“USER GUIDE” for Performance Improvement Plan and Other Approaches to Counseling Physicians

I.Purpose

Ochsner Health System supports the establishment and maintenance of physician performance and behavioral standards.Understandingand demonstratingappropriateprofessional behavior may vary, and good guidance with advice from physician leaders helps to promote exemplary performance. Separately there are policies and procedures, work rules and regulations, which serve our patients and reflect good group practice needs. Leadership is committed to ensuring that these standards, policies and procedures are communicated to physicians so they may be understood and implemented accurately, fairly and equitably.

While most physicians are never involved in situations requiring counseling about their behavior or sanctions, work-related problems and departures from acceptable behavior do occur.When such departures from acceptable actions and/or practice occur, it is in the best interest of Ochsner Health System, our patients and the group practice, that appropriate steps be taken to address and improve the conduct and/or behavior in question.

Since each occurrence will be evaluated on a case-by-case basis, each situation may require the use of some or all of the steps outlined below to assist with performance improvement. Alternatively, some situations may exist where none of these steps are warranted. For example, a physician who is not thriving in the group practice model may choose to leave by mutual consent, in which case it is not necessary to go through any of these steps. This guide is intended to assist the physician leader in fostering performance improvement and documenting those interactions. It is not intended as a template, or mandatory process, but simply as a model for setting expectations, outlining and supporting desired behavior and performance. Each plan and consequences will be carefully individualized.

II. Informal Counseling

A. The vast majority of performance/behavior interactions will be in the form of collegial discussion. The physician leader should outlinespecific, clearly identified concerns and examples of where and how they seemed to be manifest.The leader shouldremind the physician of the “Responsibilities of the Professional Staff” and provide the opportunityfor the physician to re-examine the document if the physician so requests. Subsequently, the physician leader will meet with the physicianregarding the physician’s perspective of appropriateprofessional behavior and how it relates to behavior sought by OHS. A plan of recommendations should be developed by the physician leader considering input from the physicianregarding the areas of concern andhow the physician believes he/she can best demonstrate concordance with the professional behaviors in question. Written notes should be made by the physician leader for her/his files regarding the dates, issues discussed, plan and follow-up.

B.Follow-up meetings should be held as often as necessary depending on the nature of the problem to address progress toward the identified goals and share perspectives as to how implementation is proceeding.Appropriate documentation should be added to the prior record.

Even after issues have initially improved, some ongoing monitoring should be continued to ensure no relapse occurs. A common time frame for reassessment would be approximately three (3) months, but may be much sooner, after the initial improvement. Documentation of reassessment should be added to the previous record of that situation. Follow-up meetings, as frequently as needed, should be arranged for as long as necessary.

C.In almost all situations, areas of concern will be resolved with this informal discussion. However, in the circumstances where significant improvementis not achieved, the record of informal exchanges will serve as important background and support for more robust review and possible intervention.

D. Some of these issues may be addressedin the annual or semi-annual physician review and goal setting as a part of the evaluation and discussion process. At other times, the matter may be best discussed in a separate meeting focused solely on the behavioral area of concern. If the topic is more serious, then a separate meeting would be preferable.

III. Written Action

A.A written communication with the physician may be more suitable when:

1.multiple informal (and documented) discussions have failed to satisfactorily resolve an issue, or

2.in situations where an event or its consequences were of significant gravity.

B. Two levels of written action may be considered.

1.Informalwritten communication may be used to reflect a higher degree of concern and a somewhat more formal response guidingprofessional behavior. The written communication should outline the areas of interest, how the issue or matter appears to be manifest, and may reflect back to earlier discussions, whether verbal or written. The degree of progress may be addressed, and restatedgoals may be included. A copy of the communiqué should be placed in the leader’s department file relating to that physician.

2.In the event that multiple verbal and/or written communications are issued to the physician and the leader feels that the next step will be the issuance of a Physician Performance Improvement Plan (PPIP), the leader should advise the physician that the next communication will be a PPIP. This will stress the seriousness of the matter as it should be noted that a finalized PPIP shall be placed in the physician’s employment file maintained in the Office of Professional Staff Services and will be obtainable by third parties under certain circumstances (i.e. subpoena).

3.Formal and official written communication in the form of a PPIP may be considered in those circumstances when informal verbal or written discussions are unsuccessful or inadequate to address the problem or the matter is of such gravity as to warrant a PPIP.

  1. It is recommended that the physician leader consult the appropriate AMD, Chair, and/or Regional Medical Director for advice and clarification of the issues and goals for resolution of concerns before a PPIP is drafted.
  1. A meeting with the physician will then be held to discuss the matter(s) and outline specific desired outcomes. The physician leader will ask the physician to review the PPIP draft. They shoulddialog about each area and plan of action, document a time frame within which to follow-up and assess progress and clarify potential consequences if insufficient improvement occurs. Revisions may be made to the PPIP at this time.

a.If the physician refuses to discuss the PPIP or agree to any sort of PPIP at this point, the matter should be immediately forwarded to the RMD.

