! Especially if interpretative by the trainee as undeserved. #JACRThu Jul 25 9:41:19 PDT 2013

MarilynGoskeMD @CincyKidsRad I am not sure trainees and staff should be handled in the same manner #jacrThu Jul 25 9:41:20 PDT 2013

NatriceR RT @nursefriendly: @ruthcarlosmd @wilsonjoshm #jacr Anyone can play #MondayMorningQuarterback, it takes conviction to go against the grain …Thu Jul 25 9:41:21 PDT 2013

nursefriendly @TirathPatelMD @wilsonjoshm #jacr When interrupting the #StatusQuo, it a necessary evil in the quest for positive changeThu Jul 25 9:41:32 PDT 2013

sdbromd Dept wide town meetings where leader defines what behavior is and is not acceptable and describe mechanisms for reporting and managing #jacrThu Jul 25 9:41:33 PDT 2013

DavidNaegerMD Agreed! They cannot. RT @MarilynGoskeMD: @CincyKidsRad I am not sure trainees and staff should be handled in the same manner #jacrThu Jul 25 9:41:48 PDT 2013

sdbromd Institute into core component of dept. educational curriculum. I give a talk on it early every year to our new trainees. #jacrThu Jul 25 9:41:51 PDT 2013

NatriceR @CincyKidsRad t3 very true #jacrThu Jul 25 9:41:52 PDT 2013

CincyKidsRad @MarilynGoskeMD How should they differ? #jacrThu Jul 25 9:41:54 PDT 2013

ruthcarlosmd Thanks for joining @brainbanker! Valuable insight from someone with concrete experience on the topic. #JACRThu Jul 25 9:42:09 PDT 2013

Radsdoc82 @CincyKidsRad promote and stress the people who emphasize appropriate behaviors and exemplify ideal patient care #jacrThu Jul 25 9:42:11 PDT 2013



PracticalWisdom would you agree with me that positive Peer pressure not matter what level has the chance of making a difference? @DavidNaegerMD #jacrThu Jul 25 9:42:15 PDT 2013

NatriceR RT @ruthcarlosmd: Thanks for joining @brainbanker! Valuable insight from someone with concrete experience on the topic. #JACRThu Jul 25 9:42:43 PDT 2013

wilsonjoshm T2 #jacr @MarilynGoskeMD agree could be inherent @disruptor. Disruption seems 2 b manifest of underlying issue-could be personal or orgThu Jul 25 9:42:47 PDT 2013

nursefriendly @TirathPatelMD @wilsonjoshm A Corallary, 95% of new businesses fail within 3 years, so no point in trying? Same applies to disruption #jacrThu Jul 25 9:42:48 PDT 2013

DavidNaegerMD @MarilynGoskeMD @CincyKidsRad Indeed interactions with colleagues, trainees, and staff are each governed by different rules. #JACRThu Jul 25 9:42:48 PDT 2013

bjh41647 Peer pressure is critical; but many avoid getting involved - caring is key #jacrThu Jul 25 9:42:55 PDT 2013

NatriceR RT @bjh41647: Peer pressure is critical; but many avoid getting involved - caring is key #jacrThu Jul 25 9:43:41 PDT 2013

nursefriendly @wilsonjoshm @ruthcarlosmd #jacr At the moment there are so many horribly WRONG things in #healthcare, #disruptive change is a necessity.Thu Jul 25 9:43:56 PDT 2013

CincyKidsRad Mean that process 2 discuss and correct trainee behavior is similar to process used 4 faculty. Resources & people involved may b diff #jacrThu Jul 25 9:44:03 PDT 2013

DrRKSingal Yes and requires strong, credible respected leadership MT @sdbromd: Leader defines proper conduct.. mechanisms for reporting/managing #jacrThu Jul 25 9:44:12 PDT 2013

nursefriendly RT @PracticalWisdom: Suggestion: I feel more comfortable with using the words Disruptive Behavior vs Misbehaving people. #jacrThu Jul 25 9:44:27 PDT 2013

PracticalWisdom T3: Create Models to help MD's & other leaders within #radiology deal in a healthy manner with the stress=Healthy Culture. #jacrThu Jul 25 9:44:35 PDT 2013



sdbromd T3: Be present in dept. Check in with folks informally and formally. 360 reviews. Form relationships with all levels of personnel. #jacrThu Jul 25 9:44:49 PDT 2013

