We use the strongest current evidence when we treat our patients.

So why don’t we utilize scientific evidence when it comes to our workplace culture?

A review of the scientific literature offers a deeper understanding of interpersonal dynamics.

These selections can help you get started.

 

 

The Prevalence

 

Johnson C. Bad blood: doctor-nurse behavior problems impact patient care. Physician Exec. 2009;35(6):6–11.

This special report outlines the results of a 2009 survey by the American College of Healthcare Executives (ACHE). It offers great insight into the prevalence of workplace abuse and the differences between the experiences of physician and nursing populations.

 

Cook JK, Green M, Topp RV. Exploring the impact of physician verbal abuse on perioperative nurses. AORN J 2001; 74: 317-20, 322-7, 329-31.

This survey of perioperative nurses reveals shockingly high rates of verbal abuse inflicted upon nursing staff in the operating room. Over 91% of respondents experienced verbal abuse annually; about 1 in 4 nurses experienced abuse several times per week.

 

Villafranca A, Hamlin C, Parveen D, Jacobsohn E. Bullying and incivility in the operating room: survey responses from 7,465 clinicians. Anesthesiology 2016: A3109 (abstract).

This large survey of surgical clinicians was distributed by Canadian researchers in several countries. It found nearly 98% of these healthcare workers experienced abusive behavior annually. While this abstract never became a full manuscript, the authors went on to later publish an even more comprehensive review article.

 

Mullan CP, Shapiro J, McMahon GT. Interns’ experiences of disruptive behavior in an academic medical center. J Grad Med Education 2013; 5: 25-30.

This survey of intern physicians at a single institution in Boston, MA reveals interesting trends in behavior. It comes as no surprise that interns experienced more disrespect than their attending physicians. However, you might not have guessed who they named as the biggest perpetrator: nurses.

 

Goettler CE, Butler TS, Shackleford P, Rotondo MF. Physician behavior: not ready for “Never” land. Am Surg 2011; 77: 1600-5.

Data extracted from a hospital event reporting system was analyzed and offered some insights. It suggests the minority of physicians are reported for behavioral issues, with repeat offenders accounting for the majority of complaints. The authors claim a large percentage of reports were unfounded, leading to an important question: who actually litigates accusations of misconduct?

 

 

The Effect on Clinicians

 

Vartia M. Consequences of workplace bullying with respect to the well-being of its targets and the observers of bullying. Scand J Work Environ Health 2001; 27: 63-9.

This Scandinavian study of blue-collar workers from multiple industries examines the effect of workplace bullying on victims and bystanders. It found that both the targets of bullying and those who merely observed the abuse were prone to higher levels of stress than those in bully-free environments. The targets of bullying used sleep-inducing sedatives more often than their colleagues.

 

Laschinger HK, Grau AL, Finegan J, Wilk P. New graduate nurses’ experiences of bullying and burnout in hospital settings. J Adv Nurs 2010; 66: 2732-42.

A study of newly graduated nurses in Ontario, Canada found that workplace bullying was associated with three symptoms of burnout: emotional exhaustion, cynicism, and loss of efficacy.

 

Quine L. Workplace bullying in nurses. J Health Psychol 2001; 6: 73-84.

A study from the NHS found that bullied nurses had higher levels of anxiety, depression, and propensity to leave their jobs.

 

 

The Effect on Institutions

 

Lewis PS, Malecha A. The impact of workplace incivility on the work environment, manager skill, and productivity. J Nurs Adm 2011; 41: 41-7.

This mail-in survey of American nurses found that while overall rates of workplace incivility are high, they are significantly lower in units that have earned nationally-recognized honors. The authors calculated the cost of lost productivity due to incivility at $11,581 per nurse per year.

 

Rawson JV, Thompson N, Sostre G, Deitte L. The cost of disruptive and unprofessional behaviors in health care. Acad Radiol 2013; 20: 1074-6.

A group of radiologists decided to calculate the financial cost of disruptive physician behavior due to things like staff turnover and medical errors. In a medium-sized 400-bed hospital, they estimated an annual cost of $1 million per year. Why would radiologists be interested in incivility? Maybe they’re sick of being yelled at on the phone.

 

Hogh A, Hoel H, Carneiro IG. Bullying and employee turnover among healthcare workers: a three-wave prospective study. J Nurs Manag 2011; 19: 742-51

This Danish study found lower overall rates of bullying in early-career nurses than those cited in previous studies, but linked the abusive behavior to higher rates of employee turnover.

 

Askew DA, Schluter PJ, Dick ML, Rego PM, Turner C, Wilkinson D. Bullying in the Australian medical workforce: cross-sectional data from an Australian e-Cohort study. Aust Health Rev 2012; 36: 197-204

This Australian study of bullied physicians found the victims of abuse were more likely to take sick days, decrease their total number of hours worked, and plan to leave clinical practice within the next five years.

 

 

The Effect on Patient Care

 

Riskin A, Erez A, Foulk TA, et al. The impact of rudeness on medical team performance: a randomized trial. Pediatrics 2015; 136: 487-95.

A fascinating experiment and perhaps the only true randomized controlled trial examining toxic behavior in healthcare, this study utilized simulated resuscitations in the neonatal arena to test the effect of insults on team performance. Planted observers delivering rude and passive aggressive comments were shown to adversely affect everything from diagnostic proficiency to procedural skills and error detection.

 

Aiken LH, Clarke SP, Sloane DM, Lake ET, Cheney T. Effects of hospital care environment on patient mortality and nurse outcomes. J Nurs Adm. 2008 May;38(5):223-9.

This ambitious retrospective study used large databases in Pennsylvania to match hospital culture surveys to mortality outcomes. While this particular study format cannot show causation, better work environments were strongly associated with lower patient mortality.

 

Rosenstein AH, Naylor B. Incidence and impact of physician and nurse disruptive behaviors in emergency department. J Emerg Med. 2012;43(1):139–48.

This survey asked workers in the emergency department if they had witnessed disruptive physician behavior–and what the effect of that behavior might have been. High rates of respondents had indeed seen this behavior and many thought it directly led to medical error. Over 12% thought disruptive behavior might have led to patient mortality. Eighteen percent could name a specific adverse event that had occurred as a result of disruptive behavior.

 

The Joint Commission. Sentinel Event Alert, Issue 40: Behaviors that undermine a culture of safety – 2008. 

The Joint Commission found that unprofessional behavior was the root cause of many sentinel events and released this alert in response to the potential patient safety issue.