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What I wish I’d known: How experienced physician managers diagnose, treat and prevent disruptive behaviour
  1. Christian Goodwin1,2,
  2. Susan Haas2,
  3. William Berry2
  1. 1 University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
  2. 2 Ariadne Labs, Boston, Massachusetts, USA
  1. Correspondence to Dr Susan Haas, Ariadne Labs, Boston, MA 02215, USA; shaas{at}


As health systems continue to consolidate at a rapid pace, many physicians are stepping into roles that involve managing other physicians. While more physicians are thrust into these positions each year, the managerial training they receive is highly variable and often insufficient for dealing with the challenges they will face, notably disruptive behaviour. Broadly defined, disruptive behaviour includes any actions that affect a team’s ability to effectively care for patients, and can even threaten patient and provider health. New physician managers--who typically have little prior experience in management roles--need specific supports to address this uniquely daunting challenge.

Over our management careers, we have spoken with dozens of new and experienced physician managers to understand how they manage disruptive behaviour in the workplace and to collect their advice for future physician managers. In this paper, we reflect on those conversations and distill them into a three-part approach for diagnosing, treating and preventing disruptive behaviour in the workplace. We describe how the right management approach depends on a thorough assessment of the most likely drivers of the disruptive behaviour. Second, we present strategies for treating the behaviour focusing on the physician leader’s communication skills and available institutional resources. Finally, we advocate for system-level changes that institutions or departments can implement both to prevent disruptive behaviour and to better prepare new managers to address it.

  • management
  • medical leadership
  • clinical leadership
  • behaviour
  • performance management

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  • Contributors WB and SH recorded their personal and observed experiences, as well as those colleagues had shared, over their combined 60-year careers. WB and SH edited and revised multiple drafts of the paper. CG wrote the first and all revised drafts, and submitted the paper. SH and WB are responsible for the overall content as guarantors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.