  1. The physician leader, appropriateAMD, Chair, and/or Regional Medical Director will finalize the PPIP.
  1. The physician leader and the physician will meet to review the finalized PPIP. The physician will be asked to sign the PPIP only to document it has been received. A copy of the signed PPIP should be placed in the leader’s department file as well as the physician’s employment file which is kept in the Office of Professional Staff Services.If the physician refuses to sign the PPIP, the leader should make a notation on the PPIP that it was reviewed with the physician but he/she refused to sign.
  1. If the physician disagrees with any portion of the PPIP, s/he may request a review by the AMD and/or the RMD. This review should be requested, in writing, within 5 working days of the PPIP being provided, and the physician should statethe specific manner in which s/he disagrees with the facts surrounding the alleged deficiency(ies) and/or the expected improvement(s). (See attachment A to PPIP Form)

a.If the AMD and/or the RMD agree with the physician, the PPIP will not become effective and will not be placed in the physician’s employment file but should be kept in the leader’s department file with a notation that it was rescinded and the reasons therefor.

b.If the AMD and/or the RMDagree that the PPIP is appropriate, the physician may request a review by the Professional Affairs Committee (PAC). The PAC will review the matter as outlined in the Policy to Review Adherence to the Responsibilities of the Professional Staff policy. If the PAC agrees with the PPIP, the PAC decision is final.If the physician does not request a review by the PAC, the PPIP will become effective with the expectation that the physician will comply with all components and will be placed in the physician’s employment file.

  1. Follow-up meetings will be held as per the PPIP, and records kept of those meetings and progress toward resolution of the concerns outlined in that plan.
  2. Once the physician has achieved the necessary improvement(s), and the goals of the PPIP have been met, the leader will note this achievement in a memorandum that will be placed in the physician’s employment file.
  3. Even after issues have been initially improved, some ongoing monitoring should be continued. A common time frame for reassessment would be approximately three (3) months after the initial improvement, but may be modified depending on the circumstances. Documentation of reassessment should be added to the previous record of that situation.

C.In those circumstances where the concerns are not resolved with the PPIP process, further action may be undertaken by the CEO, the Regional Medical Director, Professional Affairs Committee, Credentials Committee, and/or Medical AdvisoryCommittee as appropriate and as outlined in the Policy to Review Adherence to the Responsibilities of the Professional Staff.

Appendix:

Performance Improvement Plan Form

OCHSNER HEALTH SYSTEM

Physician Performance Improvement Plan

______

(Date)

Dear Dr. ______:

It is the goal of Ochsner to provide exemplary patient care in an environment that is conducive to doing so. Aspects of your clinical practice and/or behavior are interfering with this critical objective. The goal of this Performance Improvement Plan is to assist you in making the changes necessary to accomplish our goal of exemplary patient care. This Plan will spell out the exact nature of the identified deficiencies or behavior, the necessary improvement, the timeframe for improvement, the consequences of inadequate improvement and how we will assist you in reaching this goal.

Please note that this document, once final, shall become part of the physician’s employment file.

The following clinical practice deficiencies or behavioral problems have been identified:

______

______

______

______

(If necessary, attach additional sheet entitled “Identified Deficiencies”)

PRIOR MEETINGS & DISCUSSIONS related to these issues have occurred on the following dates:

EXPECTED IMPROVEMENT

______

______

______(If necessary, attach additional sheet entitled “Expected Improvement”)

ASSISTANCE OFFERED for IMPROVEMENT

You will be assisted in attaining the desired improvement by means of the following

monitoring, education, training, coaching or feedback mechanisms:

______

______

______

______

______

(If necessary, attach additional sheet entitled “ Assistance Offered”)

Expected performance improvement will have been reached by: ______, 20___.

Department Chair and/or Section Head and physician will review together progress of physician toward achieving improved performance:

Weekly Every other week Other______

This notice is being given to you so that you will have an opportunity to correct the problem that has been discussed with you. Should you fail to correct the problem, further corrective action may be taken, which may include written warning, suspension, or discharge from employment. Failure to achieve expected improvement may result in:

______

______

______

______

Please note this document will become part of your employment file. If you request a review, we will suspend placing this document in your employment file, until such time as that review is complete. If you believe this Performance Improvement Plan is based upon incorrect factual information and/or has been implemented unfairly, you may request a review by your Associate Medical Director and/or your Regional Medical Director. This review should be requested, in writing, within 5 working days of the PPIP being implemented, and the physician should state the specific manner in which s/he disagrees with the facts surrounding the alleged deficiency(ies) and/or the expected improvement(s). Further review will be governed by the Policy to Review Adherence to the Responsibilities of the Professional Staff another copy of whichwillbe provided to you today if you so request.

The purpose of signing this document is to demonstrate thatthis document was reviewed with you. and = Your signature on this document does not mean that you agree with it.

______

Signature of PhysicianDate of Signature

I have met with the physician and personally discussed with him/her the subject matter of this report. The physician has been given a copy of this report.

______

Signature of Medical Director/Department Chair/Section Head Date of Meeting

REVIEW REQUEST

Date: ______

Comments and Discussion:

______

Signed: ______Name Printed: ______

ATTACHMENT A