DavidNaegerMD @PracticalWisdom Absolutely 100%. I think org culture transcends and helps everyone. Addressing issues though handled differently, no? #JACRThu Jul 25 9:44:53 PDT 2013

bjh41647 change is critical, agreed; disruption is necessary; being disruptive is the wrong way to go about it #jacrThu Jul 25 9:44:57 PDT 2013

nursefriendly @PracticalWisdom #jacr It is a given that #disruptive behaviors are often labeled as misbehaving, and much much worse to maintain #statusquoThu Jul 25 9:45:09 PDT 2013

TirathPatelMD T3 Creating and Making all parties aware of proper organizational channels to deal with disruptive behavior... #jacrThu Jul 25 9:45:16 PDT 2013

DrGMcGinty #jacr we can learn a lot from the corporate world where performance evaluation is a givenThu Jul 25 9:45:38 PDT 2013

MarilynGoskeMD How do educate in recognizing disruptive behavior ? Discussed in med school as part of curriculum on substance abuse, harrassmnet. #jacrThu Jul 25 9:45:52 PDT 2013

sdbromd @bjh41647 #jacr disrupting status quo indeed positive - but thru team work building trust, cohesion, not divisionThu Jul 25 9:45:58 PDT 2013

nursefriendly @bjh41647 #jacr The #fear of retribution for #whistleblowing is real, palpable and keep many from reporting unsafe, #unethical practices.Thu Jul 25 9:46:19 PDT 2013

TravelNursingHQ RT @PracticalWisdom: Suggestion: I feel more comfortable with using the words Disruptive Behavior vs Misbehaving people. #jacrThu Jul 25 9:46:28 PDT 2013

PracticalWisdom I have used this article provided for us as the source of definition of D. Behavior: http://t.co/dmBN5E1SAE Great Ink! #jacrThu Jul 25 9:46:38 PDT 2013

TirathPatelMD T3 ... And having appropriate grievance policies for the disruptor in question. #JACRThu Jul 25 9:46:45 PDT 2013



NatriceR RT @DrGMcGinty: #jacr we can learn a lot from the corporate world where performance evaluation is a givenThu Jul 25 9:47:01 PDT 2013

nursefriendly Reporting in what context? RT @CincyKidsRad: T2: In a sense, reporting disruptive behavior is similar to peer review. #jacrThu Jul 25 9:47:14 PDT 2013

Jim_Rawson_MD T3 We use problem based learning (PBL) to teach about disruptive behavior and professionalism #jacrThu Jul 25 9:47:14 PDT 2013

Radsdoc82 @PracticalWisdom @DavidNaegerMD every interaction with a trainee is an opportunity to teach good behaviors #jacrThu Jul 25 9:47:16 PDT 2013

NatriceR RT @nursefriendly: @wilsonjoshm @ruthcarlosmd #jacr At the moment there are so many horribly WRONG things in #healthcare, #disruptive chang…Thu Jul 25 9:47:28 PDT 2013

PracticalWisdom RT @Jim_Rawson_MD: T3 We use problem based learning (PBL) to teach about disruptive behavior and professionalism #jacrThu Jul 25 9:47:44 PDT 2013

nursefriendly Zerotolerance if unenforced is a joke RT @NatriceR: @CincyKidsRad zero tolerance while in many places still doesn't solve the problems #jacrThu Jul 25 9:47:49 PDT 2013

CincyKidsRad @nursefriendly Reporting disruptive behavior. Fear of retaliation is real for some people. #jacrThu Jul 25 9:47:58 PDT 2013

sdbromd @Jim_Rawson_MD #jacr excellent format, worth writing up and disseminatingThu Jul 25 9:48:07 PDT 2013

PracticalWisdom How often? RT @Jim_Rawson_MD T3 We use problem based learning (PBL) to teach about disruptive behavior and professionalism #jacrThu Jul 25 9:48:21 PDT 2013

nursefriendly @NatriceR @CincyKidsRad #Bullying in #healthcare for instance, is prevalent, culturally accepted and basically ignored by all. #jacrThu Jul 25 9:48:28 PDT 2013

MarilynGoskeMD Younger MD training clinical scenarios as part of OSCE in some schools. More formal training ind defining behavior and reacting #jacrThu Jul 25 9:48:32 PDT 2013



nursefriendly #Bullying case in point RT @DavidNaegerMD: T2 Big challenge. Misbehaving people are the scariest to report - most likely to retaliate. #JACRThu Jul 25 9:49:01 PDT 2013

