Alan H Rosenstein MD MBA

Disruptive Behavior Specialist

Providing Education and Consultative Services on Disruptive Behaviors and Care Management in Healthcare

Alan Rosenstein

Dr. Alan Rosenstein is a practicing Internist in San Francisco, California, Medical Director for Physician Wellness Services in Minneapolis, MN, and a medical consultant in healthcare management. Throughout his career as a Medical Director and Vice President for a variety of health care organizations he has focused his efforts on engaging physicians around care efficiency, quality and patient safety.

His interest in disruptive behaviors began in 1999 while at VHA West Coast where he developed a unique survey tool to assess the frequency and impact of disruptive physician behaviors on nurse satisfaction and retention. The results, originally published in The American Journal of Nursing and The Physician Executive Journal, brought serious attention to a topic that many organizations were reluctant to address. Subsequent research extended the focus to look at disruptive behaviors in nursing and other health care disciplines, and to assess the negative impact of disruptive behaviors on psychological factors that affect clinical performance. Results have been published in a variety of journals including the Joint Commission Journal on Quality and Patient Safety, the Journal of the American College of Surgeons, the Journal of Neurology, The American College of Obstetrics & Gynecology, The Journal of Emergency Medicine, the MGMA Group Practice Journal, Harvard Policy Review, and Nursing Management.

Over the past several years his focus on disruptive behaviors has evolved more toward addressing the multiplicity of internal and external factors affecting dysfunctional behaviors with the goal of providing appropriate support services to help physicians adjust to the stresses of today's health care environment. Physicians are a precious resource. All they want to do is to practice medicine. Organizations need to recognize the pressures facing physicians today and take a pro-active role in motivating and restoring their faith, energies and capabilities to provide best practice care. It takes a village.

Dr. Rosenstein has had extensive experience in discussing strategies for addressing disruptive behavior at a number of different national conferences and on-site locations (see below). His primary goal is to help organizations gain a better understanding of why physicians behave the way they do and help the organization develop policies, procedures and supportive strategies that increase compliance with expected standards of behavior. Being a physician, he understands the current stresses and pressures that affect physician behaviors and tries to work with physicians in a positive constructive manner to raise levels of awareness and provide strategies to improve compliance and satisfaction. Key topics covered include:

List of Publications on Disruptive Behavior, Communication, Stress and Burnout:

