September 10, 2014 Physician Behaviour in the Professional Environment Online Survey Report and Analysis Introduction: The College s Physician Behaviour in the Professional Environment policy was released for external consultation between June 4th and August 5th, 2014. The purpose of this consultation was to obtain stakeholders feedback on the existing policy. In particular, to help determine how the policy can be improved in order to ensure it reflects current practice issues, embodies the values and duties of medical professionalism, and is consistent with the College s mandate to protect the public. Invitations to participate in the consultation were sent via email to a broad range of stakeholders, including the entire CPSO membership as well as key industry organizations. In addition, a general notice was posted on the College s website, Facebook page, and announced via Twitter. It was also published in Dialogue and Noteworthy (the College s public e-newsletter). Feedback was collected via regular mail, email, an online discussion forum, and an online survey. In accordance with the College s posting guidelines, all feedback received through the online discussion forum has been posted online. This report summarizes the stakeholder feedback that was received through the online survey. Caveats: 230 respondents started the survey (see Table 1). Of these, 69 respondents did not complete any of the substantive questions 1. These respondents were removed from the analysis below, leaving 161 respondents who either fully or partially completed the survey. 2 The results reproduced below capture the responses for both complete and partially complete surveys. 1 These respondents completed only the initial demographic or warm-up questions and provided an indication of their familiarity with the policy. 2 Respondents who partially completed the survey answered at least one, but not all of the substantive questions regarding the policy.
Table 1: Survey Status Summary of surveys received n=230 Complete or partially complete Incomplete 161 70% 69 30% The purpose of the online survey was to collect feedback from physicians, organizations, and the public regarding the Physician Behaviour in the Professional Environment policy. Participation in the survey was voluntary and one of a few ways in which feedback could be provided. As such, no attempt has been made to ensure that the sample is representative of the larger physician, organization or public populations, and no statistical analyses have been conducted. The quantitative data shown below are complete and the number of respondents who answered each question is provided. The qualitative data captured below are a summary of the general themes or ideas conveyed through the open-ended feedback. Respondent Profile: Nearly all survey respondents indicated that they were completing the survey on behalf of themselves (see Table 2). 2 respondents indicated that they were completing the survey on behalf of an organization. 3 Table 2: Respondents Are you completing this survey on behalf of yourself or an organization? n=161 Self 159 Organization 2 3 These included the Ontario Hospital Association and a public health unit. 2
As shown in Table 3 below, respondents were most likely to be physicians (50%) although members of the public were almost equally represented (40%). Table 3: Respondents (cont d) Are you a...? n=161 Physician 80 50% Other health care professional (e.g., nurse, pharmacist) 8 Organization staff (e.g. policy staff, registrar, senior staff) 4 2% Member of the public 64 40% Other 5 3% Experience with the Policy: A significant majority of respondents (83%) indicated that they had read the Physician Behaviour in the Professional Environment policy (see Table 4). Table 4: Read Policy Have you read the Physician Behaviour in the Professional Environment? n=161 Yes No 134 83% 27 17% Familiarity with the policy is modest with just over half (52%) of respondents reporting that they are either very (9%) or somewhat (43%) familiar with the policy (see Figure 1). Figure 1: Familiarity with Policy Familiarity 9% 43% 1 12% 17% Very familiar Somewhat familiar Neither familiar nor unfamiliar Somewhat unfamiliar Very unfamiliar Q. Before today, how familiar were you with the College s Physician Behaviour policy? n=161 3
Table 5: Turn to Policy Please tell us when you turn to this policy? (what questions or circumstances prompt you to look it up) I have never referred to this policy. I have referred to this policy when n=161 98 61% 63 39% Examples of when physician respondents refer to the policy include: after experiencing conflict with a colleague, following a complaint about their own behaviour, and in teaching and clinical supervision. Members of the public largely referred to the policy following a concern or negative experience with care they have received from a physician. Assessments of the Policy: Q1. We d like to understand whether the policy is clear. Please indicate whether you agree or disagree with each of the following statements regarding the clarity of the policy. As reported in Figure 2 below, the majority of respondents agreed 4 that the policy was easy to understand (6), clearly set out expectations for physicians (6), was well organized (70%), and clearly written (6). 4 The number of respondents reported to have agreed in each summary include both those who strongly agreed and those who somewhat agreed. Complete data are reported in the figures following each question. 4
