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Are 5 common, but undiscussable, workplace behaviors putting your patients at risk?

A new study by VitalSmarts suggests that slackers, timid supervisors, toxic peers, and arrogant doctors are common in healthcare. But, while frustrating, these behavior problems aren’t the real problem. The real problem in healthcare is silence.

VitalSmarts’ study of workplace drama in healthcare found that while most employees and physicians frequently witness these interpersonal concerns, few address the problems—and their silence results in substantial reductions in patient safety and quality of care.

David Maxfield, vice president of research at VitalSmarts, and Joseph Grenny, cofounder of VitalSmarts, asked more than 1,200 physicians, nurses, and staff to identify how common, costly, undiscussable, and unsolvable five interpersonal challenges were in their teams and organizations. They found the following issues were pervasive and destructive:

  1. Poor initiative: Team members who take shortcuts and excessive breaks and don’t do their fair share of the work. While 61 percent said poor initiative was common and nearly three-fourths said it dramatically affected safety and care, 75 percent described it as "undiscussable." The result: a widespread belief that laziness is the standard.
  1. Difficult peers: Colleagues who gossip, spread rumors, give people the cold shoulder, and are rude, sarcastic and mean. Over half said this behavior is common and two-thirds described its damaging effects. And yet, 78 percent confessed it could not be discussed in their culture.
  1. Failure to hold others accountable: Managers who neglect to hold people to the required safety and culture standards. Three out of four said persistent management weakness undermines safety and quality of care and two-thirds said it is an open secret that cannot be addressed.
  1. Unresponsive physicians: Physicians who ignore phone calls, pagers, emails, and are often late. While this concern was described as "common" by only 38 percent—a relatively lower frequency than other issues—when it happens 70 percent say it is "unsolvable" because it is also "undiscussable."
  1. Managers who play favorites: Managers who give better hours, assignments and opportunities to a select a few. Just under a third of respondents said this is a frequent occurrence and almost three-fourths declared it undiscussable.

Communication breakdown and patient care

Maxfield and Grenny found that these five challenges are a powerful predictor of the most important leading indicators in healthcare. How well or how poorly an organization masters these issues also predicts

  • the rigor of their patient safety (.47 correlation),
  • the quality of their patient care (.47 correlation),
  • the quality of patient and family experience (.42 correlation) and
  • staff and physician engagement (.57 correlation).

"You can adhere to strict checklists, surgical pauses, and other safety tools, but if people can’t talk about behavioral lapses in how those tools are used, they lose their effectiveness," Maxfield concluded.

Maxfield and Grenny, who have published two acclaimed studies documenting the impact of communication breakdowns in healthcare—in partnership with the American Association of Critical Care Nurses and the American Association of periOperative Registered Nurses—say these results make a strong case for improving the culture in healthcare and the interpersonal skills of physicians, nurses, and staff.

"Healthcare is not immune to workplace drama," says Grenny. "If anything, the stress and complexities introduced by long and difficult hours, power differentials among colleagues and mounting regulation ensures healthcare professionals will face interpersonal strain and frustration at every turn. What this research confirms is that if you can’t talk about high stakes staff issues, you can’t deliver great healthcare."

Manager needs strong interpersonal skills

The research also identified "positive deviants" who managed these challenges better than others.

"It turns out, having a manager who demonstrates strong and positive interpersonal skills can eliminate the impacts of workplace drama," says Maxfield. "Employees with skillful bosses rated their departments higher on patient safety, quality of care, patient and family experience and staff and physician engagement."

These five interpersonal issues are not the problem, though, Grenny concludes. The problem is that few healthcare facilities address them. “The finding that the influence of a manager can change the dynamic suggests a great place for healthcare executives to invest attention.”

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