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Creating a Healthy Practice Environment

Created Apr 20 2017, 08:00 PM by Lippincott Solutions
  • American Nurses Credentialing Center
  • healthy work environment
  • Pathway to Excellence
  • rudeness
  • ANCC
  • patient and staff well-being

Friday, April 21, 2017

In healthcare, rudeness can have consequences more far-reaching than mere annoyance or distaste. A recent article in HealthLeaders Media cited two studies that suggest bad behavior by clinical staff actually hurts patient care.

One, published in the September 2015 issue of Pediatrics, found that NICU teams exposed to an expert’s rude comments during a training exercise had lower diagnostic and procedural performance scores than teams not exposed to rudeness.

Another, published in the same journal this past January, found that when NICU teams experienced rude comments from a patient’s mother during a training exercise, diagnostic parameters, intervention parameters and team processes central to patient care — such as workload sharing, helping, and communication — suffered.

“Rudeness has robust, deleterious effects on the performance of medical teams,” researchers concluded. “Moreover, exposure to rudeness debilitated the very collaborative mechanisms recognized as essential for patient care and safety.”


Yet rudeness happens. Some say, it’s happening more than ever.

So what’s a hospital to do?

Take a page from the playbook of the Vanderbilt Center for Patient and Professional Advocacy, perhaps. As HealthLeaders Media reports, the center takes the professionalism and healthy work environment of Vanderbilt University Medical Center, Nashville, TN, and its other partners throughout the United States seriously. Consequently, chronic rudeness is not tolerated.

"There has to be a shared vision and values that aren't just around being the best,” said center director William O. Cooper, MD, MPH. “It's very important to have aspirational goals, but also that we will treat our colleagues with respect."

Otherwise, patient and staff well-being are on the line.

"If you have a nursing professional who has encountered a surgeon who, every time she brings up the surgical time-out, the surgeon says, ‘No, we're on the same page; let's just proceed,’ she may not bring it up the next time," said Dr. Cooper.

And that could have disastrous consequences.


When a professional is reported for rude or disruptive behavior by a staff member or patient, the alleged offender is notified of the complaint. If a pattern of poor professionalism develops, a trained peer messenger speaks privately with the offender in a nonjudgmental way.

According to the article, the “pep talk” goes like this: “I'm here as your peer today. I'm part of our professionalism committee. I just wanted to let you know that for some reason, your practice appears to be associated with more patient complaints than your colleagues.”

At that point, 80% of the offenders self-correct, Dr. Cooper said.

If the boorish behavior continues, however, the peer messenger is replaced with a higher-up. More likely than not, simply having someone in authority address the issue is enough for holdouts to reform their ways.


Throughout the process, the tone remains unthreatening and objective.

“By sharing information with them in a nonjudgmental way, you can really turn things around for them,” Dr. Cooper told HealthLeaders Media. Because while they may not even realize it, their rude behavior could set them up for malpractice or even harassment lawsuits.

The ripple effects for that individual,” Dr. Cooper continued, “and their coworkers and their patients are really phenomenal.”


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