  1. Rosenstein, A. "The Impact of Nurse-Physician Relationships on Nurse Satisfaction and Retention" American Journal of Nursing, Vol.102 No.6, June 2002, p. 26-34
  2. Rosenstein, A.; Lauve, R., Russell. H. "Disruptive Physician Behavior Contributes to Nursing Shortage" The Physician Executive, November-December 2002, p. 8-11
  3. Rosenstein, A., O'Daniel, M. "Disruptive Behavior and Clinical Outcomes: Perceptions of Nurses and Physicians" American Journal of Nursing Vol. 105 No.1 January 2005 p.54-64
  4. Rosenstein, A., O'Daniel, M. "Negative Behavior and Clinical Outcomes" Nursing Management Vol.36 No.1 January, 2005 p.18-28
  5. Rosenstein, A., O'Daniel, M. "Impact and Implications of Disruptive Behavior in the Peri-Operative Arena" Journal of American College of Surgery Vol.203 No.1 p.96-105 July 2006
  6. Rosenstein, A., O'Daniel, M. "Addressing Disruptive Nurse- Physician Behaviors: Developing Programs and Policies to Improve Relationships that Improve Outcomes of Care" Harvard Health Policy Review Spring 2005 Vol.7 No.1 p.86-97
  7. Rosenstein, A., O'Daniel, M. "Nurse- Physician Communication: The Impact of Disruptive Behaviors on Factors Affecting Decision Making Affecting Patient Outcomes of Care" Chapter VII The Psychology of Decision Making Nova Science Publishers New York 2007
  8. Rosenstein, A., O'Daniel, M. "Impact of Disruptive Behaviors on Clinical Outcomes of Care" Journal of Neurology Vol.70 No.17 April 24, 2008 p.1564-1570
  9. Rosenstein, A., O'Daniel, M. "A Survey of the Impact of Disruptive Behaviors and Communication Defects on Patient Safety" Joint Commission Journal on Quality and Patient Safety Vol34 No8 August 2008 p.464-471
  10. Rosenstein, A. "Disruptive Physician Behavior: Fact vs. Frenzy" ASPR Journal Vol.16 No.2 Spring 2009 p.25
  11. Rosenstein, A. ""Physician and Nurse Behaviors and Their Impact on Communication Efficiency and Patient Care" Journal of Communication in Healthcare Vol.2 No. 4 December 2009 p. 328-340
  12. Rosenstein, A. "Early Intervention Can Help Prevent Disruptive Behavior:" American College of Physician Executives Journal. Nov/ Dec 2009 p.14-15
  13. Rosenstein, A. "Physicians Under Stress: Life in the Fast Lane Affects Behavior and Performance" American Association of Orthopedics March 2010
  14. Rosenstein, A. "Differences in Disruptive Behaviors" Hospitals & Health Networks Vol.84 No.3 March 2010 p.8-10
  15. Rosenstein, A. "Disruptive Behavior, Nursing Care, and Patient Safety" Forum on Future of Nursing Institute of Medicine, Robert Wood Johnson Foundation, National Academies Press Washington D.C. April 2010 p.38-42
  16. Rosenstein, A. "Managing Disruptive Behaviors in the Health Care Setting: Process, Policy, Prevention and Intervention" Advances in Psychology Research. Volume 72 Nova Publications New York 2011 Chapter VII p.197-211
  17. Rosenstein, A., Danielson, D. "Addressing Physician Disruptive Behaviors to Improve Relationships, Process Flow, and Patient Outcomes" Group Management Association Journal July/ August 2010 p.40-45
  18. Rosenstein, A. "Measuring and Managing the Economic Impact of Disruptive Behaviors in the Hospital" Journal of Healthcare Risk Management Vol.30 No.2 October 2010 p.20-26
  19. Rosenstein, A., Mudge-Riley, M. "The Impact of Stress and Burnout on Physician Satisfaction and Behaviors" The Physician Executive Journal Vol. 36, Issue 6, Nov/ Dec 2010 pgs 16 23
