Sticks and stones break bones – but so do words, shows a new study. In contrast to the old saw that parents often tell their kids when some bully bothers them, insulting names – and other rude, nasty and bullying terms – can really hurt them, according to study lead Professor Arik Riskin of the Technion.
Using medical staff at Bnei Zion as subjects, the study, which was conducted by the Technion along with Haifa’s Bnai Zion Medical Center and published recently in the journal Pediatrics, demonstrates how even “moderate” rudeness dramatically impairs the medical staff’s performance – negatively affecting their will, motivation, and even ability to give high quality treatment and properly diagnose diseases. This could even endanger the lives of patients, the study said.
What’s true for adults who have more confidence in their identity and abilities is even more true for children, says the study.
Rudeness, if not outright violence, by dissatisfied clients in hospital settings is an all too common problem in Israel and around the world. In Israel, hospitals occasionally go on strike because doctors or nurses were attacked by family members, but it’s a problem all over the world – an “epidemic,” according to many experts. Those insults, the study says, can have tragic results – and not only for the target of the rudeness.
The study examined the reactions of 24 medical teams from four neonatal intensive care units at the hospital. The teams were invited to a training workshop on the subject of “flexible team management” as a tool for improving quality of care, based on the treatment of a premature infant whose condition suddenly deteriorated due to necrotizing enterocolitis, a serious intestinal illness that affects infants. As part of the exercise, staff had to identify and diagnose the condition and administer treatment, including CPR. It was explained to them that an expert from the United States would be watching them remotely (via camera) and would occasionally comment and advise them on the phone.
That “expert” was actually a plant – a member of the Technion team, whose job it was to get under the skin of the staff. As a control group, half of the teams received messages from a neutral expert who spoke in general terms about the importance of training and practice using simulations, with no comments on the quality of their work.
But for the rest of the teams, the rude “specialist” laced into them with insults about their specific performance, and the “poor quality of medicine” in Israel. The simulations were recorded on video and presented to judges who evaluated the teams’ performances in accordance with defined criteria – measuring diagnostic capabilities, performance of actions and procedures, and behaviors pertaining to sharing information and asking for help. The judges did not know the identity of the participants (whose faces were blurred) or whether they were part of the control group or the targets of the “expert’s” barbs.
The analysis of the results revealed clear conclusions, said Riskin. “The teams that were exposed to rudeness displayed lower capabilities in all performance metrics. This study demonstrates that rudeness impairs patient safety, all the more so in neonatal intensive care units and intensive care departments, where the slightest error could cause tremendous damage.”
“Rudeness had adverse consequences on the diagnostic and procedural performance of the team members,” the study concluded. “Information-sharing mediated the adverse effect of rudeness on diagnostic performance, and help-seeking mediated the effect of rudeness on procedural performance.”