How Rudeness Between Health-Care Workers Can Cost Lives

Published on April 18, 2017

We all encounter rudeness at work from time to time. I’m talking about the minor incivilities that transpire both publically and privately – the brusque dismissal of an idea, the oblique suggestion of incompetence, or unvarnished disrespect. We tell ourselves to “brush it off” or “get over it.” But studies show that we don’t – and that in health care, that costs lives.

Researchers in Israel analyzed 24 neonatal intensive-care teams (physicians and nurses) doing a training exercise to diagnose and treat a premature newborn whose health was rapidly deteriorating because of necrosis of the intestines. (It was a mannequin, not a real baby.) One group of teams received an introduction from an observing ICU chief from the U.S. who stated that he was “not impressed with the quality of medicine in Israel” and that Israeli medical staff “wouldn’t last a week” in his department. The other teams received neutral comments about improvement.

The teams randomly exposed to incivility made significantly more diagnostic errors (e.g., not recognizing bowel perforation) and treatment errors (e.g., improperly ventilating the baby). Analysis of videotapes showed that reduced collaboration and communication (like information sharing and help-seeking) accounted for the inferior performance.

How can two snide comments sabotage the ability of experienced clinicians? And would this disrespect be more damaging if it came from a colleague they saw on a regular basis? The authors explain that rudeness interferes with working memory, “which is the ‘workbench’ of the cognitive system where most planning, analyses, and management goals occurs.”

Being “tough” in these situations sounds great, but it’s not the psychological reality – even for those who think they are immune. The cloud of negativity will sap resources in their subconscious, even if their self-affirming conscious mind tells them otherwise.

At work, direct confrontation is often ineffective and can be career suicide. Prof. Christine Porath of Georgetown University writes that “the most effective way to reduce the costs of incivility in the workplace is to build a culture that rejects it—to adopt ‘the no a**hole rule,’ as Robert Sutton calls it in his best-selling book by that name.”

Culture has a million definitions, but this is the one that sticks: Culture is the worst behavior that a leader will tolerate. Leaders who are committed to rooting out incivility first need to look for it (e.g., 360-degree assessments by the rank and file).

Teamwork and communication training that creates a culture of respect and learning is essential to achieve the maximal potential of any group. Prof. Porath warns, “Don’t assume everyone knows how to be civil; many people never learned the basic skills.” But if training or remediation prove ineffective for the small minority who make this an issue in the first place, healthcare leaders need to dismiss them. It may hurt to lose a high-earner or “star.” But the business and ethical case is quite clear: It hurts a lot more to keep them around.

Dr. Gurpreet Dhaliwal is a professor of medicine at the University of California, San Francisco and a staff physician at the San Francisco VA Medical Center.

Back to Posts »