  20. Rosenstein, A. "Strategies for Addressing Physician Disruptive Behavior: Cause and Effect" The American College of Healthcare Executives Publication Vol.26 No.1 Jan/ Feb 2011 p.78-79
  21. Rosenstein, A. "Managing Disruptive Behaviors in the Health Care Setting: Focus on Obstetrical Services" American College of Obstetrics & Gynecology Vol. 204 March 2011 p. 187-192
  22. Rosenstein, A. "The Economic Impact of Disruptive Behaviors: The Risks of Non- Effective Intervention" American Journal of Medical Quality September/October 2011 Vol.26 p.372-379
  23. Rosenstein, A. "Physician Communication and Care Management: The Good, the Bad, and the Ugly" Physician Executive Journal Publication July/ August 2012
  24. Bashaw, E. Rosenstein, A., Lounsbury, K. "Culture Trifecta: Building the Infrastructure for Magnet and Just Culture at a Community Hospital" Publication pending American Nurse Today
  25. Rosenstein, A., Danielson, D. "Mitigating the Effects of Disruptive Behavior on Patient Safety, Teamwork, and Organizational Risk" Group Practice Journal Vol.61 No.3 March 2012 p.9-12
  26. Rosenstein, A., Naylor, B. "Incidence and Impact of Physician and Nurse Disruptive Behaviors in the Emergency Department" The Journal of Emergency Medicine, Volume 43, Issue No. 1. Publication pending July, 2012.
  27. Rosenstein, A. "Physician Communication and Care Management: The Good, the Bad, and the Ugly" Physician Executive Journal July/ August 2012 p.34-37
  28. Rosenstein, A. "Stress, Burnout and the Disruptive Physician" American Academy of Medical Administrators July 2012
  29. Rosenstein, A. "Physician Stress and Burnout: What Can We Do?" American College of Physician Executives November/ December 2012 p.22-30
  30. Gessler, R., Rosenstein, A. Ferron, L "How to handle disruptive physician behaviors" American Nurse Today Vol. 7 No. 11 November 2012 p.8-10
  31. Rosenstein, A. "Physician Recruitment and Retention: Factors Affecting Expectations and Reality" Journal of the Association of Staff Physician Recruiters Publication pending
  32. Rosenstein, A. "Physician Recruitment and Retention: Factors Affecting Expectations and Reality" Journal of the Association of Physician Staff Recruiters November 2013 p.18-2002
  33. Danielson, D., Ketterling, R., Rosenstein, A. "M.D Physician Stress and Burnout: Causes, Effects, and Impact on Performance and Behavior AMGA Group Practice Journal Vol.62 No.3 March 2013 p.38-41.
  34. Rosenstein, A. "Addressing Disruptive Behaviors in the Organizational Setting: The Win- Win Approach" The Journal of Medical Practice Management May- June 2013 p.348-350
  35. "Anger Management Courses are a New Tool for Dealing with Out-of-Control Doctors" Washington Post Interview Citation article published March 4, 2013
  36. Rosenstein, A. "Addressing physician stress, burnout, and compassion fatigue: the time has come" Israel Journal of Health Policy Research 2:32 August 2013 p.1-3
  37. Rosenstein, A. "Bad Medicine: Managing the Risks of Disruptive Behaviors in Health Care Settings" Risk Management Vol.60 No.10 December 2013 p.38-42
  38. Rosenstein, A., Dinkin, S., Munro, J. "The Importance of Resolving Relationship Barriers That Impact Nursing Care" Nursing Management publication pending
  39. HIStalk on Disruptive Behaviors January 27, 2014 www.Histalk2.com

