How Healthcare Team Incivility Impacts Patient Safety
Healthcare systems rely on clinical teams to assess, diagnose and treat patients each day. To avoid medical error and enhance patient safety, these teams must be able to effectively and efficiently communicate and work together. However, when medical teams’ staff members struggle to cooperate and work together in a professional manner, situations can arise that ultimately put the patient at risk. For example, Chris Turner’s TED Talk, “When Rudeness in Teams Turns Deadly,” explains how colleague treatment across healthcare can have potentially fatal consequences.
A consultant in emergency medicine at University Hospitals Coventry & Warwickshire and safety lead, Turner began his TED Talk presentation with a healthcare simulation scenario. He described a situation where a 4-year-old girl came to the hospital with shortness of breath. At the foot of her bed, the doctors met on what to do next and the discussion became heated. Ultimately, they decided on maximum drug therapy, deciding not to assist with breathing at that time.
There were no pediatric nurses in this department overnight, and one of the adult nurses had a question about the administration of aminophylline, the medication prescribed. Busy, the attending doctor snapped at the nurse when asked one question after another. As a result, the nurse took a step back and connected the drug through the pump and tubing and into her arm. Over the next half-hour, she received 15 to 20 hours’ worth of aminophylline.
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“You can only investigate so many of these when you know that the people involved are knowledgeable, good, diligent professionals before you realize that you must be missing something,” Turner said. “I was missing this: Process is written on paper, but practice happens between individuals and in the environment and I simply wasn’t respecting the complacency of the situation.”
Although Turner still believes that process has a place in healthcare, people are more important. This is demonstrated by the 2015 study by Arieh RIskin and Amir Erez, titled “The Impact of Rudeness on Medical Team Performance: A Randomized Trial.” During this study, 24 NICU teams participated in a clinical simulation involving a preterm infant whose condition acutely deteriorated due to necrotizing enterocolitis.
According to the landmark research, participants were informed that a foreign expert on team reflexivity in medicine would observe them. Teams were randomly assigned to either exposure to rudeness (in which the expert’s comments included mildly rude statements completely unrelated to the teams’ performance) or control (neutral comments). The videotaped clinical simulation sessions were evaluated by three independent judges (blinded to team exposure) who used structured questionnaires to assess team performance, information-sharing and help-seeking.
Ultimately, the results showcased that composite diagnostic and procedural performance scores were lower for members of teams exposed to rudeness than to members of the control teams. Specifically, rudeness alone explained nearly 12% of the variance in diagnostic and procedural performance. Therefore, researchers were able to conclude that rudeness had adverse consequences on the diagnostic and procedural performance of the NICU team members.
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“They found unsurprisingly that we grade on a curve. We grade from the truly fantastic care that we all want for ourselves and our loved ones all the way around to the catastrophic care where patients die unnecessarily,” Turner explained. “They found that one factor was responsible for 40% to 60% of that variance: and that’s incivility or rudeness.”
Further, Turner added that the single most important factor to determine if a team is competent is how they treat each other. He explains how when someone is rude to another person, they are making them feel inferior.
“On average when someone is rude to us in a mild to moderate way our bandwidth reduces by 61%. Then we cart it with us through the day,” Turner said.
Further, there is a common notion that the way someone treats the last person will be the way they treat the next person. Turner explains this is why onlookers are also impacted by rudeness. According to his presentation, there is a 20% decrease in staff onlookers’ performance after an instance of rudeness is observed. They will reportedly be 50% less likely to help others as well.
“This stuff is simply contagious,” Turner stressed. “By choosing to behave in ways that value and respect the people around us, we help individuals and teams to perform at their peak. In my world, civility can literally save lives.”
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Lance Baily, BA, EMT-B, is the Founder & CEO of HealthySimulation.com, which he started while serving as the Director of the Nevada System of Higher Education’s Clinical Simulation Center of Las Vegas back in 2010. Lance is also the Founder and acting Advisor to the Board of SimGHOSTS.org, the world’s only non-profit organization dedicated to supporting professionals operating healthcare simulation technologies. His co-edited Book: “Comprehensive Healthcare Simulation: Operations, Technology, and Innovative Practice” is cited as a key source for professional certification in the industry. Lance’s background also includes serving as a Simulation Technology Specialist for the LA Community College District, EMS fire fighting, Hollywood movie production, rescue diving, and global travel. He and his wife Abigail Baily, PhD live in Las Vegas, Nevada with their two amazing daughters.
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