Reducing Physician Incivility Using Hard Data

As a nurse, I’ve seen my share of nurse bullying and physician incivility. The undermining, condescension, gossip, backstabbing, and refusing to help, are commonplace. 10 years ago, I decided to tackle this problem by first, focusing on nurse bullying. Over and over again, a consistent and common question was asked by the nurses – what about the physicians?

After all, if you really want to cultivate and sustain a professional workforce culture, you can’t just focus on the nurses. You have to include physicians too. It’s not any one of us – it’s all of us who contributes to culture.

The strategies and tactics to address nurse and physician incivility are very much the same. However, getting physician buy-in requires a different approach.

The best approach to get physicians onboard with culture change.

Reducing physician incivility always starts with awareness. After all, you can’t expect people to adapt their behavior if they don’t realize their behavior needs to be adapted. This all starts with convincing people that they need to change; that there is a valid reason.

What we have learned over the last 10 years working with organizations to address disruptive behavior is that when convincing physicians that behavior is just as important as clinical expertise, you must use a different approach.

An interview with physician incivility expert, Dr. Mitch Kusy

Dr. Mitch Kusy is an organizational psychologist and culture change expert. We invited him to join our team at the Healthy Workforce Institute because of his expertise with addressing physician incivility. When an organization reaches out asking for our help and we discover that there is a significant physician conduct issue, we call Mitch.

Mitch and I recently talked about addressing disruptive physicians during one our live Q & A calls, which is included in our Healthy Workforce Academy’s foundational online course, Eradicating Bullying & Incivility: Essential Skills for Healthcare Leaders.

Here is an excerpt from our conversation about addressing physician incivility:

[RT] Dr. Kusy, when we work with an organization to address disruptive behaviors, many nurses ask, “What about the physicians. Why aren’t they here?”

How do you convince the physicians that they need to address behavior too? Especially when many topics like conflict resolution, emotional intelligence, and assertive communication are just “soft skills”.

They don’t necessarily buy into this culture change stuff. How do you get them to understand that they need to get involved in change?

[MK] One of the ways we help physicians understand they need to change is by not talking about the soft skills and not talking about the relationship. We talk about the hard data with physicians.

When discussing the importance of addressing incivility with physicians, start the conversation by sharing just a few statistics. For example:

• 51% of nurses reported an increase in patient errors as a result of verbal abuse (Rosenstein & O’Daniel, 2008).
• 6% of pediatric nurses reported that when on the receiving end of physician incivility, there was a negative impact on critical thinking (Pejic, 2005).
• In terms of safe medicine, 71% of medical professionals across the board reported a link between disruptive behaviors and negative patient outcomes (Rosenstein & O’Daniel, 2008).

Subsequently, one of the things we do first is help them understand this data.

We tell them, “It is not about the soft skills. It’s about why you’re here in business.”

And your business is patient care and patient safety. Then I do something rather engaging with these physicians, I say (ask for permission)…

“May I send you a few of these articles to review yourself?”

You don’t want to implode them with 15 different ways of looking at the statistics, give them two or three high points. So it’s the data that is critical.

[RT] What you’re appealing to are the “left-brain logical” people. When we help leaders improve how they communicate with their teams, we teach them how to always spin information to engage two types of thinkers – left brain logical AND the right brain emotional.

When you’re trying to get physicians to buy into culture change and be willing to turn the mirror back on themselves, you got to hit them with the hard data.

[End Interview]

In an article published by KevinMD on the topic of physician incivility, Philip Master, MD wrote,

“…there is evidence that the quality of care provided by clinical teams is dramatically affected by the relationships and interactions between team members, with uncivil behavior being associated with declines in both diagnostic and procedural performance.” 

This isn’t what YOU say. This is what Johns Hopkins or The Joint Commission discovered. It’s about the evidence and you can’t say your evidence based if you choose to ignore the evidence!