List of Presentations at National Seminars and Workshops:

  1. "Nurse- Physician Relationships: Impact on Nurse Satisfaction and Retention" 2002 VHA Annual Leadership Conference, Chicago, IL, April 23, 2002
  2. "Impact of Nurse- Physician Relationships on Nurse Satisfaction "Iowa Nurses Association, Cedar Rapids, IA, October 23, 2002
  3. "Nurse - Physician Relationships: Is it Impacting Nurse Satisfaction and Retention in Your Hospital?" Joint Commission Resources Conference, December 4, 2002
  4. "Nurse - Physician Relationships: The Impact of Disruptive Physician Behavior" National Managed Health Care Congress, Washington, D.C., March 12, 2003
  5. "Nurse - Physician Relationships: Impact and Resolution" Tucson Medical Center/Tucson Medical Society, Tucson, AZ, March 26, 2003
  6. "Nurse - Physician Relationships: Perceptions and Reality" California Association of Health Care Quality, San Diego, CA, March 28, 2003
  7. "Disruptive Docs: How Bad Behavior Drives Nurses Away" Minnesota Nurses Association, Nurses Academy, Brainerd, MN, October 18, 2003
  8. "Nurse - Physician Relationships: Impact on Clinical Outcomes of Care" CNO Health Care Roundtable Annual Conference, Amelia Island, FL, April 2, 2004
  9. "Impact of Disruptive Nurse and Physician on Clinical Outcomes of Care" New York Presbyterian Hospital, June 4, 2004
  10. "Disruptive Behavior and Its Impact on Psychological Behaviors and Clinical Outcomes of Care" All, Day Workshop Christian Hospital (Barnes-Jewish-Christian Hospital System), June 9, 2004
  11. "Nurse- Physician Communication" Mayo Clinic Medical and Surgical Grand Rounds January 28, 2005 Scottsdale, AZ
  12. "Impact of Nurse and Physician Disruptive Behavior on Clinical Outcomes of Care" Executive Roundtable on Patient Safety February 11, 2005 San Francisco, CA
  13. "Impact of Nurse and Physician Disruptive Behavior on Clinical Outcomes of Care" California Association for Healthcare Quality March 18, 2005 Los Angeles, CA
  14. Nurse- Physician Relationships: Disruptive Behavior, Communication Gaps and its Impact on Patient Safety and Clinical Outcomes of Care" All Day Workshop The Queens Medical Center Honolulu, HI July 17, 18, 2005
  15. "Nurse- Physician- Staff Communication: Impact on Rapid Response Teams and Patient Safety" Providence Health System Rapid Response Team Collaborative Seattle, WA. September 26, 2005
  16. Disruptive Behavior and its Impact on Peri- Operative Services" National Peri- Operative Conference October 21, 2005 San Diego, CA
  17. "Disruptive Behavior in the Surgical Suite: Impact on Communication, Patient Safety and Clinical Outcomes of Care" Rush University Medical Center All Day Workshop November 2, 2005 Chicago, IL
  18. "Impact of Disruptive Behavior on Clinical Care" New York Presbyterian Hospital Executive Retreat April 27, 2006 New York, NY
  19. "Disruptive Behavior: Impact on Communication, Team Collaboration and Outcomes of Care" AHA/ Health Forum Leadership Summit July 15, 2006 San Francisco, CA
  20. "Implementing an Integrated Patient Safety Strategy to Improve Patient Outcomes: The Impact of Disruptive Behaviors on Patient Safety and Quality Outcomes" Health Management Congress Las Vegas, NV September 13, 2006"
  21. "The Impact of Disruptive Behaviors on Patient Safety and Quality Outcomes of Care" VHA National Transformation of the OR Collaborative Denver, CO October 9, 2006
  22. "The Impact and Implications of Disruptive Behavior in the Peri- Operative Area" American Association of Clinical Directors Anesthesiology Phoenix, AZ March 9, 2007
  23. "A Systems Approach to Improving Nurse- Physician Hospital Relationships Catholic Health Partners Cincinnati, OH All Day Workshop April 26, 2007
  24. Impact of Disruptive Behaviors in the OR" McKesson National WebEx Educational Series May 7, 2007
  25. "Disruptive Behavior and Patient Safety" John Muir Medical Center Grand Rounds Walnut Creek, CA August 3, 2007
  26. "Impact of Disruptive Behaviors on Peri-Operative Care National Peri-Operative Managers Conference San Diego, CA All Day Workshop October 3, 2008
  27. "Impact of Disruptive Behaviors on Staff Satisfaction and Morale" The 8th Annual HealthCare Service Excellence Conference Nashville, TN October 24, 2007
  28. "The Impact of Disruptive Behaviors in the OR" McKesson Surgical Services/ OR Manager Webinar November 6, 2007
  29. "The Impact of Disruptive Behaviors in the OR" Mayo Clinic Franciscan Skemp Hospital March 4, 2008 LaCrosse, WI
  30. "The Impact of Physician/ Nurse/ Staff Relationships on Clinical Outcomes of Care" Joint Commission Peri- Operative Care Symposium April 28, 2008 Chicago, IL
  31. "The Impact of Physician and Staff Disruptive Behaviors on Clinical Outcomes of Care" University of Southern Nevada Pharmacy Academic Conference Salt Lake City, September 19, 2008
  32. "Disruptive Behaviors, Staff Relationships, Collaboration and Communication: Lessons Learned and Where Do We Go From Here?" Nebraska Medical Center Kearney, Nebraska October 7, 2008
  33. "How Improved Physician Behaviors Toward Staff Can Influence Satisfaction, Communication and Clinical Outcomes of Care" Health Care National Service excellence Conference Louisville, Kentucky November 6, 2008
  34. "How Improved Physician Behaviors Towards Staff Can Influence Satisfaction, Communication and Clinical Outcomes of Care" HealthStream Education Services Web Ex January 13, 2009
