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At least 235 records · Page 13Linked to original sources
PubMed2004

Characteristics associated with physician discipline: a case-control study.

BACKGROUND: There has been increasing attention devoted to patient safety. However, the focus has been on system improvements rather than individual physician performance issues. The purpose of this study was to determine if there is an association between certain physician characteristics and the likelihood of medical board-imposed discipline. METHODS: Unmatched, case-control study of 890 physicians disciplined by the Medical Board of California between July 1, 1998, and June 30, 2001, compared with 2981 randomly selected, nondisciplined controls. Odds ratios (ORs) were calculated for physician discipline with respect to age, sex, board certification, international medical school education, and specialty. RESULTS: Male sex (OR, 2.76; P<.001), lack of board certification (OR, 2.22; P<.001), increasing age (OR, 1.64; P<.001), and international medical school education (OR, 1.36; P<.001) were associated with an elevated risk for disciplinary action that included license revocation, practice suspension, probation, and public reprimand. The following specialties had an increased risk for discipline compared with internal medicine: family practice (OR, 1.68; P =.002); general practice (OR, 1.97, P =.001); obstetrics and gynecology (OR, 2.25; P<.001); and psychiatry (OR, 1.87; P<.001). Physicians in pediatrics (OR, 0.62; P =.001) and radiology (OR, 0.36; P<.001) were less likely to receive discipline compared with those in internal medicine. CONCLUSION: Certain physician characteristics and medical specialties are associated with an increased likelihood of discipline.

Adult↗
PubMedDate not supplied

Nonpunitive discipline. A method of reducing absenteeism.

Absenteeism affects healthcare by reducing the work force during a time of crisis in availability of skilled nursing care providers. An absent worker is a loss to the employer both financially and emotionally. By understanding and using the concept of nonpunitive discipline, nurse administrators can effectively reduce absenteeism and increase the availability of professional nursing resources.

Absenteeism↗
PubMed2005

The risk of disciplinary action by state medical boards against physicians prescribing opioids.

Concern of physicians about being disciplined for prescribing opioids for patients in pain is one cause for undertreatment of pain. This study was done to assess the actual risk of being disciplined by state medical boards. A review of records of actions by the New York State Board for Professional Medical Misconduct for 3 years and of all medical boards in the United States for 9 months was done to determine this risk. New York State, with 7.8% of U.S. physicians, had 10 physicians disciplined annually related to overprescribing opioids, while the total for the entire U.S. was 120 physicians annually. Most physicians disciplined had multiple violations in addition to overprescribing controlled substances. In the national sample, 43% were prescribing for themselves or for nonpatients, 12% prescribed for addicts without addressing the patients' problems of addiction, 42% had inadequate records, 19% prescribed without indication for opioids, 13% were incompetent in additional ways, and 8% were having sexual activity with patients. Not a single physician, for whom information was available, was disciplined solely for overprescribing opioids. The actual risk of an American physician being disciplined by a state medical board for treating a real patient with opioids for a painful medical condition is virtually nonexistent.

Drug Prescriptions↗
PubMedDate not supplied

The levers of influence.

Physicians often determine the demand for health care services, as well as control the clinical processes aimed at improving health outcomes at the individual and population level. Given their important role in enhancing health status and improving the health care delivery system, it is critical that physician executives master the tools necessary to positively influence physician behavior. But changing behavior is far more complex than "doing it or not doing it." The Nike slogan "just do it" is motivating, but over-simplified. The roots of human change include: consciousness-raising, emotional arousal, commitment, helping relationships, self-reevaluation, reward, and environmental control. A model to effectively influence behavior is presented and includes setting clear expectations, measuring and monitoring performance, providing feedback, and rewarding and recognizing improvement. If all else fails, try discipline. This five-step approach is based on the science of human behavior and working with physicians in diverse settings, ranging from academic medical centers to small practices.

Behavior↗
PubMed1998

Violations of the nurse practice act: implications for nurse managers.

Violations of nurse practice acts and disciplinary actions against RNs continue to increase. This study profiles the disciplined nurse, describes the prevalence of violations, and qualitatively examines the nurses' experiences with disciplinary action, as well as initiatives that guide nurse managers in addressing the ethical/legal dilemmas nurses face each day.

Adult↗
PubMed1996

Ethics, discipline and discharge.

