Imagine a serious car accident. A team of doctors and nurses work in unison treating an acutely injured patient. While focused on saving the patient’s life, a lead physician comments that she is unimpressed with the work of the team. Could that one off-hand comment in the heat of a stressful situation damage performance? If you think it could, by how much?

The answer is 52% according to a recent peer-reviewed study in the journal, Pediatrics. This study was an experiment using a real training simulation of a life-or-death situation. Misdiagnoses, difficulty remembering instructions, improper ventilation, and not asking for help when needed were all linked to a rude comment given by an observing physician. As we grapple with reducing medical errors, currently the third leading cause of death, we must confront the interpersonal factors that lead to mistakes.

The rude comment study looked at the effect of only one instance of rudeness or poor manners. Experience, research, and common sense tell us there are many perpetrators of rudeness frequently leading to toxic environments. Often, these people are talented physicians, nurses, or other high-performing team members. Their repetitive acts of rudeness—or even cruelty—are overlooked because of their contributions. In this way, bullies, jerks, or sometimes-rude-people, leverage power while hurting others.

Whether it’s serial perpetrators of abuse or a person who occasionally makes a hurtful remark, these behaviors directly harm patient care. Experiencing bullying and rudeness, whether as the victim or an observer, is like catching a cold or flu. The incident gradually pulls energy away from our working memory and makes us feel unsafe—consequently draining our attention and energy as we focus on avoiding additional attacks instead of caring for patients.

Bullying and rudeness also indirectly harms patient care through instability and turnover. Because rudeness is contagious, a few rude employees can create an environment where employees attack each other in order to survive. When people are more focused on protecting themselves from psychological harm than patient care, medical errors increase.

Further, an environment of rudeness and bullying will lead employees to question their employment. In fact, upwards of 60% of bullying victims leave their employer. Newer and more junior employees are more likely to be the targets of rudeness and bullying—making training and developing new talent difficult. This highlights a huge problem for talent retention as more than 1 in 7 healthcare professionals report being the target of repeated bullying, and more than 40% of newer nurses report chronic bullying. This turnover creates unstable teams and environments with a greater rate of medical errors and malpractice claims.

A problem as large as this needs multiple solutions. Whether rudeness is mild and widespread across teams, or there’s a pattern of bullying by a few employees, the problem starts with culture and spreads outwards to your organization’s expectations, policies, and how you hire and select new employees. Here are some possible solutions:

1. Define your culture

Strong and healthy cultures start with clear definitions of success based on the values and beliefs of leadership. These definitions shouldn’t end with patient care and market positioning. They should include clear expectations about how people should care for and treat one another—and beliefs about how success is achieved. Define what your organization promises to provide employees. This could include how you will provide an environment that allows people to grow, flourish, and work as a team. Culture statements can also include promises you expect from employees with specific definitions of how you define respect, manners, and teamwork.

2. Live your culture

Often, discussions of bullying start with policy instead of examining the causes. For example, some healthcare organizations have established codes for rudeness and bullying similar to codes for other emergencies. While this is admirable, starting with culture first and building policies to support your beliefs about success is more likely to help you achieve your goals.

With your culture and expectations of employees defined, surveys, focus groups, and other information gathering strategies can help uncover root causes for mistreatment. Perceptions of unfair treatment, competition for scarce resources (or resources that are perceived as scarce), and an inability to cope with patient and family demands can all lead to an environment that breeds rudeness and bullying.

By objectively looking for the root causes of the problem, you can address it in ways that reflect your culture and what you want to achieve. Objectively looking at who is being victimized can help you target interventions at specific departments or job groups. It may also be possible in an anonymous survey, perhaps completed by a third party, to get the “jerks” or bullies to self-report their behavior—leading to an understanding of what drives the problem.

3. Hire the right fit

One solution to bullying and rudeness is to simply not hire the “jerks” in the first place. By defining your culture and values, you can ensure only people that meet your expectations for treating others—both team members and patients—are hired.

For example, you can build structured behavioral interviews that measure how candidates treat others in challenging situations frequently encountered on the job. By working with your HR team or a firm specializing in talent acquisition and pre-employment assessments, you can implement science-based assessments to increase your odds of selecting quality hires: People who perform in ways aligned with your culture, fit your values and beliefs for how people should be treated, and who will ultimately stay and thrive.

Taking a culture-first perspective to diagnosing and addressing the reasons for rudeness and bullying, combined with hiring the right people, will ensure you achieve not only your intended patient experience, but build stable teams committed to your vision for care.

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