Becker's Hospital Review

29 CMO / CARE DELIVERY Rudeness: A care quality issue By Mackenzie Bean and Erica Carbajal F or many people, rude behavior is no more than an unwelcome nuisance. But for those in healthcare, the conse- quences can be far more detrimental. From impolite behavior to violence, rude- ness is on the rise, e Atlantic's Olga Khaz- an reports. is is likely driven by increased stress and isolation from society — which the ongoing pandemic doesn't help. e healthcare industry is not immune to this trend. Hospitals across the country are reporting an uptick in disrespectful, dis- criminatory or violent behaviors from pa- tients. Nearly 24 percent of physicians have experienced workplace mistreatment in the past year, including verbal mistreatment or abuse, according to a study published May 6 in JAMA Network Open. Rude or inappropriate behavior from pa- tients, family members or colleagues is not only linked to burnout among clinicians but may also hinder their performance, a grow- ing body of research shows. e Joint Commission has routinely warned of the effect poor behaviors can have on healthcare teams' performance and urged organizations to address and prevent work- place violence. "Workplace violence is not merely the heinous, violent events that make the news; it is also the everyday occurrenc- es, such as verbal abuse, that are oen over- looked," e Joint Commission said in a June 2021 sentinel event alert. "Intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfac- tion and to preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators and managers to seek new positions in more professional en- vironments," it said in a separate alert. A study published in Pediatrics involving 24 neonatal intensive care unit teams across four hospitals in Israel found being ex- posed to rudeness adversely affected team members' diagnostic and procedural per- formance. e NICU teams participated in a training simulation involving a preterm infant whose condition acutely deteriorat- ed due to necrotizing enterocolitis. Team members were then randomly subjected to either rudeness, which included mildly rude statements unrelated to their clinical perfor- mance from an outside expert, or a control group, in which they were exposed to neu- tral comments from the outside expert. Aer the outside expert review, the team members continued treating the infant in the training simulation. Team members exposed to rudeness had lower scores for diagnostic and procedur- al performance. Researchers said rudeness alone accounted for nearly 12 percent of the variance in clinical performance between the two cohorts. A separate study published in BMJ Quality & Safety found clinical teams exposed to inci- vility in simulated operating room situations scored lower on every performance metric compared to a control group. Incivility af- fected clinical teams' vigilance, diagnosis, communication and patient management. It's worth noting that both studies were pub- lished before the pandemic and the increas- ing politicization of medicine. Since then, encounters with poor behavior have only become more common, especially in the era of mask mandates, vaccine requirements and other public health rules. "Although the rude behaviors regularly ex- perienced by medical practitioners can seem benign, our findings indicate that they may result in iatrogenesis, with potentially devas- tating outcomes," the authors of the Pediat- rics study said. "In taking steps to enhance patient safety, policy makers should begin to consider the role played by the subtle and seemingly benign verbal aggression to which medical professionals are subjected on a rou- tine basis." n Physician's viral tweet spotlights shortcomings of airplane medical kits By Cailey Gleeson P hysician Andrea Merrill, MD, went viral June 12 after tweeting about her experience with an in-air medical emergency on Delta Airlines. "Dear @Delta, I just assisted in a medical emergency in the air," she tweeted. "Your medical kits need a glucometer, epi pen, and automatic blood pressure cuffs- it's impossible to hear with a disposable stethoscope in the air. Please im- prove this for passenger safety!" Among the thousands of replies to the tweet was Sophia Spadafore, MD, an emergency medicine resident and member of the American Medical Association. She said the issue is currently being discussed at the organization and asked what a standardized medical kit should look like. A spokesperson from Delta emailed the following state- ment to on Becker's June 13: "The health and safety of our customers and people re- mains Delta's top priority, and as such, the medical and emergency equipment on all our aircraft go above and beyond the regulatory requirements. Our flight attendants rigorously train to prepare for medical events and rely on expert advice from our partners at STAT-MD and medical professionals who volunteer to respond to such emergen- cies. We applaud our crew's quick thinking, bravery, and training-based reactions that keep all on board safe." n

• Cover