MGMA Insights: Managing Disruptive Physician Behavior with Dr. Christopher Kodama
Download MP3Hi, everyone. Daniel Williams here with the MGMA podcast. Today, we're tackling a topic that keeps a lot of practice leaders up at night, disruptive physician behavior. We have the right person here, an expert on this topic, doctor Christopher Kadama. He's an MD, an MBA, a former company CEO, and now founder of Everspark.
Daniel Williams:And also, doctor Kadama is going to be speaking at our MGMA Leaders Conference this fall in Orlando, and we're really excited about that. So, doctor Kadama, first of all, welcome to the show.
Dr. Christopher Kodama:Danielle, it's a pleasure to be here. Thank you so much for having me on.
Daniel Williams:Yeah. So let's first start by getting to know you a little bit better. As I mentioned, some of our listeners may be able to meet you in person in Orlando coming up here in the fall. But, for those who might not, or just are interested in who you are, tell us a little bit about your healthcare background, some highlights there you might want to share.
Dr. Christopher Kodama:Sure. I am a pediatric hospitalist by background, and my attraction to pediatrics originally was really spawned through a passion around advocating for others, populations that don't necessarily have the voice or agency to do so themselves. And that's what attracted me to pediatrics ultimately. What I found is that I was gravitating more towards a complex more complex level of care for that patient population. And in retrospect, I believe it had to do with the fact that I really enjoy creating clarity out of chaos and putting my interests around how to connect seemingly disparate dots into a comprehensive cohesive plan.
Dr. Christopher Kodama:And hospitalist medicine is essentially encompasses a lot of those interests. On any given day, you may be juggling a variety of inputs from specialists, parents and caregivers, care managers, nurses, etcetera, the patient if they're old enough to participate. And then you have to weave that together into a plan that everybody can get behind and operate off of. And so as a result of that, I through circumstances, the opportunity to step into an administrative role presented itself. And what I found in that work was it was very much the same skill sets in some regards or foundational skills and ultimately ended up pursuing a career in executive management, went back to business school, as you noted earlier, so that I could enhance my fluency and understanding of concepts to better collaborate with my nonphysician business colleagues.
Dr. Christopher Kodama:Through the course of that work, every now and then you would come across these quote, unquote HR situations. And you mentioned very graciously that I'm an expert in this topic. I don't know that anybody truly aspires to be an expert, and I'm not sure that I am one. It's a constant learning journey. But oftentimes, these things come up from time to time, and they range in degree of severity and intensity.
Dr. Christopher Kodama:And with time, repetition, intention, learning from failures, that's what gets me here today to this conversation so that if there's anything that I can share with either audience members on the podcast or at the leaders conference later this year that helps make their lives a little easier or accelerates the learning curve for them, I'm happy to do it because I wish I had those types of resources and more intentional guidance. I will say, just as a quick caveat, disruptive behavior is disruptive behavior, whether you've got an MD or a DO after your name or not. So some of this practice also incorporates managing nonphysician disruptive behavior as well. I do believe, however, for a variety of reasons, we do look at physicians differently in the workplace, particularly when it comes to matters such as perhaps perceived 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 a physician or particularly comfortable in this area.
Daniel Williams:Yeah. Thank you for sharing that. So we're gonna get deep into this topic of disruptive physician and just disruptive, perhaps, employee as well. First, though, you are currently with Everspark. Talk about that organization just so we have an idea of what Everspark does.
Daniel Williams:Sure. So about a year and a
Dr. Christopher Kodama:half ago, almost two years now that I think about it, I decided it was time to strike out on my own and learn and grow in a different way than I had within a large corporate environment. And over the course of my clinical and administrative career, I've always been a bit of a generalist, touching a lot of different things, which speaks to another interest of mine, which is lifelong learning. Independent consulting, which is what Spark is, was a vehicle for me to be able to exercise those skills, share them with others, and continue to learn in a different way. What I do ranges from working with organizations to help them hone in on strategic plans. One of the areas that I'm particularly passionate about is transforming those plans and ideas into action.
Dr. Christopher Kodama:So I work on a fair amount of implementation activity as well as optimizing existing processes. And then public speaking and group facilitation. Those are the grand tour of things that I do at Everspark.
Daniel Williams: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.
Daniel Williams:It can mean a lot of things. So in 2025, as you are, I called you an expert, maybe you're someone who studies this topic who offers advice about this topic. With that in mind, just define what, disruptive physician means in 2025.
Dr. Christopher Kodama:Sure. I typically look at the broad definition of disruption. And what was interesting when I first started doing this work is there's a fair amount of resource and general guidance through the American Medical Association on this very topic. In the beginning, I didn't realize that, so I was operating in a vacuum off of my own definitions. Over time, it appears that there's actually quite a bit of overlap between how I define disruptive physician behavior and how the AMA defines it through their work.