Discipline in today's workplace focuses on a collegial "training that corrects, molds, strengthens or perfects." It requires self-discipline, which is possible only if each team member (1) knows the rules, (2) understands their purpose and (3) agrees that they deserve compliance. Only when all else fails is discharge justifiable--and then the burden of proof rests on the employer.

Employee Discipline↗
PubMed2004

Chiropractors disciplined by a state chiropractic board and a comparison with disciplined medical physicians.

OBJECTIVE: To determine categories of offense, experience, and gender of disciplined doctors of chiropractic (DC) in California and compare them with disciplined medical physicians in California. METHODS: Retrospective reviews of publicly available data from the California Board of Chiropractic Examiners. RESULTS: The DC disciplinary categories, in descending order, were fraud (44%), sexual boundary issues (22%), other offenses (13%), abuse of alcohol or drugs (10%), negligence or incompetence (6%), poor supervision (2%), and mental impairment (.3%). CONCLUSIONS: The professions differ in the major reasons for disciplinary actions. Two thirds (67%) of the doctors of chiropractic were disciplined for fraud and sexual boundary issues, compared with 59% for negligence and substance misuse for medical physicians. Additional study in each profession may reveal methods to identify causes and possible intervention for those who are at high risk.

California↗
PubMed2005

Attitudes of soldiers taking drugs to military service, training, and discipline.

The studies performed confirmed the existence of effects of drug addiction on the processes of discipline and training of soldiers. Soldiers taking drugs have more critical attitudes toward military service obligation and to a greater degree accept the opinion that it is a waste of time for them. Soldiers taking drugs have worse results in general and professional military training.

Adult↗
PubMed2006

Factors associated with high-severity disciplinary action by a state medical board: a Texas study of medical license revocation.

CONTEXT: There has been an increase in research evaluating factors associated with disciplinary action of physicians by state medical boards. However, factors related to the severity of disciplinary action are lacking. By investigating these factors while controlling for the type of violation, the authors sought to determine whether physician characteristics influenced the process of disciplinary action by state medical boards. METHODS: Physicians disciplined by the Texas Medical Board between January 1, 1989, and December 31, 1998, were included in this case-controlled study (N=1129). Multivariate logistic regression analysis was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with license revocation, the most severe disciplinary action, compared with all other forms of disciplinary action combined. RESULTS: Anesthesiologists (OR, 2.45; 95% CI, 1.05-5.74), general practitioners (OR, 1.80; 95% CI, 1.01-3.19), and psychiatrists (OR, 2.68; 95% CI, 1.41-5.13), as well as those with multiple disciplinary actions (OR, 1.91; 95% CI, 1.29-2.83) were most susceptible to license revocation. The more years a disciplined physician was in practice, the greater risk he or she had of license revocation (OR, 1.05; 95% CI, 1.04-1.07). CONCLUSIONS: Factors associated with a greater likelihood of license revocation for physicians are: primary medical specialty, number of years in practice, and a history of multiple disciplinary actions.

Adult↗
PubMed2005

Processes for disciplining nurses for unprofessional conduct of a serious nature: a critique.

AIMS: This paper critiques the deliberative processes used by the discipline panels of an Australian statutory nurse regulating authority when appraising the alleged unprofessional conduct of nurses and determining appropriate remedies. BACKGROUND: Little is known about the nature and effectiveness of the deliberative processes used by nurse regulating authorities (NRAs) disciplinary panels established to appraise and make determinations in response to allegations of unprofessional conduct by nurses. METHODS: A qualitative exploratory descriptive/pragmatic research approach was used. Data were obtained from two case-orientated sampling units: (1) 84 Reasons for Determination made between 1994 and 2000 and (2) a purposeful sample of 12 former and current nurse regulating authority members, nurse regulating authority staff and a nurse regulating authority representative who had experience of disciplinary proceedings and/or who had served on a formal hearing panel. Data were analysed using content and thematic analysis strategies. RESULTS: Attitudinal considerations (e.g. whether a nurse understood the 'wrongness' of his or her conduct; accepted responsibility for his or her conduct; exhibited contrition/shame during the hearing; was candid in his or her demeanour) emerged as the singularly most significant factor influencing discipline panel determinations. Disciplinary action is taken appropriately against nurses who have committed acts of deliberate malfeasance. NRAs may not, however, be dealing appropriately with nurses when disciplining them for making honest mistakes/genuine practice errors. CONCLUSION: Traditional processes used for appraising and disciplining nurses who have made honest mistakes in the course of their work need to be substantially modified as they are at odds with the models of human error management that are currently being advocated and adopted globally to improve patient safety and quality of care in health care domains.

