To Jody Foster, disruptive people in any type of organisation – from a big corporation to a major health centre – can poison the atmosphere for everyone with whom they interact. "People are people, no matter what industry they are in, and they bring their basic personalities to work," says Foster. "When they act out in inappropriate ways – by, for example, bullying employees who work under them, compulsively micro managing, displaying narcissistic tendencies – it can be devastating to the entire workplace."
Foster, who is chair of the department of psychiatry at Pennsylvania Hospital in Philadelphia, founded and heads up the Professionalism Programme at Penn Medicine (PPPM), which came about, in part, because The Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organisations) requires hospitals to have a policy in place for addressing behaviours that "undermine a culture of safety."
Foster, who has both an MD and MBA
, has dealt with disruptive personalities in both the business and health care sectors. During an interview with Knowledge@Wharton, she talked about different types of unprofessional behaviours and what organisations can do about them. I know that after you got your MBA from Wharton – on top of the MD you already had – you worked as a consultant assessing entrepreneurial teams for venture capital companies. Can you explain what you did?
Sure. The assessment programme that I and a partner developed was intended to help venture capitalists – specifically the ones about to invest in a particular company – understand who the main players in that company were, how the team functioned together, what kinds of personalities they had, and which ones needed watching as the company, and the venture capitalists' investment, grew. As everyone knows, a bad management team can destroy even the best company.
This was all happening just before the tech bubble burst. Around that same time, I was offered a promotion as psychiatry department chair – and became the first female to chair any medical department in Pennsylvania Hospital's then 250-year history. That drew me more fully back into medicine.
But my experience is that disruptive behaviours can show up anywhere, and they can usually be divided into certain types. What do you mean by disruptive behaviour, and how is it displayed?
It's actually a variety of behaviours that include, for example, verbally or physically threatening others, intimidating co-workers, or exhibiting condescending behaviour that puts people on edge and [makes] them unable to function.
People say that dealing with disruptive behaviour in the corporate world is easier than in the medical profession, because in a company, you just fire the troublemakers. But that's in and of itself incredibly disruptive, and besides, it's not the point. Human capital is important, and good human capital is hard to come by. You make investments in people. It may be that you have a senior vice president who is extremely valuable to the company but terribly inept interpersonally. Do you want to get rid of him, or give him a chance to do better? Don't forget that the cost of replacing employees is huge. What about screening job applicants – in any field – for potential behavioural issues?
Yes, that's a key component of what I do. Say you have two identical candidates. One displays characteristics – such as egocentricity or obsessionality – that make you wonder if he or she will succeed in your workplace, especially after you take into account the culture of the company and the type of team already in place. Making a mistake in the initial hiring is especially damaging because once you allow someone in, it's not always easy to get him or her out.
As I said, everyone has to work together, whether you are talking about people in the operating room or people on a corporate marketing team. The person at the head of the team may wield a certain amount of power that can be used creatively, or destructively. The person lower down on the team who manages up can also cause interpersonal problems. Are men, overall, more disruptive than women?
The literature says "yes." The lion's share of disruptive men who I've seen tend to fall – and I am making gross generalisations here – into what I would call "vanilla silos" of narcissism, and the interventions – including cognitive behavioural therapy or executive coaching – can be relatively formulaic.
As a psychiatrist, I categorise people based upon prominent personality traits. Disruptive behaviour spans the entire spectrum of categories. The biggest trouble areas are people who have these basic narcissistic tendencies, manifesting as an inability to see past their personal needs or goals for the good of the team.
I also see a lot of people who have avoidance or obsessive-compulsive traits – for example, micromanaging that gets in the way of work. On the other end of the personality spectrum are people who are paranoid and look at the world suspiciously. There's another group of people who simply lack social skills or etiquette, and this, too, leads to unpleasant interactions. Is there a standardised code of ethics around disruptive behaviours?
The problem is there are broad categories of disruptive behaviour, and behaviour itself is an amorphous measuring tool. So it is the kind of thing where you will know it [disruptive behaviour] when you see it. But telling you what it will be is hard. Is this true also in the corporate world?