Dr. Christopher Kodama:And in essence, disruptive behavior is any conduct in the workplace that distracts others to the extent that it interferes with their ability to do their job optimally. And one of the nuances I was alluding to earlier, Daniel, about sometimes the stakes are a little bit more specific when physicians are the ones exhibiting the disruptive behavior. The impacting others' ability to do their job optimally begins to move into the areas of patient safety and quality, which is why I think this is such an important topic for us to collectively understand and lean into with grace and fairness and respect rather than taking the easier path sometimes, which is to turn a blind eye.
Daniel Williams:Let's talk about some of those first signals then. If someone were to walk into a practice or a service line that's having some issues, what is the disruptive dynamic? What culturally, what does it look like? What is going on in the hallways? The maybe data points show up.
Daniel Williams:What else is going on there that someone could go, okay. I see it.
Dr. Christopher Kodama:So based on my experience, I would say it's something this might sound a little hokey, but you can sense. It's almost like a dark aura that's hovering over the environment. And the way that it tends to manifest in my experience has been when you are encountering staff that are pretty cynical, seemingly burnt out, disengaged, disengaged, meaning things like barely doing their job or resenting when they're asked to do something, even if it is within their scope of practice or job. What you'll find is a very polished exterior with a lot of chaos underneath. So people who are putting on the brave face because they believe that's what they need to do for the benefit of their colleagues and their patients.
Dr. Christopher Kodama:A lot of times, single word answers to questions like how are things going today? Oh, it's fine. Everything's fine. It's almost as though these folks have been so used in more dramatic instances of disruptive behavior if it's chronic and indolent. It's as though these people have figured out ways to cope and rationalize almost in an abusive situation.
Dr. Christopher Kodama:I don't know that there's any magical hallmark of this other than you're more likely to sense it. And then asking probative questions and learning over time has been helpful for me because I think sometimes people are so used to suffering through this. They don't trust others or they've been told before that it would be taken care of and it wasn't. And so they're less likely to come forward initially. So it takes a bit of time to understand and learn the culture, what's acceptable and isn't.
Dr. Christopher Kodama:There's also oftentimes a signal when you watch how people interact with one another, how they treat the patients, how they talk to one another, those oftentimes are subtle cues that are more tangible that might give you an inkling that you need to dig a little deeper.
Daniel Williams:Okay. I wanna go back to the definition then again, maybe it may not encompass all disruptive behaviors, but is there a checklist? Is it verbal, physical, sexual, emotional? What's the checklist of behavior that fits into this category that
Dr. Christopher Kodama:would be termed disruptive? Absolutely. And it's all of the above that you listed, Daniel. It may be verbal abuse, talking disrespectfully to others, demeaning language. It may be physical, and there have been situations where I've had to intervene, where there are allegations that a physician has laid hands on another individual, thrown things in the OR is a very common frustration maneuver that will come up.
Dr. Christopher Kodama:There are nonverbal gestures, so that could be facial expressions, rolling your eyes. Obviously, there are a lot of other gestures that somebody can make nonverbally. And then there's more of a passive type of disruption, which is exclusion, blackballing somebody who spoke up or spoke out. Those tend to be the most common categories as I
Daniel Williams:see them. Thank you so much. One of the things I saw from your talk that you're gonna have in Orlando is something called the talk, having the talk. And as it's described here, many leaders dread that sit down in the moment, what language or stance keeps the discussion productive rather than punitive? So when you have to go have the talk with a disruptive individual, how do you get through that?
Daniel Williams:How do you approach it? Just walk us through some of that just so we get a better idea of how to navigate a very difficult situation.
Dr. Christopher Kodama:Sure. And I'm glad you started there, Daniel, because I think that's the natural inclination for all of us is to go straight to the what's that conversation gonna look like. In the framework that I'll review in greater detail at the conference, that is one of a handful of steps that I have found consistently. It's more likely to not only set the individual you're meeting with up for success to the extent that you have any control over that because they have a lot of say in how this goes down as well. It helps boost and promote a healthier culture.
Dr. Christopher Kodama:So some of the hallmarks that we were describing earlier, that's not a great sign that you've got a thriving practice or business. So how do you get at that? And these are watershed moments where you have the opportunity to do that. Initially, what I recommend highly is gather your facts and evaluate the situation because it's an allegation until proven otherwise. Yeah.
Dr. Christopher Kodama:And there may be more sides to this story than what you're being told. And that's a common pitfall I see people kind of somebody they're really busy. There are a million things they're dealing with. Somebody comes into the office. They make a complaint, and then there's this knee jerk reaction.
Dr. Christopher Kodama:So an email goes off or a quick phone call to somebody and you say knock it off, and there's really no conversation about it. And that can be equally damaging for reasons that I'll go into greater detail at another time, but understanding the facts and doing your due diligence is really important. The second thing even before the conversation that I recommend is understanding the dynamics in your practice. Who are the individuals and areas of your practice or outside your practice that are involved and to what degree? So there may be somebody who was directly the target of the disruptive behavior.
Dr. Christopher Kodama:Sometimes it's not targeted. Sometimes it's just exhibited behavior that's very distracting or disruptive to people, like expressing frustration, verbally shouting, those sorts of things, but it's not necessarily directed at any one individual. But understanding who's impacted by this and why. And everybody within the sphere of that physician is impacted in one way or another, but probably not the same. So there may be the people that are with this individual on a daily basis.
