The Cost of Rudeness in Healthcare and How to Mitigate It

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.