  35. "Impact of Disruptive Behavior on Patient Safety" Mercy Hospital Monroe, MI April 29, 2009
  36. "Disruptive Behavior and Its Impact on Staff Relationships" Doctors Hospital San Pablo, CA May 20, 2009
  37. "Disruptive Behaviors and Patient Safety" Community Hospital of Monterey Medical Staff/ Administrative Executive Retreat August 13, 2009 Monterey, CA
  38. "Impact of Disruptive Behaviors on Patient Safety" Altura Health System Healthcare Horizons National Nursing Conference Oct 13, 2009 Grand Forks, ND
  39. "Disruptive Behavior and Its Impact on Interdisciplinary Collaboration" Institute of Medicine (IOM), Robert Wood Johnson Nursing Forum on the Future of Nursing Cedars Sinai Medical Center LA, CA October 18, 2009
  40. "Conflict in Healthcare: The Impact of Disruptive Behaviors on Quality Care and Patient Safety" Emerging Healthcare Communities Retreat Pescadero, CA January 14, 2010
  41. "Impact of Disruptive Behaviors on Staff Relationships and Patient Care" Minnesota Group Management Association St. Paul, MN March 2, 2010
  42. "Addressing Disruptive Physician Behaviors to Improve Relationships, Process Flow and Patient Outcomes" American Group Management Association March 20, 2010 New Orleans, LA
  43. "Addressing Disruptive Behaviors: Strategies to Improve Work Relationships and Patient Outcomes of Care" Allegiance Health MI March 16, 2010
  44. "Addressing Disruptive Physician Behaviors to Improve Relationships, Process Flow and Patient Outcomes" Sanford Health System Sioux Falls, SD June 23, 2010
  45. "Addressing Disruptive Behaviors: Strategies to Improve Work Relationships and Patient Outcomes of Care" Trinity Health System Detroit, MI June 9, 2010 (perinatal)/ October 20, 2010 (Perioperative)
  46. "Disruptive Physician Behavior and Its Impact on Staff Relationships, Recruitment and Retention" American Society of Physician Recruiters Aug 17, 2010 San Antonio, TX
  47. "Disruptive Behavior in Healthcare- Searching Out Practical Solutions: Impact and Implications" California Society of Health Lawyers November 12, 2010 San Francisco, CA
  48. "The Impact of Disruptive Physicians and Poor MD/RN Communication on Patient Care and Staff Well Being" Keynote Address VHA Upper Midwest Patient Safety Conference Minneapolis, MN April 5, 2011
  49. "Addressing Disruptive Behaviors and Impaired Communication in the OB/ GYN Setting" OBGYN.net podcast April 13, 2011
  50. Factors Contributing to Unprofessional/ Disruptive Physician Behaviors: Strategies and Solutions MGMA Annual Conference Las Vegas, NV Oct. 23, 2011
  51. Series of Case Examples on Disruptive Behavior Quantia MD/ ACPE Webcast June 2012
  52. "Addressing Disruptive Behaviors and Their Negative Impact on Staff Relationships, Communication Efficiency and Patient Safety" Eisenhower Medical April 5, 2012 Palm Springs, CA
  53. "Physician Stress and Burnout: Cause, Effect and What Can be Done" Association of Staff Physician Recruiters Annual Conference August 15, 2012 Los Angeles, CA
  54. "Understanding and Addressing Disruptive Behaviors: Best Practices" HealthLeaders Web Cast September 17, 2012
  55. "Surgeon Burnout" American College of Orthopedic Surgeons National Conference on Practice Management in an Era of Health Care Transformation September 28, 2012 Chicago, IL
  56. "Physician Stress and Burnout: Cause, Effect, Cost and What Can Be Done About It" American Public Health Association 140th Annual Meeting Oct. 30, 2012 San Francisco, CA
  57. "Addressing Disruptive Behaviors and Their Negative Impact on Staff Relationships, Communication Efficiency and Patient Safety" Samaritan Health Oct 21, 2012 Newport, OR
  58. "Addressing Disruptive Behaviors Workshop" Veteran's Administration Hospital San Francisco, CA December 4, 2012
  59. "Physician Stress and Burnout: What You Can Do?" Stamford Hospital Medical Staff Retreat Stamford, CT February 27, 2013
  60. "Engagement Strategies to Improve Physician Communication and Collaboration" Oregon Health Quality Network Webinar April 16, 2013
  61. "Conflict Resolution Skills to Increase Collaboration, Patient Safety and Quality of Care" American College of Healthcare Executives Web Seminar July 17, 2013
  62. "Addressing Disruptive Behaviors and Their Negative Impact on Staff Relationships, Communication Efficiency and Patient Safety" Bon Secours Good Samaritan Regional Medical Center Suffern, NY Web Seminar September 25, 2013
  63. "Addressing Disruptive Behaviors and Their Negative Impact on Staff Relationships, Communication Efficiency and Patient Safety" Brooke Army Medical Center San Antonio, TX September 27, 2013
  64. Impact of Stress and Burnout on Staff Satisfaction, Institutional Morale, and Behaviors Affecting Quality of Patient Care University of Rochester Medical Center November 18, 2013
  65. "Physician Stress and Burnout: Provider Impact and What We Can Do" Illinois State Medical Society Educational Series Chicago, Ill January 10, 2014
  66. "A Multidirectional Approach to Improving Communication in the Health Care Delivery Team" PerfectServe Ask the Expert Seminar Knoxville, TN January 22, 2014
  67. "Addressing Disruptive Behaviors That Impact Peri-operative Care" Patient Stream Educational Series Seattle, WA January 24, 2014