NatriceR RT @CincyKidsRad: @nursefriendly Reporting disruptive behavior. Fear of retaliation is real for some people. #jacrThu Jul 25 9:50:21 PDT 2013

PracticalWisdom Spot On! RT @Radsdoc82 @PracticalWisdom @DavidNaegerMD every interaction with a trainee is an opportunity to teach good behaviors #jacrThu Jul 25 9:50:42 PDT 2013

sdbromd @CincyKidsRad @nursefriendly #jacr many hospitals have offices of clinician support - this may be a good option to start.Thu Jul 25 9:51:03 PDT 2013

taggcleanhands RT @nursefriendly: @wilsonjoshm @ruthcarlosmd #jacr At the moment there are so many horribly WRONG things in #healthcare, #disruptive chang…Thu Jul 25 9:51:25 PDT 2013

RadiologyACR RT @Radsdoc82: @PracticalWisdom @DavidNaegerMD every interaction with a trainee is an opportunity to teach good behaviors #jacrThu Jul 25 9:51:28 PDT 2013

MattHawkinsMD Disappointed to just now be joining. #JACR Out of my hands...Thu Jul 25 9:51:29 PDT 2013

nursefriendly @CincyKidsRad #jacr The fear is real for 99.9% of people with jobs, careers, families to feed. http://t.co/FjMTnHjlP8Thu Jul 25 9:51:30 PDT 2013

ruthcarlosmd @CincyKidsRad Need to empower trainees but also provide org channels to maintain confidentiality of the trainee and the disruptor. #JACRThu Jul 25 9:51:51 PDT 2013

NatriceR RT @nursefriendly: @CincyKidsRad #jacr The fear is real for 99.9% of people with jobs, careers, families to feed. http://t.co/7yIssXTYoCThu Jul 25 9:52:04 PDT 2013

DavidNaegerMD Perfection. Nothing better than prevention! RT @Jim_Rawson_MD: T3 We use problem based learning (PBL) to teach abt disruptive behavior #jacrThu Jul 25 9:52:13 PDT 2013

nursefriendly @sdbromd @CincyKidsRad #jacr My fear is that many "complaints" "concerns" "Grievances" end up in the #CircularFile - ignored ;(Thu Jul 25 9:52:26 PDT 2013



PracticalWisdom We accept you as U are=If appropriate Expect you to be the best u can be MT @sdbromd Form relationships with all levels of personnel. #jacrThu Jul 25 9:52:32 PDT 2013

NatriceR RT @sdbromd: @CincyKidsRad @nursefriendly #jacr many hospitals have offices of clinician support - this may be a good option to start.Thu Jul 25 9:52:34 PDT 2013

nursefriendly @sdbromd @CincyKidsRad #jacr #CorporateCompliance #Policies are lovely for SHOW, but rarely have any teeth or real function in changesThu Jul 25 9:53:28 PDT 2013

CincyKidsRad @nursefriendly Department chairs should take complaints about disruptive behavior seriously, not place them in the garbage #jacrThu Jul 25 9:53:33 PDT 2013

TirathPatelMD .@MarilynGoskeMD Agreed. Engage and mandate 'active' learning of trainees, and this requires more than web modules or tests. #JACR #MedEdThu Jul 25 9:53:42 PDT 2013

bjh41647 before we end, I want to thank Drs. Carlos, Goske, and Brown for all their efforts -terrific success with many more to come #jacrThu Jul 25 9:53:42 PDT 2013

sdbromd @nursefriendly @CincyKidsRad #jacr you are defining an unhealthy professional culture.Thu Jul 25 9:53:43 PDT 2013

EOLCaregiver RT @nursefriendly: @wilsonjoshm @ruthcarlosmd #jacr At the moment there are so many horribly WRONG things in #healthcare, #disruptive chang…Thu Jul 25 9:53:45 PDT 2013

MarilynGoskeMD Need formal training..at least emphasizes that good behavior is a value of the department/health system #jacrThu Jul 25 9:54:16 PDT 2013

tarheelrad T3: Integrate knowledge of disruptive behaviors into team training sessions #jacrThu Jul 25 9:54:17 PDT 2013

