Could rudeness in the workplace increase patient mortality?

Sounds extreme? Many of us will have experienced inappropriate behaviour in the workplace. In fact, two thirds of operating room staff have witnessed rude behaviour and nearly one half have been on the receiving end of it. But could it result in increased patient mortality?

RCT of medical rudeness
A recent study ‘The Impact of Rudeness on Medical Team Performance: A Randomised Trial’, published in Paediatrics last September suggests this may indeed be the case. Researchers found that a rude comment from a third party doctor decreased performance of doctors and nurses by more than 50% in an exercise involving a hypothetical life-or-death situation.

“We found that rudeness damages your ability to think, manage information, and make decisions,” said Amir Erez, the author of the study. “You can be highly motivated to work, but if rudeness damages your cognitive system then you can't function appropriately in a complex situation. And that hurts patients.”

For the experiment the researchers gave 24 medical teams - each composed of one doctor and two nurses - an hour to diagnose and treat a simulated case of necrotising enterocolitis. The researcher told the teams that an expert from the United States would be watching their progress via webcam. At the start, the ‘expert’ was conferenced in and a pre-recorded message was played to the teams. Half the teams received a message that said the observer had been watching other teams and was ‘not impressed by the quality of medicine in their country’. Control groups were simply told that he had observed other teams, without any rude comments. Ten minutes into the simulation, another expert recording was played, telling the control group that he hoped the simulation was helping them improve as physicians. The other teams, however, were told that the physicians and nurses he had been observing ‘wouldn’t last a week’ in his department.

The rudeness experienced by half the teams had a profound effect on the outcome. Those who were exposed suffered a severe drop in performance, making incorrect diagnoses, struggled with communication and teamwork, asking for incorrect drugs, demonstrated poor ventilation technique and failed to ask for help at an appropriate time. Overall, the rude comments led to a 52% difference in success at diagnosis and 43% difference in treatment success. The assessment was made by 3 independent assessors who were blind to the study’s thesis. In real world situation, as Erez pointed out, these performance deficits could be the difference between a patient living or dying.

Postponing emotions
Erez expected that the more experienced staff would bounce back from the rude comments and keep working as a team, especially as the situation was an emergency one. “But we found consistently and dramatically that rudeness isn't something people can easily get over,” he says. “It's not something that you can postpone emotionally to a later time because it affects the cognitive system.” You don't even have to be the target of the bad behaviour - merely witnessing rudeness results in cognitive decline.

People spend time and energy processing why rude comments were made to them, and how it affects them, taking crucial mental resources from the task at hand. This lack of focus could literally be life threatening to the patient involved. Previous work by Erez has revealed that rudeness can spread through teams like a virus, resulting in a culture of negativity threatening patient safety.

Call to action
We all need to be aware of the direct and indirect effect this negative behaviour has on our teams, both immediately and - in the longer term - on team functioning and culture. It is our responsibility to not only model positive behaviours, but to call out others who are rude, or think that it is OK to behave in a way that is harmful to our colleagues, teams and patients.

Is this important?
Join the positive leadership movement; talk about the issues
Share with colleagues and share/like on social media so word spreads
Be the change you want to see in our health care systems

Discuss...

FHPC: 4 ways to make the world a better place

I'm a firm believer of embracing creativity in life. That is creativity both as a pursuit outside of medicine as well as approaching the challenges of our work in a creative way. 'We've always done it that way' is one of the most dangerous phrases in the English language.

George Mpanga is a spoken word artist from humble beginnings in inner city London. He began rapping as a teenager, went on to study politics, psychology and sociology in Cambridge. He subsequently won a social enterprise competition and used his $30,000 prize money to fund a series of secondary school poetry workshops for underprivileged children in London.

'I think rappers are primarily expected to make money for the industry and provide party soundtracks, but obviously there are exceptions and grey areas. The poet’s 'role' is usually to provide thoughtful social commentary'

George provides us with a framework for life in the video below, urging us to consider 4 things before we speak or act.

Is it Fair?   Is it Honest?   Is it Positive?   Is it Creative?

If you can answer yes to all four, then your words and actions are likely to be sustainable and lead to a better world.

'Do you ever question your plan of action; or are you just on a quest for satisfaction?'

More on his website or Facebook page.

Organisational culture

As a leader, you are building the culture every single moment of every single day in your organisation. Your behaviour more than any other single thing creates the culture of your workplace. People look at you and say 'OK, that's what he or she expects'

If you're a junior doctor, the medical students learn from you, if you're a registrar both the medical students and the RMOs are watching how you behave and will emulate the words you use, the way you approach workplace relationships and how you treat others. As a consultant, will be expected to have the courage to both do the right things and pull up those whose behaviour is unacceptable.

Leadership character starts with you.

Discuss...

Seeking fulfillment and happiness?

How can you be happy in your daily work? What makes your job fulfilling? Wouldn't it be amazing to have a job where you gain fulfillment every day. Where you feel a bond with those around you and you know that you are working to a common goal. The irony is that in a world where we are becoming less physically connected - the answer lies in the PEOPLE we spend our days with, not the actual work we do.

Fulfilment and happiness in life comes not from what you are doing, but the fact that you are helping someone else. Giving and gratitude are the keys to happiness. Sounds corny I know, but stick with me on this one!

When you get a thank you card from a patient at work, or when they gush over you the next day, thanking you for your successful operation or the medical intervention you did, how good does that feel? Don't you go home and feel good about yourself, happy that you have done something for a fellow human being and that it has been acknowledged. Even when it's not acknowledged or the patient doesn't seem particularly grateful, you still have that warm feeling inside - not because you did a technically sound procedure (OK, well maybe a little bit of that) - but because you know you have helped someone.

It's not just about our patients; when you take the extra 10 minutes to teach your medical student, you can see they are hanging on your words and how grateful they are; when you ask a colleague if they need a hand with their job list because you finished yours. The irony is that you have more to gain by helping them than they do, because helping others makes us happy.

Give feedback
As leaders, we have to help others understand that team working isn't only good medicine, it's happy medicine and work satisfaction. We have to find ways to bring people together and help them recongise the benefits of doing so. If you are the team registrar, that means making sure your medical student and RMO have the opportunity for ownership of their work, and to give them feedback and support that acknowledges their contribution.

Every single day look for opportunities to recognise and reward individuals of your team for the good that they do. We don't do it enough and it's profoundly important to their development - and the strength of our teams as a whole.

Dealing with compliments and criticism

Feedback can be one of the most difficult and sensitive processes within any team, but it's something we all have to deal with -  after all, everyone's answerable to someone. When we are on the receiving end of feedback, compliments can make us complacent and criticism can damage our self-esteem.

Introduce your your team to the concept that when they receive feedback, not to see it as a simple two dimensional result, rather ask what they can DO with it. In other words, what needs to stay the same as it is now, and what needs to change?

M Krogerus & R Tschäppeler

When you get feedback, don't just think about what went well or what wasn't so good. You have to consider how you are going to react. Organise the feedback you received under the headings of the matrix above. Which criticisms prompt you to take action? Which suggestions can you ignore?

By doing this, you'll be able to take the feedback in the way it was (hopefully) intended & come up with a considered plan of action. You can also use the matrix when constructing feedback for others.