How Protection Plans Keep Patients and Practitioners Safe

How Protection Plans Keep Patients and Practitioners Safe

September 2021

PBI pioneered the use of the Personalized Protection Plan© more than 20 years ago. These plans are central to helping clinicians protect their patients, themselves, and their license.

Participants in PBI courses graduate with something much more valuable than a certificate. They leave with a written plan detailing how they are going to improve their practice and avoid future transgressions. Each plan is as unique as the individual who creates it, reflecting what that person has learned about their own internal vulnerabilities and the risks they face in their practice.

Participants present their plan to their instructor and each other for review and feedback to ensure they are addressing the concerns identified during the course, and are being realistic about what they can achieve. Quick fixes and easy solutions are cast aside; overly ambitious strategies are rethought. The final document is a concrete action plan outlining the steps the participant plans to take and the changes they intend to make in three domains: organizational (their work environment), professional (their own conduct at work), and personal (their lives outside of work).

PBI Personalized Protection Plans outline the steps
participants plan to take in three domains:

1. Organizational (their work environment)

2. Professional (their own conduct at work)


3. Personal (their lives outside of work)

No plan is perfect and all plans need to be revised as clinicians face new challenges and opportunities in their lives. Whether it’s a new baby or a parent’s decline, a promotion or a retirement, significant events prompt re-evaluations of protection plans. Even when nothing much has changed, participants are urged to review their plans regularly to be sure the plans are still adequately addressing their risk factors and vulnerabilities.

Developing a Protection Plan: Case Study

The following case study (a composite of PBI course graduates’ experiences) offers a look into the process PBI course participants go through to create and implement their Personalized Protection Plan.

Melissa, a young internist in a small group practice, has been disciplined for repeatedly losing her temper and shouting at patients. During her PBI Elevating Civility and Communication Course, Melissa talked about being angry at her husband, who she said complained constantly about how little time she spent with him and their two kids. Melissa blamed her long hours at work on overly demanding senior partners.

Melissa shared that she had a hard time dealing with patients who were often angry about having to wait so long past their scheduled appointment times. Part of the problem, she felt, was that she too was feeling angry and frustrated. The same over-booking that enraged patients, she explained, left her with no downtime between appointments for completing medical records or just decompressing a bit.

Overall, Melissa felt trapped by what others demanded of her, and angry about how little time she had to do what she wanted. She especially missed watching her kids play soccer and her weekly tennis games with friends.

Reviewing the Three Domains of the Personalized Protection Plan:
Organizational, Professional, and Personal

After discussing with her fellow course participants how they were tackling their own protection plans and listening to their critiques of her plan, Melissa ended up with the following strategy:

Organizational: Melissa started out wanting to immediately demand shorter hours and end overbooking. After discussing it with others, she realized her demands would only convince the partners that she was still the same hot head she had been. Instead, Melissa decided to share what she had learned about herself with her supervisor and explain her plans for improving her performance.

She would also explain why she felt it was important for the patients, her colleagues, and her own wellbeing that the practice resolve scheduling difficulties. She planned to offer suggestions that might help — hiring a PA or perhaps a scribe to relieve some of the strain. She would be patient as long as she felt she was making progress. If things did not go well, though, she promised herself that she would start looking for a new practice.

Professional: Melissa was concerned about her ability to manage these negotiations with her supervisor without losing her temper. She considered taking an anger-management course, but after doing a little research opted instead to ask one of the senior partners (a different partner than her supervisor) to be her mentor. This partner was known for her ability to defuse tense situations and remain calm. She understood the office culture and knew the other partners well. Additionally, she was nearing retirement, so might welcome the chance to share all that she had learned in her career.

Personal: Melissa realized that her anger at her husband was spilling over into her work. Having come to see his point-of-view, she planned to talk to him about what she had learned and offer to accept his suggestion that they begin couples therapy. She would also explain the steps she was taking at work to have more time with the family.

Melissa planned to share with her kids how she was making changes that would allow her to attend their soccer games. It would show them how much she wanted to be with them and, as a side benefit, help increase her sense of accountability.

Overall Accountability: Accountability is an important part of the PBI Formula©. Melissa felt that her supervisor, mentor, husband, and kids would all provide a fair amount of oversight. But she had appreciated the type of candid feedback she received during her course from the PBI course faculty and other participants, who understood what she was going through. The instructor had described PBI’s Maintenance and Accountability Seminars (MAS), a weekly, teleconference group discussion course, where participants share about progress and discuss the implementation of their protection plans with their cohort and faculty facilitator. Melissa decided to try out these seminars to gain additional accountability as she began to implement her protection plan.

Here’s what Melissa’s protection plan looked like:

Melissa’s Personalized Protection Plan

Organizational

  • Meet with supervisor to explain what I’ve learned and how I plan to improve my performance
  • Request bi-weekly meetings to review my progress and discuss possible changes to scheduling that should benefit patients, colleagues, and help me as well. Work with mentor (below) to prepare concrete suggestions to bring to these meetings.
  • If no progress after a few months, begin search for new job.

Professional

  • Ask senior partner to work with me as my mentor. Explain what I’ve learned and share my protection plan. Work with her on ways to resolve scheduling issues.
  • If she does not want to mentor me, enroll in an anger-management course.

Personal

  • Discuss my plans with my husband and offer to start couple’s therapy if he is still willing to.
  • Explain my plan to get more time with him and the kids and pledge to look for a new job if things don’t start improving in a few months.
  • Tell the kids I’m working on getting to their soccer games.

Overall

  • Enroll in MAS for 12-week cycle to maintain accountability as I implement plan and revise plan as needed.

One Year Later

While it took several months, Melissa’s talks with her supervisor improved and became productive opportunities for her to receive feedback. Melissa implemented and mastered many of the techniques she had learned during her PBI Civility and Communication Course, allowing her to control her emotions and communicate professionally, regardless of the emotions of those she was interacting with. Melissa realized that when she was able to calmly and confidently communicate with her colleagues, they could work together, allowing them to improve the scheduling process and, as a result, the overall office culture. She worked closely with her mentor to discuss how best to provide feedback and make suggestions during her meetings with her supervisor. After meeting for a year, they chose to continue the mentorship, speaking with each other on a monthly basis, even as her mentor began to transition into retirement.

At home, Melissa and her husband continued couple’s therapy, which helped them communicate better as a couple. At the therapist’s suggestion, Melissa began individual therapy as well, which helped her understand some of the less-obvious reasons for her anger. Melissa’s kids transitioned to playing basketball; however, unlike with their previous soccer games, Melissa and her husband attended these events together as often as possible. She also made a priority of being home for dinner and being intentional about spending weekend time with her family.

Melissa has remained in the MAS course both to make sure she doesn’t backslide and to help others struggling with similar issues by sharing how the implementation of her protection plan changed not only her career, but her entire life.

Takeaways

  • PBI pioneered the use of Personalized Protection Plans more than 20 years ago.
  • Plans build on what each person has learned about their own internal vulnerabilities and the risks they face in their practice.
  • These are not academic exercises, but concrete action plans outlining the steps the participant plans to take and the changes they intend to make in three domains: organizational (their work environment), professional (their own conduct at work), and personal (their lives outside of work).
  • Participants revise plans as needed when facing new challenges and opportunities.
  • Accountability is an important part of the PBI Formula and protection plans.
  • Many participants join PBI’s Maintenance and Accountability Seminars to help themselves stay on track and to help others in their own journeys.