The Impact of Rudeness on Medical Team Performance: A Randomized Trial

1. The Impact of Rudeness on Medical Team Performance: A Randomized Trial Arieh Riskin, MD, MHA, Amir Erez, PhD, Trevor A. Foulk, BBA, Amir Kugelman, MD, Ayala Gover, MD, Irit Shoris, RN, BA, Kinneret S. Riskine and, Peter A. Bamberger, PhD PEDIATRICS Volume 136, number 3, September 2015 Powerpoint by Camille Joyce O. Cruzada, MD

2. Introduction

3. Iatrogenesis refers to an adverse patient condition associated with medical treatment[1]. Diagnostic errors Dosing errors Procedure errors Failure to identify and respond timely to these errors = delay, morbidity or mortality

4. Often linked to patient-related factors (eg. Age) [1,2-5] Can be caused by practitioner stressors (eg. Rudeness)[6-8] Preventable Research has focused on patient-related factors and there is a lack of evidence on other causes of iatrogenesis[9]. • THE FACTS ON IATROGENESIS

5. Relevance

6. Health care workers often experience incivility, mostly coming from patients[6, 10-13]. Such treatment is speculated to affect cognitive and communication skills leading to iatrogenic events[9]. This study can confirm the effect of rudeness on health care professionals and provide opportunities for prevention of iatrogenic events.

7. Objectives

8. To explore the impact of rudeness on the performance of medical teams. Specifically, to: Determine the effect of rudeness on the diagnostic and procedural performance of medical teams Determine the effect of rudeness on information-sharing and help-seeking behavior of medical teams Establish associations between the effect of rudeness on the performance and behavior of medical teams

9. Highlights

10. This is a triple blind randomized clinical trial A research assistant randomized 72 neonatal intensive care unit professionals into teams and exposure An experimenter subjected the teams to case simulations and team reflexivity exercises A panel of physicians assessed each person based on written outputs and videos of the activity With the assignments only known to the research assistant Statistical analysis was done to interpret the results

11. There is a significant decrease in diagnostic performance of medical teams exposed to rudeness Table 1. Comparison of Mean Diagnostic Performance Variables (N=72)

12. There is a significant decrease in procedural performance of medical teams exposed to rudeness Table 2. Comparison of Mean Procedural Performance Variables (N=72)

13. Multivariate analysis showed rudeness is responsible for the significant ∼12% variation in diagnostic and procedural performance of the medical teams Characteristics of the medical teams were not significantly different and cannot account for the variation in performance.

14. There is a significant decrease in information sharing and help-seeking behavior in medical teams exposed to rudeness Table 3. Standardized Coefficients for Mediation Models Information sharing has a significant positive relationship with diagnostic performance Help-seeking has a significant positive relationship with procedural performance

15. Rudeness decreased diagnostic performance by reducing information sharing and decreased procedural performance by reducing help-seeking

16. Conclusion

17. Rudeness decreases both diagnostic and procedural performance Rudeness decreases both information sharing and help-seeking behavior Rudeness decreases diagnostic performance by reducing information sharing and decreases procedural performance by reducing help-seeking behavior

18. Acts of rudeness disrupt the performance of the medical team and the collaborative processes that can overcome errors, increasing the risk for iatrogenic events.

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