It's a bit harder there because, in some ways, ruthlessness can be perceived – depending on the situation – as positive. Even in medicine, the person who is nakedly ambitious might be more likely to get ahead. That said, should anybody be discriminated against, harassed, yelled at or assaulted? Of course not. But sending your child to military school or to a Quaker school – there will be different codes of conduct based on what that entity wishes to engender in its students. This kind of flexibility seems fine so long as respectful interactions are the rule.
In the field of medicine, it used to be perceived that a certain amount of bullying was okay – it is now considered totally unacceptable – which means that some of the older doctors are having trouble adjusting. It's reasonable to assume that as our culture becomes more attuned to this, people will increasingly understand that a cooperative working environment leads to more worker satisfaction and higher productivity. Has the recession affected people's behaviour in the workplace?
Absolutely. Part of what makes people, at least in the medical sector, act out is that they are frustrated. When doctors could make their own decisions, and they were reimbursed for what they did at a less intense work pace, there was more job satisfaction. But increasingly, doctors are no longer seen as leaders, they get less respect and their reimbursements are down. At the same time, they are called upon to do more work for less, which might erode what doctors really value, which is spending time with patients. What would you advise companies to do to cut down on disruption?
I would advise consultation at the front door. Before you put a management team together, you should have the members of the team interviewed, with behaviour as one of the factors you are considering. Then see how the team functions together before you lock them in.
In addition, managers need to be educated about the cost of disruptive behaviour. Early detection and intervention are tremendously important and can make all the difference in salvaging a team. Can you tell me more about your role in the Penn health system?
What the Penn Health System did was create a professionalism committee so that chairs and chiefs of each department had a place to send individuals who were displaying disruptive behaviour. We could offer potential intervention before the behaviour got too bad.
In addition to being chair of psychiatry at Pennsylvania Hospital, I am the executive medical director of Penn Behavioural Health Corporate Services, a division of the larger department of psychiatry at the University of Pennsylvania Health System. One of my responsibilities has been to manage the employee assistance programme (EAP) and do the interventions for attending physicians. So when it was time to create the professionalism committee, I was asked to do that, the idea being that it's important to not just identify the behaviours, but to offer a mode of intervention rather than have problems drag on endlessly and end up with no concrete resolution.
In the past, the process of intervening has taken so long that an entire medical board will change over, and a new group will come in and say: "But he (the doctor) is a good guy, and why don't we try another round of anger management?" The bad behaviour just continues. With a "professionalism" consultation, I might be able to say upfront that a behaviour is a result of a very fixed personality structure, and it's not going to change anytime soon. You can throw all the anger management tools you want at this person, but the behaviour will creep back in.
So we respond within a few hours to any report of disruptive behaviour, make a quick diagnostic assessment and get a treatment plan out right after the first consultation. That treatment plan can consist of identifying the need for a structural or systemic change within the entity, a referral for a short-term supportive therapy if a particular adjustment issue is identified, cognitive behavioural therapy for anger or frustration management, longer-term therapy, executive coaching, neuropsychological testing, etc.
This programme has gotten tremendous traction at Penn, so about one year ago we created an entrepreneurial product, the Professionalism Programme at Penn Medicine, to offer the service publicly. I am now working at the state level doing evaluations across Pennsylvania and hope to do so nationally. How can you tell when you have been successful in an intervention?
The best measure is ongoing good behaviour and a well-functioning team. When a physician contacts me months after his or her intervention to ask my advice about how to assist a disruptive colleague, I know that the lessons have been internalised. My most satisfying moments, however, are when I get an unsolicited call from a physician I've seen, thanking me for bringing him or her to treatment that would never have been otherwise considered, and telling me that it has made a substantive impact on his/her work and/or personal life. Often, a physician will complete the "required" therapeutic intervention and elect to stay on in treatment for his or her own personal benefit. What could be more successful than that?