NatriceR RT @nursefriendly: @sdbromd @CincyKidsRad #jacr #CorporateCompliance#Policies are lovely for SHOW, but rarely have any teeth or real funct…Thu Jul 25 9:54:38 PDT 2013

MattHawkinsMD It has probably already been said -- but nothing replaces role modeling. No more impactful way to learn/teach. #JACRThu Jul 25 9:54:51 PDT 2013



Radsdoc82 RT @tarheelrad: T3: Integrate knowledge of disruptive behaviors into team training sessions #jacrThu Jul 25 9:54:52 PDT 2013

ruthcarlosmd Time for closing thoughts...#JACRThu Jul 25 9:54:59 PDT 2013

CincyKidsRad RT @MattHawkinsMD: It has probably already been said -- but nothing replaces role modeling. No more impactful way to learn/teach. #JACRThu Jul 25 9:55:02 PDT 2013

nursefriendly @PracticalWisdom @Radsdoc82 @DavidNaegerMD Yet, #Trainees are often #bullied, #disrepected, made to feel two inches tall by "Mentors" #jacrThu Jul 25 9:55:06 PDT 2013

wilsonjoshm T2 #JACR @sdbromd #OzPreventionLbCure Pos Org culture enables communication, pre-empt some disruptive behaviour?Thu Jul 25 9:55:12 PDT 2013

NatriceR RT @MattHawkinsMD: It has probably already been said -- but nothing replaces role modeling. No more impactful way to learn/teach. #JACRThu Jul 25 9:55:22 PDT 2013

RadiologyACR Thanks for joining us for our first #JACR tweet chat. Any last thoughts on the topic?Thu Jul 25 9:55:37 PDT 2013

TirathPatelMD RT @MattHawkinsMD: It has probably already been said -- but nothing replaces role modeling. No more impactful way to learn/teach. #JACRThu Jul 25 9:55:38 PDT 2013

MattHawkinsMD RT @NatriceR: RT @nursefriendly: @CincyKidsRad #jacr The fear is real for 99.9% of people with jobs, careers, families to feed. http://t.co…Thu Jul 25 9:55:44 PDT 2013

NatriceR RT @Radsdoc82: T3: Integrate knowledge of disruptive behaviors into team training sessions #jacrThu Jul 25 9:55:47 PDT 2013

MattHawkinsMD RT @Radsdoc82: @PracticalWisdom @DavidNaegerMD every interaction with a trainee is an opportunity to teach good behaviors #jacrThu Jul 25 9:55:53 PDT 2013

MarilynGoskeMD Again in formal training provide insight into underlying mental health issues #jacrThu Jul 25 9:55:54 PDT 2013

@PracticalWisdom @Radsdoc82 @DavidNaegerMD #jacr In same thought, #medicalerrors are "learning opportunities" yet used punitively :(



nursefriendly Thu Jul 25 9:55:55 PDT 2013

CincyKidsRad @MattHawkinsMD Role modeling can be both postive and neegative #jacrThu Jul 25 9:55:56 PDT 2013

PracticalWisdom Thanks for this important chat. Tweet Chats take lots of preparation and Hard work. cc: @Jim_Rawson_MD @ruthcarlosmd @MattHawkinsMD #jacrThu Jul 25 9:56:17 PDT 2013

ruthcarlosmd CT: Safety first. All responses to disruptive behavior must come from that position. #JACRThu Jul 25 9:56:28 PDT 2013

PracticalWisdom RT @MattHawkinsMD: It has probably already been said -- but nothing replaces role modeling. No more impactful way to learn/teach. #JACRThu Jul 25 9:56:41 PDT 2013

tarheelrad RT @ruthcarlosmd: CT: Safety first. All responses to disruptive behavior must come from that position. #JACRThu Jul 25 9:56:48 PDT 2013

NatriceR #jacr enjoyed meeting you all and listening in on great insight/ideas, thank u for invite @ruthcarlosmdThu Jul 25 9:56:52 PDT 2013

PracticalWisdom RT @ruthcarlosmd: CT: Safety first. All responses to disruptive behavior must come from that position. #JACRThu Jul 25 9:56:55 PDT 2013

Jim_Rawson_MD @PracticalWisdom #jacr we have 3-4 PBL sessions each fall on professionalism.Thu Jul 25 9:56:56 PDT 2013

nursefriendly @PracticalWisdom @Radsdoc82 @DavidNaegerMD #jacr Many #medicationerrors#medicalmistakes go unreported out of #FEAR of retribution :(Thu Jul 25 9:57:02 PDT 2013

