Medical Malpractice

An article on MSNBC website on July 9, 2008, "Hospital bullies take a toll on patient safety," cited how a lack of emotional intelligence affects the quality of medical care, and health care costs. Hospitals today are stressful workplaces and most of the healthcare professionals within them work hard to save lives and provide compassionate care. However, studies have found that a small percentage of clinicians acting in an arrogant, intimidating manner can have major impact within the healthcare system.

As in the business sector, a lack of emotional intelligence affects staff morale and turnover among healthcare workers. But in health care, there's growing evidence that disruptive behaviors are tied to costly medical mistakes. An article published in the spring journal of Obstetric, Gynecologic & Neonatal Nursing finds links between disruptive behavior and adverse outcomes, and patient mortality.

The article focuses on doctors, who are often seen as the "higher authority," as being the major contributors to abusive, bullying behavior. However, bad behavior can also covers nurses, pharmacists and other clinicians.

Also of note is that there is evidence that ignoring bad behavior has potentially serious consequences for patients. The article cites a 2004 study of workplace intimidation by the Institute for Safe Medication Practices (ISMP) in Horsham, Pa., which found that 40% of clinicians avoided talking to an intimidating colleague about improper medication. In these cases, the incorrect medication or dosage is allowed to continue.

I have worked in two hospital administrations, and I know how this intimidation works. For example, a pharmacist tells a doctor that he has prescribed the wrong dosage. The doctor gets furious at the pharmacist and maybe tells the Medical Director that this pharmacist has an attitude problem. The next time the doctor prescribes incorrectly, the pharmacist decides to let it go.

As you can see, lack of emotional intelligence on the part of both the bullies and the bullied contribute dearly to adverse outcomes in hospitals. A hospital regulatory agency, The Joint Commission (JCAHO), is concerned enough to be taking action by creating new requirements to take place in January of 2009.

Bullying occurs in all environments, not just hospitals. What do I recommend?

Training and coaching managers in emotional intelligence will help to minimize the problem. The bullies themselves need to be confronted with the bad outcomes of their behavior. They don't really get away with it. Patients suffer. They are more liable for malpractice suits. In all industries, their relationships with others deteriorate.

The victims of bullies need training in confrontation skills. Most people shy away from confrontations in part because they don't believe they can do it right. They fear they will just make matters worse. But with training, they can step up to confront bullies and make their point. For example, the pharmacist can tell a doctor that his prescription dosage is not right. If necessary, the victim will have the courage to appeal to a higher authority.

Managers need training in how to handle these cases of bullying. Good performance management practices are required for the bullies. Also the managers need to be able to encourage everyone to step forward and expose the bullies. That means the managers have to instill trust. That includes convincing victims that they will be safe in whistle blowing, with no repercussions.