Dr. Christopher Kodama:They're gonna be impacted perhaps in a more intense way than those who are peripheral and don't have a lot of direct contact with the individual in question. However, the latter group still needs some attention because they're watching, they're listening, they're hearing the conversation at the water cooler, and they wanna see how this is gonna be handled. And the manner in which this is role modeled sets the tone for interactions that people have with one another when you're not around as a leader. And then that gets you ready for that conversation. And I like to plan ahead and have an outline.
Dr. Christopher Kodama:I also know that I don't like surprises, so I'd prefer that the individual I'm gonna be meeting with has an understanding of what we're gonna be talking about when we schedule the time to get together. In other words, avoiding the ambush tactic. There probably are some rare instances where that may be what's required, but I can't really think of off the top of my head. And I like to be succinct and focused. So going through a litany or a laundry list of specific infractions or grievances, I don't find that to be particularly helpful.
Dr. Christopher Kodama:What I try to do in preparation for that discussion is if there's a long list of those types of complaints is more often than not, there are general themes that are reflected across those different infractions. So looking for what the one or two primary theme is, it's like, you seem really angry, and you're taking it out on the staff. It's coming across in your patient interactions, those sorts of things rather than data this. Then capturing that in a way, I'm a big fan of the SBI feedback framework. So I prep this in advance, and I practice it before I go into the meeting.
Dr. Christopher Kodama:So a very succinct statement of a specific situation in which the disruptive behavior occurred, a statement of what the observed behavior was, and then a description of the impact that had on those that were involved. And I just roll through those. I can't think of a time when I've ever had to have more than three themes covered in a given interaction. And I will actually describe this in a brief letter so that there's documentation that the person can review after the conversation. Because sometimes they're in a bit of shock, and they're not gonna take everything in that they need to.
Dr. Christopher Kodama:So having that after you go through it together, so you have a script in a way. You also have some standardization and reliability in your approach and framework. And then there's also a document of what's going on that both parties can benefit from having as a reference, I believe. Okay. There's some nuances about what you put in that, what you don't.
Dr. Christopher Kodama:That's a conversation for whoever might be advising you from an HR perspective, but that's the general approach. And then finally, the fourth step really is about mitigating risk, following up with impacted parties, so on and so forth.
Daniel Williams:Yeah. For our last question, I really wanna take that a step further than that follow-up. So once an intervention is in motion, depending on the severity of what the disruptions were, there could literally be some PTSD or just people there is some trauma involved in how do they react? How do they are they simply keeping the peace now that the intervention has been done? Or how are they feeling?
Daniel Williams:So what are the measurables? Are there KPIs? Are there ways to follow-up with that team to see how they're doing? Not only how is that individual doing in their own behavior, but how is the team doing? How are they moving forward?
Daniel Williams:What can you share with us about that?
Dr. Christopher Kodama:Absolutely. I would say depending on the severity of the infraction, there may be a higher touch approach in certain circumstances. At a baseline, regardless of the situation, if not already being practiced, it's a good reminder to practice essentially leader rounding where you are spending time even when things are going fine and there aren't issues, but especially if you haven't been doing that and now you have this moment, using that as a platform to initiate the leader rounding, you will continue after things have abated. So standard questions like asking what's working well for people. Do they have the tools and resources they need to be successful in their jobs?
Dr. Christopher Kodama:What suggestions or feedback they might have for how the practice can continue to get better are standard leader rounding questions. Now to go in straight with those general questions after an instance like that may be a little tone deaf. So starting out with a little bit more of a targeted set of questions that generally adhere to that framework, like how things changed for you? Are you feeling a difference? Can you provide some examples of how things are different?
Dr. Christopher Kodama:Do you feel like you're getting the support that you need as we move through this chapter and set the tone for how we wanna move forward? And are there any other concerns or questions that you have for me? What I have found is that is important in those situations to be sensitive to that. But at some point, you're gonna know your constituency when it's time to move on because it starts to feel like beating a dead horse, especially in circumstances where the disruption was enough that an intervention was required, but not so much that you're just gonna dwell on this forever. There needs to be a growth mindset where people learn from those stakes and then move on and not dwell.
Daniel Williams:Okay. Alright. Doctor. Kadama, I wanna thank you for joining us on the MGMA podcast. It's a it's been
Dr. Christopher Kodama:a pleasure, Danielle. I really appreciate the opportunity to share some ideas and thoughts with the audience.
Daniel Williams:You've got it. And I cannot wait to meet you in person in Orlando. I'll be there at that session. Looking forward to that. And so everybody listening, I want to bring the information up again.
Daniel Williams:Doctor. Kadama will talk about this topic in much more detail in his session, Strategies for Managing Disruptive Physician Behavior. That's going to be October 1 at our MGMA Leaders Conference. It's going to be held in Orlando. I am going to put direct links to that, his session, and registration for that so you can be there and meet us in person in Orlando.
Daniel Williams:So until then, thank you so much everyone for listening to the MGMA podcast.
