Nurses In Operating Room
07 February 2017

Rudeness May Cause A Surprising Amount Of Medical Errors

Why do doctors make mistakes? As researchers at Johns Hopkins University have found, over 250,000 deaths in the United States can be attributed to medical errors every year. These mistakes run the gamut from momentary lapses of attention to systemic breakdowns in communication between nurses and surgeons.

How Incivility In The Operating Room Hurts Patient Care

Over the last few decades, many members of the medical community have struggled to establish new guidelines that could promise a reduction in medical errors and unnecessary patient harm. Progress has been slow, however. Thus far, researchers have disagreed on why some medical professionals commit errors and why particular doctors appear to make far more mistakes than others.

One possible answer? Rude patients and co-workers. In fact, according to University of Florida professor Amir Erez and his doctoral student Trevor Foulk, rudeness may increase the likelihood of a medical error by nearly 40%.

Physician and nurses in surgery

In a new study published by Pediatrics, Erez and Foulk found that exposing teams of doctors and nurses to rude behavior significantly impacted a medical team’s performance, leading to higher rates of misdiagnosis, poor information sharing and ill-conceived therapy plans.

“Berated” By Actor, Doctors & Nurses Misdiagnose & Mistreat

To conduct their study, the 2 researchers ran 39 groups of  Neonatal Intensive Care Unit (NICU) professionals from Israel through a simulation of acute child care. Each team – made up of 2 doctors and 2 nurses – had to diagnose and properly treat a variety of emergency health conditions in an infant mannequin. One half of the teams were exposed to rudeness: an actor playing the part of the baby’s mother berated the doctors and nurses as they worked. The other half of the teams were treated in a civil manner.

Surprisingly, rudeness had an extreme effect on a NICU team’s performance. Teams exposed to uncivil behavior and disrespectful comments were much worse at diagnosing the infant mannequin’s symptoms and more likely to choose inappropriate treatments. The teams who had been treated rudely also performed poorly on measures of teamwork, communicating less and sharing fewer important details with their co-workers.

In order to reverse the effects of rudeness, Ezra and Foulk included an “intervention” designed to raise the professionals’ cognitive defenses against experiences of anger or aggression. One team of doctors and nurses was put through a cognitive bias modification program before the simulation began. These doctors and nurses, even though they were exposed to the “berating mother,” performed just as well as teams in the experiment’s control arm – who had been treated with civility. In an interview with the University of Florida, Professor Erez said: “it’s really shocking how well it worked. They were basically immunized from the effects of rudeness.”

Demeaning Colleagues Have Damaging Effects

In previous research, Erez and Foulk have already found that rudeness from a colleague or authority figure can reduce the performance of medical professionals in drastic ways. For a 2015 Pediatrics study, the University of Florida researchers gathered 24 teams of NICU professionals from 4 hospitals in Israel. Each team – comprised of 1 physician and 2 nurses – was run through a lengthy simulation in which they treated an infant mannequin for progressive medical emergencies, including severe respiratory failure.

Along the way, 12 of the NICU teams were exposed to rude behavior. Before beginning the treatment simulation, these 12 “experimental” groups participated in a teleconference in which a US doctor said he was “not impressed with the quality of medicine in Israel.” As the simulation progressed, the American physician continued to express his displeasure with the state of Israeli medicine. Groups assigned to the experiment’s “control” arm, on the other hand, were treated with civility and respect.

In the end, the teams who had been treated rudely were far less likely to come up with correct diagnoses and far more likely to implement the wrong treatment methods or implement the right treatment methods poorly. In fact, Erez and Foulk concluded that rudeness could explain more than 50% of diagnostic inaccuracies and 43% of procedural performance errors.

Vast Majority Of Employees Treated Poorly

Incivility is everywhere. In polls conducted by the Harvard Business Review, researchers have found that 98% of employees – from every industry – report being treated poorly at work. Half of employees say they become the target of uncivil behavior at least once a week. Rudeness has a real effect on job performance. We all react badly to being treated in a demeaning way. Harvard’s polling data shows that at least 50% of employees are willing to admit that they “deliberately decrease their effort or lower the quality of their work” after being treated rudely.

Why would physicians or nurses be any different?

Most recent discussions of medical errors have focused on changing the framework in which doctors and nurses diagnose and treat patients. Technology is often the emphasis here, with its promise to integrate the work of doctors, nurses and specialists – all of whom may treat the same patient, but rarely consult one another. Implementing new technologies and refining healthcare systems, however, has led to only meager results in patient safety. Erez and Foulk think that patient safety advocates may be focusing too much on systemic changes in the healthcare system, while neglecting human and relationship factors, like the “incivility that runs rampant in health care organizations.”

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