State Medical Board Recommendations for Stronger Approaches to Sexual Misconduct by Physicians

Huddles for unprofessional behaviours in the healthcare setting that may require immediate investigation, inquiry or intervention

BACKGROUND

Some unprofessional behaviours, including allegations of discrimination, hostile work environment, violent behaviour, sexual boundary violations, potentially impaired clinicians, professional integrity and retaliation, require healthcare organisations to have a timely and reliable process to guide investigation, inquiry and/or interventions. Failure to have a consistent approach creates extraordinary risk for organisations, their team members and their patients.

METHODS

Descriptive study of five health systems that participate in a national professionalism collaborative through the Vanderbilt Health Center for Patient and Professional Advocacy (CPPA) and implemented a huddle process to guide the initial disposition of event reports describing unprofessional behaviours that might warrant investigation, inquiry or intervention. Each site applied lessons learnt over the study period to refine the huddle participants, the process for the huddle and the tracking of information based on their experience.

RESULTS

During the study, the participating sites held 219 huddles, which represented <1% of reports processed by CPPA during the study period. The most common type of reports resulting in a huddle included allegations of discrimination (30% of huddles) or hostile work environment (29%). Other common reasons for huddles included violent or aggressive behaviour (15%) or potential sexual boundary violations (13%). Additional reasons for huddles included concerns for an impaired clinician (3%), integrity (2%) or retaliation against a reporter for a previous electronic safety event report (2%).

CONCLUSIONS

Implementing a huddle to review and guide next steps for reports including allegations of serious behaviours provided the healthcare organisations a process to reduce the variability of response to such reports and fostered increased communication and trust among organisational key stakeholders.

A Proposed Approach to Allegations of Sexual Boundary Violation in Health Care

BACKGROUND

Sexual boundary violations in the health care setting cause harm for victims, threaten an organization's culture, and create extraordinary organizational risk. The inherent complexities of health care organizations present unique challenges for the initial triage and response to reports of alleged violations.

METHODS

A group of experts with experience in law, leadership, human resources, medicine, and health care operations identified processes for organizations to triage and implement an early response to allegations of sexual boundary violations. The group reviewed a series of 100 reports of alleged violations described by patients and coworkers from a 200-hospital professional accountability collaborative to identify the elements of an ideal initial triage and management approach.

RESULTS

The group identified three domains to guide early triage and response to reports of boundary violations: (1) severity and acuity of the alleged violation; (2) roles and relationship(s) of the complainant, respondent, and other affected individuals; and (3) contextual information such as prior activity or other mitigating factors. The group identified leadership engagement; coordinated responses; clear articulation of values, policies, and procedures; aligned data reporting; thoughtful reviews; and securing appropriate resources as essential elements of an organization's response.

CONCLUSION

A structured systematic approach to classify and respond to allegations of sexual boundary violation is described. The initial response should be guided by assessment of the severity and timing of the reported behavior, followed by assessment of roles and responsibilities with involvement of all relevant stakeholders. Contextual issues and special circumstances of relevance should be identified and incorporated into the response. Systems to identify, store, and retrieve behavior of concern should be improved and integrated.

Intimacy in Psychotherapy: An Exploratory Survey Among Therapists

A certain level of intimacy is necessary in psychotherapeutic relationships for them to be effective, but it can sometimes develop further into more intimate feelings and behaviors related to friendship and sexuality, into friendship, or even into sexual relationships. In this study, a self-administered questionnaire was sent to psychotherapists in Flanders (Belgium), asking about the occurrence of these situations. It provides an overview of these occurrences and comparative data to view for generational and cultural differences with previous studies. A response rate of 40% was obtained (N = 786): 69% of respondents were female therapists and none were transgender. A total of 758 therapists stated that they had actually provided psychotherapy and were included for further analysis. Three percent started a sexual relationship with a current and/or former client, 3.7% started a friendship during therapy, and 13.4% started a friendship after therapy. About seven out of ten therapists found a client sexually attractive, a quarter fantasized about a romantic relationship, and a fifth gave a goodbye hug at the end of a session (22%). In general, more male therapists reported sexual feelings and behaviors than female therapists. Older therapists more often behaved informally and started friendships with former clients compared to younger colleagues. Psychiatrists reported sexual feelings and fantasies less often than non-psychiatrists, and behavioral therapists reported this less frequently than person-centered and psychoanalytic therapists. Overall, prevalence rates of intimate feelings and behaviors related to friendship and sexuality are lower than those in previous studies.