Rudeness and Medical Team Performance

Study Questions:

What are the effects of rudeness on a medical teams’ performance?

Methods:

This study included 39 neonatal intensive care teams who participated in acute care simulations. In each workshop, two teams were randomly assigned to either an exposure of rudeness (in which the comments of the patient’s mother included rude statements completely unrelated to the teams’ performance) or a control condition (neutral comments). Two additional teams were assigned to rude comments, but also had a preventive cognitive biased modification or therapeutic narrative intervention. Simulations were evaluated by two independent judges, blinded to team exposure. Judges used structured questionnaires to assess team performance.

Results:

Rudeness had adverse consequences not only on diagnostic and intervention parameters (mean therapeutic score 3.81 ± 0.36 vs. 4.31 ± 0.35 in controls, p < 0.01), but also on team processes (such as information and workload sharing, helping, and communication) central to patient care (mean teamwork score 4.04 ± 0.34 vs. 4.43 ± 0.37, p < 0.05). Cognitive-based modification mitigated most of the adverse effects of rudeness, but the post-exposure narrative intervention had no significant effect.

Conclusions:

The authors concluded that rudeness has robust, deleterious effects on the performance of medical teams. Moreover, exposure to rudeness debilitated the very collaborative mechanisms recognized as essential for patient care and safety. Interventions focusing on teaching medical professionals to implicitly avoid cognitive distraction may offer a means to mitigate the adverse consequences of behaviors that, unfortunately, cannot be prevented.

Perspective:

This well done study supports the hypothesis that rudeness impacts care. In this experiment, rudeness from patient’ families was the exposure of interest; however, it is likely that similar deleterious effects would be observed if rude behaviors were from healthcare providers. Thus, efforts to reduce rude behaviors are a key component of healthcare. Given increased stress, it is not likely that rude comments will be completely prevented; therefore, implementing effective mitigating strategies such as the cognitive-based modification intervention described in this study may be important.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Prevention, CHD & Pediatrics and Arrhythmias

Keywords: Cognition, Communication, Health Personnel, Infant, Newborn, Intensive Care, Neonatal, Patient Care, Pediatrics, Secondary Prevention, Workload


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