Rudeness: A care quality issue

For many people, rude behavior is no more than an unwelcome nuisance. But for those in healthcare, the consequences can be far more detrimental. 

From impolite behavior to violence, rudeness is on the rise, The Atlantic's Olga Khazan reports. This is likely driven by increased stress and isolation from society — which the ongoing pandemic doesn't help.

The healthcare industry is not immune to this trend. Hospitals across the country are reporting an uptick in disrespectful, discriminatory or violent behaviors from patients. Nearly 24 percent of physicians have experienced workplace mistreatment in the past year, including verbal mistreatment or abuse, according to a study published May 6 in JAMA Network Open. 

Rude or inappropriate behavior from patients, family members or colleagues is not only linked to burnout among clinicians but may also hinder their performance, a growing body of research shows. 

The Joint Commission has routinely warned of the effect poor behaviors can have on healthcare teams' performance and urged organizations to address and prevent workplace violence. "Workplace violence is not merely the heinous, violent events that make the news; it is also the everyday occurrences, such as verbal abuse, that are often overlooked," The Joint Commission said in a June 2021 sentinel event alert. "Intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators and managers to seek new positions in more professional environments," it said in a separate alert.

A study published in Pediatrics involving 24 neonatal intensive care unit teams across four hospitals in Israel found being exposed to rudeness adversely affected team members' diagnostic and procedural performance. The NICU teams participated in a training simulation involving a preterm infant whose condition acutely deteriorated due to necrotizing enterocolitis. Team members were then randomly subjected to either rudeness, which included mildly rude statements unrelated to their clinical performance from an outside expert, or a control group, in which they were exposed to neutral comments from the outside expert. After the outside expert review, the team members continued treating the infant in the training simulation. 

Team members exposed to rudeness had lower scores for diagnostic and procedural performance. Researchers said rudeness alone accounted for nearly 12 percent of the variance in clinical performance between the two cohorts. 

A separate study published in BMJ Quality & Safety found clinical teams exposed to incivility in simulated operating room situations scored lower on every performance metric compared to a control group. Incivility affected clinical teams' vigilance, diagnosis, communication and patient management.

It's worth noting that both studies were published before the pandemic and the increasing politicization of medicine. Since then, encounters with poor behavior have only become more common, especially in the era of mask mandates, vaccine requirements and other public health rules. 

"Although the rude behaviors regularly experienced by medical practitioners can seem benign, our findings indicate that they may result in iatrogenesis, with potentially devastating outcomes," the authors of the Pediatrics study said. "In taking steps to enhance patient safety, policy makers should begin to consider the role played by the subtle and seemingly benign verbal aggression to which medical professionals are subjected on a routine basis." 

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