BLOG
The Cost of Rudeness in Healthcare and How to Mitigate It
Numerous studies across a variety of industries find that rudeness negatively impacts creativity, performance, and team morale. Not to mention, it increases employee turnover and drives customers away. Apply those consequences to the high-risk, high-stress environment of healthcare delivery (where we face a shortage of doctors and high competition for patients), and the implications are concerning.
Physicians, Advanced Practice Providers (APPs), nurses, and hospital staff regularly encounter rude behavior. Sometimes it is an impolite or demeaning comment from a patient or a patient family member. Other times, it is a negative or thoughtless jab from a colleague. The unfortunate truth is that rude behavior pervades many organizations. Rudeness does not just hurt our feelings; it negatively impacts our ability to do our jobs and it puts our patients at risk.
Numerous studies across a variety of industries find that rudeness negatively impacts creativity, performance, and team morale. Not to mention, it increases employee turnover and drives customers away. Apply those consequences to the high-risk, high-stress environment of healthcare delivery (where we face a shortage of doctors and high competition for patients), and the implications are concerning. If we want to lead successful hospitals and hospital teams and provide excellent patient care, we cannot afford to tolerate rudeness.
A study focused specifically on the impact of rudeness on medical teams found that a rude comment by a physician decreases the performance among other doctors and nurses by more than 50%. Not only that, it also negatively impacts patient care quality and safety.
The reality is, when humans are consumed by an emotion (perhaps anger, fear, frustration, or shame), they lose the ability to focus on details and they lose perspective. An example cited in Rhona Flin’s editorial, Rudeness at Work: A Threat to Patient Safety and Quality of Care , showcases the concerning impact rudeness can have in a high-stakes industry. The example comes from the aviation industry, not healthcare.
In her example, two pilots flying a commercial flight carrying 147 passengers from San Diego to Minneapolis became so involved in a “heated discussion over airline policy” that they “lost situational awareness” and passed the airport they were meant to land at by 150 miles before a member of their cabin crew called them and they realized their mistake. This example shows how emotionally charged interactions like arguing can impact our concentration and ability to do our jobs well and care for our customers (in our case, our patients).
Keeping the immense implications of a practice culture that tolerates rudeness in mind, it is clear that it is worthwhile to take action to prevent it. Implementing strategies to reduce instances of rudeness not only improve provider satisfaction and morale, they also reduce medical errors and patient mortality rates and increate patient satisfaction and patient safety. We recommend these strategies to reduce rudeness in your practice:
Determine the most common sources of conflict in your practice: In order to prevent something, you need to understand its root cause. Common causes in healthcare include siloed communication or lack of any thoughtful communication, feeling put down by superiors, misaligned goals/rules, and a sense that there are unreasonable expectations. As a leader you can identify issues by having conversations with everyone on your staff and provider team to understand the issues they face. In turn, you can begin to take action to put strategies in place that respond to the issues they voiced, confirming that you heard your team and that they have a true voice in the operation of the practice.
Educate your team on the importance of emotional intelligence: Hospitals are full of people with extremely high IQs. Physicians, APPs, and nurses are commonly hard-driving, type A people with high IQs. However, sometimes emotional and interpersonal skills such as self-awareness, management of emotions, and empathy do not come as naturally. As a leader, you can help your team cultivate their emotional intelligence by providing communication training and creating opportunities to talk to their colleagues, get to know them (perhaps even outside of work), and to truly listen to one another in order to learn what makes them “tick” and what motivates them. The best way to engender emotional intelligence in your team is to practice what you preach. Show your team that you do not take them for granted by expressing your appreciation and truly listening to them. Show that you are self-aware by openly taking responsibility for your own errors. Above all, be kind. Kindness begets kindness.
Create a process for real-time resolution: When it comes to high-intensity conflict, it is almost-always better to address it immediately. Letting conflict simmer can turn anger into rage and frustration into apathy. Therefore, it is best to address it as soon as appropriate with the team member(s) involved. It is always best to address it calmly, avoiding direct accusation, listening, and asking questions about what happened. When addressing a tense situation, always focus on behavior, not personality and express empathy for the situation. In particularly severe situations, it is also important to calmly, clearly, and directly explain the consequences of further rude behavior.
Set ground rules for escalation and follow-up: When a team member knows how disruptive behavior will be handled, how it will be escalated, and what the eventual consequences will be, it can help deter the rude behavior from happening in the first place. It also takes personality out of the equation if discipline becomes necessary. This requires establishing a professional code of conduct. When incidents do happen, it is also important to have candid conversations with the team to learn from the experience and prevent it from happening in the future.
By taking the time to determine the most common sources of rudeness, educating our teams on the impact of rudeness, giving our team training and tools to communicate in a positive manner, and setting ground rules to resolve conflict, we can prevent incidents of rudeness and create a better work environment for our teams to deliver safer, higher quality care.
Sources:
https://www.ncbi.nlm.nih.gov/pubmed/15659998
https://www.sciencedaily.com/releases/2013/01/130130184048.htm
https://pediatrics.aappublications.org/content/136/3/487.short
https://www.ncbi.nlm.nih.gov/pubmed/18714748
https://www.nytimes.com/2017/04/10/well/family/rude-doctors-rude-nurses-rude-patients.html
The Transformative Power of Clinical Mission Work
Dr. Gicheru knew that emergency medicine would be challenging and that burnout was common. But he was determined to find an outlet that would reinvigorate him, anchor him, and give him a deeper sense of purpose. He found his answer when he began participating in non-profit clinical mission work with colleagues.