TirathPatelMD RT @ruthcarlosmd: CT: Safety first. All responses to disruptive behavior must come from that position. #JACRThu Jul 25 9:57:05 PDT 2013

PracticalWisdom RT @Jim_Rawson_MD: @PracticalWisdom #jacr we have 3-4 PBL sessions each fall on professionalism.Thu Jul 25 9:57:19 PDT 2013

T3 We had a Grand Rounds on Disruptive Behavior. Also review relevant policies in Faculty and Resident meetings #jacr



Jim_Rawson_MD Thu Jul 25 9:57:20 PDT 2013

tarheelrad RT @DrGMcGinty: #jacr we can learn a lot from the corporate world where performance evaluation is a givenThu Jul 25 9:57:35 PDT 2013

CincyKidsRad Culture of reporting is important. Must be allowed to report without retribution #jacrThu Jul 25 9:57:43 PDT 2013

MattHawkinsMD @PracticalWisdom Thanks to you and other thought-leaders for joining us. Very meaningful... #JACRThu Jul 25 9:57:51 PDT 2013

AllisonTitcomb Check out this definition of #burnout. Sad how many fit... How can we turn it around? http://t.co/UE8q9jbJ43 #jacr tip @PracticalWisdomThu Jul 25 9:57:54 PDT 2013

RadiologyACR RT @ruthcarlosmd: CT: Safety first. All responses to disruptive behavior must come from that position. #JACRThu Jul 25 9:57:55 PDT 2013

NatriceR RT @nursefriendly: @CincyKidsRad #jacr The fear is real for 99.9% of people with jobs, careers, families to feed. http://t.co/FjMTnHjlP8Thu Jul 25 9:58:01 PDT 2013

nursefriendly @sdbromd @CincyKidsRad #jacr I am describing the professional culture which exists in most major hospitals today :(Thu Jul 25 9:58:01 PDT 2013

MarilynGoskeMD Thanks all for thoughtful comments and reactions to paper and others comments. Tweetchat raised my awareness of this important issue #jacrThu Jul 25 9:58:03 PDT 2013

PracticalWisdom So this is a continuos process. One going discussions MT @Jim_Rawson_MD we have 3-4 PBL sessions each fall on professionalism. #jacrThu Jul 25 9:58:21 PDT 2013

DavidNaegerMD Wow. A great model for setting dept culture. RT @Jim_Rawson_MD: T3 We had a Grand Rounds on Disruptive Behavior. Also review dept mtg #jacrThu Jul 25 9:58:22 PDT 2013

NatriceR RT @nursefriendly: @PracticalWisdom @Radsdoc82 @DavidNaegerMD #jacr In same thought, #medicalerrors are "learning opportunities" yet used p…Thu Jul 25 9:58:26 PDT 2013

@ruthcarlosmd When is the next #JACR tweetchat? What is the topic?



MattHawkinsMD Thu Jul 25 9:58:33 PDT 2013

NatriceR RT @nursefriendly: @PracticalWisdom @Radsdoc82 @DavidNaegerMD #jacr Many #medicationerrors #medicalmistakes go unreported out of #FEAR of r…Thu Jul 25 9:58:35 PDT 2013

NatriceR RT @MattHawkinsMD: @PracticalWisdom Thanks to you and other thought-leaders for joining us. Very meaningful... #JACRThu Jul 25 9:58:43 PDT 2013

nursefriendly @sdbromd @CincyKidsRad #jacr #doctors #bully other #doctors #nurses #patients#families - yes, it is very unhealthy.Thu Jul 25 9:58:49 PDT 2013

NatriceR RT @AllisonTitcomb: Check out this definition of #burnout. Sad how many fit... How can we turn it around? http://t.co/UE8q9jbJ43 #jacr tip …Thu Jul 25 9:58:51 PDT 2013

sdbromd Thank you for including me in this wonderful conversation #jacrThu Jul 25 9:58:57 PDT 2013

NatriceR RT @MattHawkinsMD: @ruthcarlosmd When is the next #JACR tweetchat? What is the topic?Thu Jul 25 9:59:13 PDT 2013

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#jacr transcript › pb...ruthcarlosmd thu jul 25 9:05:40 pdt 2013 natricer rt @davidnaegermd: happy...

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