Attitude of Health Personnel↗
PubMed2003

Nursing discipline: demystifying the process.

This article provides a general overview of the disciplinary process for nurses. It also outlines at least one example of an alternative, often called a diversion program, to the standard disciplinary process. It urges school nurses to obtain legal counsel when responding to an inquiry from the board of nursing and discusses several factors to consider when seeking an attorney. The article also briefly discusses how the Nurse Licensure Compact affects the disciplinary process.

Employee Discipline↗
PubMedDate not supplied

Disciplining physicians: what every physician and health care administrator needs to know about the Health Care Quality Improvement Act.

This article highlights the critical provisions of the Health Care Quality Improvement Act that must be considered by physicians and health care entities in conjunction with disciplinary actions. These include: when professional review actions are covered by the Act's immunity; what constitutes adequate notice and a fair hearing for affected physicians; when professional review actions should be reported to the National Practitioner Data Bank; and what must be reported.

Employee Discipline↗
PubMed2006

How safe are HEMS-programmes in Germany? A retrospective analysis.

INTRODUCTION: Recent accidents with helicopter emergency medical service (HEMS) aircraft raise the question how safe HEMS in Germany is and how accidents could be prevented. MATERIALS AND METHODS: We surveyed all German HEMS-programmes and reviewed the data of the German Aviation Authority regarding accidents with HEMS. RESULTS: An average German HEMS-programme encounters one accident leading to at least severe damage or loss of the helicopter in 26 operating years, one accident resulting in casualties in 65 operating years and one fatal accident in 111 operating years. The major causes of accidents were obstacle strikes during landing at the scene. Flying in bad weather conditions and lack of discipline were other factors contributing to HEMS-accidents. CONCLUSION: HEMS-safety could be improved by special training programmes for pilots and HEMS-crewmembers to address the factors listed above. Safety training for doctors is recommended but we did not find support for the notion of changing the doctor's legal position of a passenger to a HEMS-crewmember.

Accidents, Aviation↗
PubMed1997

Effects of the program-management model: a case study on professional rehabilitation nursing.

In an attempt to increase organizational innovation and flexibility, Cardinal Hill Rehabilitation Hospital moved from the traditional discipline-management model to the program-management model. In the restructuring, the integrity of professional nursing practices was put to the test when the director of nursing position and numerous staff nursing positions were eliminated. This article evaluates statistics from the three years that have elapsed since the restructuring event in order to determine the new program-management model's compatibility with patient outcomes associated with professional nursing standards.

Disease Management↗
PubMed2002

Processing complaints and disciplining nurses. An overview of the investigative process by the Kansas State Board of Nursing.

This is a brief review of the process the Kansas State Board of Nursing would utilize when investigating a complaint and determining discipline against a licensee, and does not include all points of law that could apply. Although the Kansas Administrative Procedures Act was discussed, there are many sections of the statute that were not addressed. The Board of Nursing has published two pamphlets "Your Rights Before the Kansas State Board of Nursing" and "The Investigative Process" which are valuable to the nurse in understanding the process. These are available on the KSBN's website www.ksbn.org or by mail.

Data Collection↗
PubMed1989

How to reduce absenteeism: a comparative analysis.

One way for hospitals to control costs and increase productivity is to reduce absenteeism. This study evaluates the comparative effectiveness of seven prevalent absentee-control programs. Three are reward programs (bonus, buy back, and personal recognition); three are disciplinary programs (disciplinary action, no-fault, and year-end review); and one combines reward and discipline (paid leave bank). Data from 464 hospitals located in 42 states are analyzed. Statistical significance was obtained by using an ANOVA (p less than .05). The results suggest that a paid leave bank offers the most promise for controlling absenteeism. The data show no significant difference in levels of absenteeism among hospitals that use a mix of reward and disciplinary programs from those that use only reward or only disciplinary interventions. Implications of the findings are subsequently addressed.

Absenteeism↗