Just a few years after completing his residency in emergency medicine, CareCulture Health Partners CEO Dr. Eugene Gicheru felt the burnout so many physicians face seeping into his life. The monotonous cycle was ingrained: wake up, work, do it all again. The gap between his daily grind and a feeling of fulfillment and purpose widened. Even though he had accomplished his personal goal of becoming a physician, he felt there had to be more. He resolved to break the cycle. He always knew that it was possible to cultivate fulfilling harmony between work and life. But how?
Dr. Gicheru knew that emergency medicine would be challenging and that burnout was common. But he was determined to find an outlet that would reinvigorate him, anchor him, and give him a deeper sense of purpose. He found his answer when he began participating in non-profit clinical mission work with colleagues.
In 2010, Dr. Gicheru went on his first medical mission trip to Armenia. That trip, and the many that followed, sparked a lasting passion for service through mission work. Dr. Gicheru traveled about twice a year to serve, and for him, each trip was a rededication for his commitment to serving others. It filled the void. It blended a sense of purpose he could apply interchangeably to work and to life. And, it turned out, the renewed fervor and purpose it gave him was contagious. Today, Dr. Gicheru is able to travel with his wife Laura and 2 sons so they can experience this sense of purpose as a family.
After joining other organization’s trips for years, Dr. Gicheru co-founded his own non-profit, Great Commission Outreach (GCO). GCO’s mission is to provide high quality health care to communities in need locally and across the world. GCO evolved from encouraging the spirit of service by going on short term mission trips to a complex organization that supports communities both in the United States and all over the world. GCO’s domestic arm, Clinic for the Cities, is dedicated to partnering with churches to provide free local community clinics in the United States.
Dr. Gicheru believes all humans eventually search for meaning and purpose in their lives and for him that purpose was found through service. He enjoys seeing the clinical team members who join him on trips return to their clinical teams with the same renewed enthusiasm for the practice of medicine he experiences. The feeling is often contagious, extending to co-workers and patients and drastically improving the overall team dynamic.
To learn more about the transformative power of clinical mission work, we spoke with a colleague Dr. Gicheru inspired, Jessica Hughes Kisicki, MD, FACEP, about the way clinical mission work has transformed her approach to her life and career.
What do you find most rewarding about service?
Dr. Hughes Kisicki: Since I was a child, I have always been inclined to help people in need. I know my purpose is to serve people in need and my goal is to do that in all facets of my life. If I see an opportunity to serve someone in need, I seize it. I find it rewarding to share my knowledge, strength, and love with communities in need. It’s an incredible feeling to watch these same communities grow to be self-sustaining and thriving.
Why do you recommend that clinicians participate in non-profit clinical work?
Dr. Hughes Kisicki: I would recommend missions because serving others not only benefits the person you are serving, but also benefits the person serving. It is incredibly fulfilling to give your time, energy, and love to others. You receive far more than you give. If the world is full of servants, our world will be a better place.
How has service impacted your life at home?
Dr. Hughes Kisicki: Mission work has changed my life. I’ve always valued selflessness and mission work has enhanced my intention to live that value every day. This work has helped me see that every person has struggles and there is always an opportunity to help others. As a mom and emergency department medical director, I strive to be a servant leader in every aspect of my life. I am raising my children to be servants who are selfless and loving.
I have also found that by treating people selflessly, others have become inspired to do the same. In fact, the Guatemala trip in June 2018 will be full of people from my hospital who have become inspired to serve by seeing how we treat people and by hearing our stories. I have learned that serving is what truly matters in life, not material things.
How has service made you stronger clinical leader?
Dr. Hughes Kisicki: Service has made me a much stronger leader. I have learned to slow down and really listen to people. I have learned that it is important to inspire others to serve and grow. Every single person has a need that you can fulfill at some point, and it is very important to lift other people up. Status and material things are not important, people are. Love and strength can build people up and change their life.
Culture Check Up: How to Assess Your Emergency Department Culture
This post outlines steps to follow to assure your emergency department team is united and headed in a direction that mutually benefits the providers, staff, hospital or health system, and the patients and community you serve.
Whether you are aware of it or not, your emergency department has a unique subculture within your organization. Hopefully the subculture is positive and harmonious. If there are elements of dysfunction begin by assessing your emergency department’s current strengths, weaknesses, and opportunity areas. Outlined below are steps to follow to assure your emergency department team is united and headed in a direction that mutually benefits the providers, staff, hospital or health system, and the patients and community you serve.
Identify key stakeholders
When working to assess the culture of the emergency department, it is crucial to include everyone who works within or interfaces with the emergency department in your assessment. This includes:
Hospital administration
Hospital leaders and community providers who interface with the emergency department
Physicians and Advanced Practice Providers
Nurses and technicians
Have face-to-face conversations with key stakeholders
Once you have identified stakeholders, talk with them to clearly understand their vision, needs, and goals. The act of asking for input is itself a great opportunity to promote a culture where everyone feels valued. Start by asking:
What do you love most about your job?
What would you change that would make coming to work each day a more positive experience?
How does/can the emergency department contribute to achieving your goals/meeting your needs?
Summarize key challenges and opportunities
A collective review of answers to the questions in the previous section can illuminate core strengths and weaknesses of department culture. After you have this information, natural themes will emerge around which workflows, processes, and training need to be improved to promote a more satisfied staff and in turn safer, more cost-effective, efficient patient care. Your summary should include a full assessment of the following:
How does the community perceive the emergency department?
What are the abilities of the current clinical staff?
What is important to each stakeholder and are priorities aligned?
Physician turnover, how often are providers leaving and why?
How are physician relations with APPs, nursing staff, and techs?
What defines success?
What is the general attitude among staff?
Does the clinical staff feel supported?
Does the clinical staff feel invested?
What are the primary communication issues within the department?
Where does efficiency/throughput break down? Why?