Journal Club Report: Impact of Rudeness on Team Performance

Author: Rebecca Treleaven, Paediatric Trainee, Severn Deanery

Article citation:

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

Arieh Riskin, Amir Erez, Trevor A. Foulk, Amir Kugelman, Ayala Gover, Irit Shoris, Kinneret S. Riskin, Peter A. Bamberger

Pediatrics Sep 2015, 136 (3) 487-495; DOI: 10.1542/peds.2015-1385

Study question:

What impact does rudeness have on team performance?

Study design:

Randomised intervention, simulation

Methods:

This was a double blind randomised control trial carried out in a neonatal unit in Israel. Each team’s task was to identify and resuscitate a preterm infant with NEC. Instructions were provided on how the simulation would run with the intervention groups receiving additional non-specific rude comments about the standard of healthcare in their country from a bogus external professor observing via a weblink.

Intervention:

Instructions were provided on how the simulation would run with the intervention groups receiving additional non-specific rude comments about the standard of healthcare in their country from a simulated bogus external observer. Four outcome measures were subjectively scored by 3 blinded independent judges: help seeking behaviour, information sharing, diagnostic performance and procedural performance; with moderate to high reliability between judges. Participants were also asked to rate perceived rudeness post-simulation.

Results

The study demonstrated that external rudeness had a significant impact on team performance within a simulation setting compared to a control group. This was seen across the majority of outcome measures. Help-seeking behaviour positively impacted procedural performance and similarly information sharing improved diagnostic performance.

Analysis/critical appraisal

Some limitations of the study included; a lack of a power calculation, no documentation on the randomisation process and no data provided on age, gender or expertise between the two groups. Though the teams were debriefed, there was no detail on how they supported the psychological welfare of participants.

Overall the study provides good evidence that an individual’s behaviour can impact the performance of a team and therefore patient care. Though this was in a simulation setting, the comments were relatively mild and impersonal and still performance was significantly reduced. Future research could look in to the effect praise has on team performance and how that differs from rudeness versus a control.

Conclusion

This study highlights the importance of creating an open and compassionate culture within healthcare settings to ensure the best outcomes for patients.