Color & Control:

Deviant behaviour in healthcare

By Dr. Renee Thompson

There is an epidemic of bullying and incivility in health care that can not only affect morale and turnover, but also affect patient outcomes.

The average clinically competent health care professional is not equipped with the skills and strategies needed to address his or her colleague’s uncivil behaviors. Therefore, they often do what’s comfortable—they do nothing. As a result, some health care organizations are hemorrhaging really great employees and putting the very patients they serve at risk.

Stopping nastiness

Research shows that disruptive behaviors are more prevalent in the health care field than in any other industry. While nurses, physicians, pharmacists, and therapists can be so caring and compassionate to their patients, they can also be quite cruel towards one other. Disruptive behaviors are also organizationally tolerated, and accepted as the norm, even though study after study shows the negative impact on both employee retention and patient outcomes.

The first step then, to stop bullying, incivility, and deviance, is to heighten awareness of what constitutes undermining or unacceptable behavior and work on fostering a culture of respect, professionalism, and patient safety. After all, you can’t expect people to adapt their behavior if they don’t realize their behavior needs to be adapted.

We have blinders on

A participant in my online course, Eradicating Bullying & Incivility: Essentials Skills for Health care Leaders, told me she wasn’t sure why she was asked to take my course.

She didn’t think they had a problem. After she completed the course, we talked. She shared that over 29 years, she had become numb to the eye-rolling, condescending attitudes, nitpicking, and even the overt criticisms, gossiping, and mocking. She didn’t even notice it. However, once she took her blinders off, she was appalled at how badly people on her teams treated each other. She had normalized the deviance!

Acting like a frog?

If you take a frog and you drop it into boiling water, the frog will jump out. But if you put a frog into tepid water and slowly increase the temperature to boiling, the frog will sit there until it boils to death. Why? Because the frog doesn’t recognize its environment is toxic. When the following phrases are spoken and heard, it is usually a sign that deviant behaviors have been accepted as the norm:

– “Well, that’s just the way she is. Don’t take anything she says personally.”

– “If you have any questions, don’t go to him. He doesn’t like people very much.”

– “Just ignore her tirades. She’s a really great therapist.”

When comments like these are accepted to the point where health care professionals fail to recognize them as abnormal, they have, in a sense, become boiled frogs swimming in a pond of deviance.

Link to patient care

Numerous studies show the devastating impact that disruptive behaviors have on employee retention, patient safety, and also the financial health of the organization. One study conducted with radiology techs found that only nine per cent of top health care executives even identified addressing disruptive behaviors as a top priority.

Another in the nursing field shockingly found that 48 per cent of registered nurses in the survey admitted to being bullied in the workplace during the previous six months, with 35 per cent reporting that they had experienced it on a weekly basis, and 28 per cent reporting that they had experienced it daily. A recent Occupational Safety and Health Administration (OSHA) survey reported over 50 per cent of registered nurses and nursing students felt that they had been verbally abused, (a category that included bullying), in the past 12 months. And, most alarmingly, a 2016 National Health care Retention & RN Staffing Report highlighted the fact that 70 per cent of nurses reported an association between disruptive behaviors and compromised quality of their patient’s care.

Ethical responsibility

Regulatory agencies and professional organizations have finally recognized the impact disruptive behaviors have on patient safety and are now beginning to hold health care organizations and the individuals themselves accountable. It is time for health care organizations to take decisive action by raising awareness of behaviors that undermine a culture of safety and respect. Here are some suggestions:

1. Infuse content related to behavior everywhere

By delivering content related to professional conduct in new employee orientation, staff meetings, leadership development programs, and any ongoing education program, you’ll be heading things off at the pass and focusing on prevention. Include behaviour-related content with skill development opportunities throughout the year in order for employees to learn how to use tools and new strategies, and gain confidence in identifying which behaviors are disruptive to a culture of safety and hold each other accountable for creating and fostering a better environment.

2. Pay attention

Start paying attention to co-workers and observing their actions. Do you see the eye-rolling, mocking behind someone’s back, gossip, nitpicking and criticism, etc.? Suddenly unprofessional behavior, while once unnoticed, will became obvious. Watch for these types of statements:

You’re young, you’ve got to pay your dues.
It’s always been done this way.
I’m making her a stronger nurse.
If she thinks I’m hard on her wait till she meets _______.
Just suck it up, buttercup.
It’s sink or swim here, so if you want to survive, you’d better learn how to swim.
Just ignore him like everyone else does.

3. Look in the mirror

If nearly ¾ of health care employees report witnessing or experiencing disruptive behaviors, it is clear that the disruptors cannot be everyone else. Each of us and our management have to look in the mirror to determine how we might be contributing (good or bad) and be ready to make change.

It is time to make a commitment, starting today, that you will no longer accept bad behavior as the norm and that you and your leadership team will take action. After all, the way health care workers treat each other should be just as important as the care they provide!

References available on request.

Renee Thompson is a nursing professional development/ bullying and incivility thought leader and founder of the Healthy Workforce Institute.

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