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.
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