Independent Medical Reviewing for
Behaviour and Conduct Issues
My background in outbreak management and 30 years of experience in leadership roles at different levels has brought me experience in many problematic situations. My interest in this space has led me to develop deep expertise in unravelling these events, conducting high-integrity investigations, and producing tailored and sustainable recommendations.
As an experienced external reviewer,
I help health authorities to:
- Investigate medical matters and conflict with or between practitioners;
- Assess opportunities for improvement, resilience, and sustainability in patient-facing systems;
- Conduct systems reviews;
- Manage intractable or recurrent outbreak events;
- Assist organizations in moving beyond adverse events
- Explore patient safety and quality concerns; and
- Build research capacity.
Why work with an external reviewer?
- Ensure Neutrality and Impartiality
- Access Deep Expertise
- Augment Resources
- Manage Reputational Risk
When a Clinical Review Doesn’t Tell the Whole Story
If a physician’s practice is called into question, a clinical chart review may answer questions about whether diagnosis and treatment were appropriate and whether the standard of care was met. However, usually this is not the whole story, and broader aspects such as conduct, behaviour and communication need to be addressed to ensure a long-lasting solution.
As a lead reviewer, I support organizations in determining how best to conduct the investigation to produce an integrated solution to systems, behavioural, and clinical issues. This allows the clinical review to be managed as a component of an overarching process, giving better clarity about the foundational issues, and leading to stronger recommendations.
Most physicians who wind up in difficulties are intrinsically sound - few are “bad apples”. Systems issues – and a lack of understanding about how best to resolve them – often lead to frustration, creating dysfunction within a team. It can even become overwhelming, resulting in outright bad behaviour. Prompt intervention is usually the best option.
An Exacting Methodology
My approach starts by avoiding preconceptions. It uses deep listening and in-depth observation from first principles, and is informed by broad leadership experience in medicine, in the military, and as an expedition leader.
Every situation is different, and cultivating a deep understanding of the issues, dynamics, culture, and organizational pathology is foundational to developing the best approach.
This methodology has proven particularly effective in situations where conflict has been suppressed or allowed to simmer rather than being resolved, where imposed simplistic solutions have compounded deep seated problems, where lack of progress has led to hopelessness in the face of dysfunction, or where trust has become completely broken.
What to Expect
- Discovery and Initial Assessment
- Case Documentation Review
- Investigation with Affected Parties
- A Full Report with Recommendations
Case Aftercare
Most external reviews end with the presentation of a report and recommendations. I have long felt that this was a missed opportunity to build better from the sound and impartial foundation of a high-integrity external review. If the client desires, their package can include use of the WE-I instrument and individual or team coaching, to transfer the initiative back to the physician(s) involved and enable them to identify priorities and principles for navigating the professional landscape post-review.
An external review is usually commissioned in response to a situation which exceeds internal capacity or needs to be resolved more rapidly than can be achieved in-house, but the need for organizational healing doesn’t end with presentation of the report. Effective and tailored aftercare allows the key players to mindfully and smoothly transition to the post-review situation.