The high cost of rudeness
Eleanor Feldman Barbera, Ph.D.
A study about rudeness in the medical journal Pediatrics got me thinking about the possible effects of rudeness in long-term care.
In “The Impact of Rudeness on Medical Team Performance: A Randomized Trial,” teams were subjected to rude comments by a supposed visiting medical colleague. For example, he suggested that the team members in the neonatal intensive care unit (NICU) “wouldn't last a week” in his country.
Compared to the control group, teams that had been exposed to the rude comments had lower diagnostic and procedural performance scores.
Naturally, I wondered how this research might translate to senior living.
I'm sure I'm not the only person who has observed rudeness occurring in eldercare settings, whether it's an administrator being curt with staff, nasty remarks between staff members, a discourteous statement to or from a resident, or a sharp comment by a family member.
To complicate matters, LTC teams are often multi-cultural. What's considered reasonable for one culture may be deemed rude by another culture.
In addition, a comment can be interpreted differently depending on the ages and genders of the people involved. If an older female staff member compliments a young woman on her outfit, it can come across differently than if an older male staff member similarly compliments his young female colleague.
Long-term care is also very hierarchical. Doctors often “get away with” rude comments to nurses, as do administrators with underlings.
The research, however, suggests that nobody is getting away with anything. Rude statements negatively affect team performance in the NICU and, I suspect, in teams everywhere.
The good news is that the study found two behaviors reduced the impact of rudeness: information sharing lessened the negative impact of rudeness on diagnostic scores and help-seeking reduced the adverse impact of rudeness on procedural performance scores.
Here are some ways to address rudeness in LTC:
• As always, it starts at the top. When administrators and supervisors of all types model appropriate behavior, it establishes a culture of respect.
• During staff training on customer service techniques, include a section on the importance of courteous interactions between staff members. Not only are residents continually observing (and reacting to) the behavior of staff, it's difficult to emerge from an unpleasant exchange with a coworker to calmly assist residents and families.
• Cultural sensitivity training can help your multicultural teams work together successfully. In addition, provide information about generational expectations to increase understanding when staff members in their 20s are working with teammates in their 50s to provide services to people in their 80s.
• Offer strategies for staff to handle impolite behavior on the part of residents without taking it personally. Refer disrespectful residents for psychological services before they've alienated their helpers.
• There will always be rude family members, but we can lessen the likelihood by observing what's triggering the rudeness on their part. Is it lack of information about the condition of their loved one? Was it because they were standing at the desk for five minutes before being acknowledged? Each situation provides information about how we can improve services: For every rude family, there were many others who handled it silently. Perhaps the organization needs to be more proactive about sharing resident information or about teaching staff how to address the customer service needs of families while simultaneously attending to other responsibilities.
• Find ways to increase information-sharing between employees. It's always concerned me that the day shift leaves at 3 p.m. and the evening shift arrives at 3 p.m., leaving no opportunity for team members to communicate with each other in person. Consider widening the scope of information noted in the change of shift log to go behind admissions, hospitalizations, illnesses and falls to address behavioral issues and concerns such as “worried about her husband's operation tomorrow.” Use an intranet or email blast to inform staff about coworkers' vacation coverage or departures from the organization. Find out what information isn't getting to staff members and establish a way to deliver it.
• Make it easier to ask for help by training senior staffers in mentoring techniques, pairing new employees with an experienced buddy or establishing cross-trained teams that are able to cover for one another. Leaders can model help-seeking in team meetings (and simultaneously increase the flow of information between team members) by saying, for example, “I need your help with this new project. If we did it this way, how would it affect each of your departments?”
It may seem obvious not to be rude to others, but given the stresses of caregiving and the complexities of human relationships, incivility happens. Considering the potential impact of rudeness on care, it's worth the effort to understand and prevent rudeness when we can.
Eleanor Feldman Barbera, PhD, author of The Savvy Resident's Guide, is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the 2014 American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with nearly 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.