1. This randomized controlled study used a simulated training experience in the neonatal intensive care unit (NICU) to demonstrate the impact that rudeness can have on the diagnostic and procedural performance of the team. Teams exposed to rudeness had lower diagnostic and procedural performances scores than those not exposed to rudeness.
2. Two qualities of team members had positive impacts on performance: information-sharing improved diagnostic performance and help-seeking improved procedural performance.
Evidence Rating Level: 2 (Good)
Study Rundown: Medical errors often occur due to lapses in provider performance, which may be exacerbated by the impact of rudeness on behaviors. Medical team members may experience rudeness from other team members, those above them in the hospital hierarchy, and even patients and their families; however, it is unknown how this rudeness affects functioning of the team. This randomized control study sought to determine the impact of rudeness on the performance of a NICU hospital team. In this simulated exercise, teams exposed to rudeness were found to have lower diagnostic and procedural performance scores compared to teams who were not exposed to rudeness. Conversely, several behaviors were found to have improved performance; specifically, information-sharing positively impacted diagnostic performance scores and help-seeking had a positive impact on procedural performance scores. This study is limited by an external source of rudeness and did not evaluate how peer or patient rudeness might impact performance. However, physicians should be mindful of the deleterious effects that negative interpersonal interactions, such as rude behavior, can have on their diagnostic and procedural experiences.
Relevant Reading: The effects of rudeness on task performance and helpfulness.
In-Depth [randomized controlled trial]: Participants included a total of 72 NICU nurses and physicians from 4 Israeli hospitals. They were placed in 24 teams comprising of 1 physician and 2 nurses that participated in simulation exercise involving a preterm neonate whose condition acutely deteriorated due to necrotizing enterocolitis. Teams were told that a foreign expert would be observing the simulation, and they were randomly assigned to a control group or an exposure group in which the foreign expert made rude comments. Groups did not differ significantly in age, gender, hierarchical status, level of expertise, and tenure of participants. Teams exposed to rudeness had lower mean diagnostic scores compared to the control teams (2.65 ± 0.69 vs. 3.18 ± 0.92; p = .0004). Similarly, teams exposed to rudeness had lower mean procedural performance scores compared to control teams (2.77 ± 0.67 vs. 3.26 ± 0.72; p = .0002). Study authors used a complex path model to test the effect that rudeness (an exogenous variable) had on diagnostic and procedural performance (endogenous variables) through an intermediary mechanism (via decrease in information-sharing and help-seeking). In this model, the 95% confidence intervals were significant for both the indirect effect of rudeness on diagnostic performance through information-sharing (-0.49 to – 0.05) and the indirect effect of rudeness on procedural performance through help-seeking (-0.36 to -0.02).
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