Evidence-based framework for the management of disruptive physician behavior

The consistent promotion of a culture of respect and accountability in the workplace is vital to the success of healthcare organizations. However, the existing literature on practical strategies for addressing misconduct, particularly with respect to physician behavior, is relatively sparse. The aim of this review was to thus devise an evidence-based, empirical framework for the management and remediation of disruptive physician actions. Core themes on which to center the framework were initially identified based on the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) statement. A MEDLINE search was undertaken to identify original peer-reviewed works using terms associated with unprofessionalism with the goal of building a foundational basis. Articles published from January 2014 to March 2025 and restricted to the English language were included. Among the 1123 original articles that entered the final selection process, 1112 were excluded because they were focused solely on the characterization of disruptive behavior (n = 429); limited to trainees (n = 277), limited to ancillary staff (n = 150); concentrated on prevention (n = 148); and described consequences (n = 108). A total of 11 original publications thus met criteria for inclusion and differed in their design, methods, and endpoints. The core themes that emerged for framework construction were expectation setting (four studies); climate/organizational analysis (three studies); peer involvement (two studies); and professional training (two studies). The feasibility of developing an evidence-based framework to address disruptive physician behavior was demonstrated. The management implications specific to risk are discussed.