Figure 2: The policy is easy to understand. 32% 36% 22% The policy clearly articulates expectations for physicians in terms of their behaviour. 33% 19% 9% The policy clearly articulates examples of disruptive behaviour. 34% 20% 9% The policy is clearly written. 36% 32% 24% It is clear when the policy applies. 27% 37% 21% 12% The policy is well organized. 24% Strongly agree Neither agree nor disagree Strongly disagree Base: n=161 Somewhat agree Somewhat disagree Note: Results < are not labelled. Open ended feedback regarding the clarity of the policy was received from 65 respondents. Representative suggestions for how the policy could be clarified include the following: Provide additional examples of disruptive behaviour; Clarify the definition of certain terms (such as bullying, inappropriate rudeness) and whether this policy applies to physician behaviour outside of the professional environment; Simplify the language to make the policy more accessible to the public; Place a greater emphasis on positive physician behaviour. Q2. We d like your thoughts on whether the policy is comprehensive. Please indicate whether you agree or disagree with each of the following statements regarding the comprehensiveness of the policy. 5
As reported in Figure 3 below, overall, the majority of respondents agreed that the expectations for physicians are reasonable (70%) and that it addresses all of the important issues relating to physician behaviour (51%). The policy was seen as most helpful to physicians (6 agreed) although most thought it helpful to the public as well (5 agreed). Figure 3: The expectations for physicians are reasonable. 40% 30% 14% 9% The policy addresses all of the important issues relating to 14% 37% 17% 1 13% The policy is helpful to physicians. 30% 1 7% 6% The policy is helpful to health system organizations (i.e. 27% 19% 6% 6% The policy is helpful to other members of the health care 2 32% 20% 7% The policy is helpful to the public. 22% 36% 20% 13% Strongly agree Neither agree nor disagree Strongly disagree Base: n=142 Somewhat agree Somewhat disagree Don't know Note: Results < not labelled. Open ended feedback regarding the comprehensiveness and helpfulness of the policy was received from 58 respondents. Respondents provided a number of suggestions for additional topics that should be addressed in the policy, including (but not limited to): Provide suggestions of concrete ways to address disruptive behaviour issues as they arise. Include references to additional resources such as hospital codes of conduct and applicable legislation (such as Violence and Harassment in the Workplace). Increase awareness of the existence of this policy to both physicians and the public. Clarify the existing examples and provide additional examples of disruptive behaviour. Q3. Thinking more generally about issues relating to the policy, please tell us whether you agree or disagree with each of the following statements. 6
Figure 4: For physicians to act in the best interest of patients; courteous, dignified and civil behaviour is required. 79% 12% Unprofessional physician behaviour can negatively impact the public's perception of the medical profession. Physicians must work respectfully and collaboratively with other members of the health care team in order to promote the safe and efficient delivery of health care. Unprofessional behaviour by an individual physician can compromise patient safety and negatively affect health outcomes. Base: n=136 Strongly agree Neither agree nor disagree Strongly disagree 83% 8 80% Somewhat agree Somewhat disagree Don't know 11% 12% Note: Results < not labelled. As reported in Figure 4, respondents were extremely supportive of these statements of professional behaviour. The open ended feedback included the following comments: I completely agree that unprofessional behaviour by physicians compromise the health of patients. Should there also be a patient s code of conduct? Physician behaviour outside of the health care environment should not be disciplined by the college. I think "courteous, dignified, and civil" elaborates "professional" very well. Is courteous, dignified, and civil the definition of professional? And if so who defines dignified and courteous? Those are subject to cultural and generational biases. 7
Open ended feedback regarding any additional comments was collected from 22 respondents. 5 Feedback included the following: The policy is not needed, it is common sense. Look forward to reading the revised policy. Disruptive behaviour must be better defined so that physicians are not left vulnerable to unfounded complaints. 5 Q19: If you have any additional comments that you have not yet provided, please provide them below, by email or through our online discussion forum. 8