The Impact of Rudeness on Medical Team Performance: A Randomized Trial - PowerPoint Presentation

Slide1

The Impact of Rudeness on Medical Team Performance: A Randomized Trial

Arieh Riskin, MD, MHA, Amir Erez, PhD, Trevor A. Foulk, BBA, Amir Kugelman, MD, Ayala Gover, MD, Irit Shoris, RN, BA, Kinneret S. Riskine and, Peter A. Bamberger, PhDPEDIATRICS Volume 136, number 3, September 2015

Powerpoint by Camille Joyce O. Cruzada, MD

Introduction

Iatrogenesis

refers to an adverse patient condition associated with medical treatment[1].Diagnostic errorsDosing errorsProcedure errors

Failure to identify and respond timely to these errors

= delay, morbidity or mortality

THE FACTS ON IATROGENESIS

Often linked to patient-related factors (eg. Age) [1,2-5]Can be caused by practitioner stressors (eg. Rudeness)[6-8]Preventable

Research has focused on patient-related factors and there is a lack of evidence on other causes of iatrogenesis

[9]

.

Relevance

Health care workers often experience incivility, mostly coming from patients

[6, 10-13]. Such treatment is speculated to affect cognitive and communication skills leading to iatrogenic events[9].This study can confirm the effect of rudeness on health care professionals and provide opportunities for prevention of iatrogenic events.

Objectives

To

explore the impact of rudeness on the performance of medical teams. Specifically, to:Determine the effect of rudeness on the diagnostic and procedural performance of medical teamsDetermine the effect of rudeness on information-sharing and help-seeking behavior of medical teams

Establish

associations

between the effect of rudeness on the performance and behavior of medical teams

Highlights

This is a

triple blind randomized clinical trialA research assistant randomized 72 neonatal intensive care unit professionals into teams and exposureAn experimenter subjected the teams to case simulations and team reflexivity exercises A panel of physicians assessed each person based on written outputs and videos of the activity

With

the assignments only known to the research assistant

Statistical analysis was done to interpret the results

Table 1. Comparison of Mean Diagnostic Performance Variables (N=72)

There is a significant decrease in diagnostic performance of medical teams exposed to rudeness

Table 2. Comparison of Mean Procedural Performance Variables (N=72)

There is a significant decrease in procedural performance of medical teams exposed to rudeness

Multivariate analysis showed rudeness is responsible for the significant ∼12% variation in diagnostic and procedural performance of the medical teams

Characteristics of the medical teams were not significantly different and cannot account for the variation in performance.

Table 3. Standardized Coefficients for Mediation Models

There is a significant decrease in information sharing and help-seeking behavior in medical teams exposed to rudeness

Information sharing has a significant positive relationship with diagnostic performance

Help-seeking has a significant positive relationship with procedural performance

Rudeness decreased diagnostic performance by reducing information sharing and decreased procedural performance by reducing help-seeking

Conclusion

Rudeness decreases both diagnostic and procedural performance

Rudeness decreases both information sharing and help-seeking behaviorRudeness decreases diagnostic performance by reducing information sharing and decreases procedural performance by reducing help-seeking behavior

Acts of rudeness disrupt the performance of the medical team and the collaborative processes that can overcome errors, increasing the risk for iatrogenic events.

[1] Kugelman A, Inbar-Sanado E, Shinwell ES, et al. Iatrogenesis in neonatal intensive care units: observational and interventional, prospective, multicenter study. Pediatrics. 2008;122(3):550–555

[2] Kanter DE, Turenne W, Slonim AD. Hospital-reported medical errors in premature neonates. Pediatr Crit Care Med. 2004;5(2):119–123[3] Ligi I, Arnaud F, Jouve E, Tardieu S, Sambuc R, Simeoni U. Iatrogenic events in admitted neonates: a prospective cohort study. Lancet. 2008;371(9610): 404–410[4] Sharek PJ, Horbar JD, Mason W, et al. Adverse events in the neonatal intensive care unit: development, testing, and findings of an NICU-focused trigger tool to identify harm in North American NICUs. Pediatrics. 2006;118(4): 1332–1340

[5] Ligi I, Millet V, Sartor C, et al. Iatrogenic events in neonates: beneficial effects of prevention strategies and continuous monitoring. Pediatrics. 2010;126(6). Available at: www.pediatrics.org/cgi/ content/full/126/6/e1461

[6] Rosenstein AH, O’Daniel M. A survey of the impact of disruptive behaviors and communication defects on patient safety. Jt Comm J Qual Patient Saf. 2008;34(8): 464–471

[7] Leroyer E, Romieu V, Mediouni Z, Bécour B, Descatha A. Extended-duration hospital shifts, medical errors and patient mortality. Br J Hosp Med (Lond). 2014;75(2):96–101

[8] Starmer AJ, Spector ND, Srivastava R, et al; I-PASS Study Group. Changes in medical errors after implementation of a handoff program. N Engl J Med. 2014; 371(19):1803–1812

[9] Suresh G, Horbar JD, Plsek P, et al. Voluntary anonymous reporting of medical errors for neonatal intensive care. Pediatrics. 2004;113(6): 1609–1618

[10] Blum LA, Hunt DW, Hanks J, et al. Rude awakenings. Emerg Med Serv. 1995; 24(5):31–34, 73–75, 80–85

[11] Flin R. Rudeness at work. BMJ. 2010;340: c2480

[12] Grandey AA, Dickter DN, Sin H. The customer is not always right: customer aggression and emotion regulation of service employees. J Organ Behav. 2004; 25(3):397–418

[13]Ringstad R. Conflict in the workplace: social workers as victims and perpetrators. Soc Work. 2005;50(4): 305–313

References: