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Politeness Pays



Does being rude stimulate people to do better, or does it have adverse effects on performance, and team functioning? And how to prove it on way or another?

This really interesting, innovative paper from a team in Israel has performed an RCT to address the problem. Riskin A, et al. The Impact of Rudeness on Medical Team Performance: A Randomized Trial. Pediatrics. 2015. The authors created 24 NICU teams and arranged for them to receive some comments from a supposed visiting expert from the USA. Half of them included some mildly rude comments, which the team received either just before or midway through a simulated resuscitation of a newborn manikin.

Just before the simulation, to the rudeness exposed group, the "expert" stated that he was "not impressed with the quality of medicine in Israel". Ten minutes later the simulation was stopped and the participants heard that "medical staff like those observed wouldn’t last a week in his department". He added that he "hoped that he would not get sick while in Israel".

The study found substantial negative effects of what they refer to as "mild incivility" on both diagnosis of problems during the simulation and on procedural performance. For example the subjects were much less likely to correctly verify the position of a tube when they had been the target of the rudeness.

They also showed that the rude comments affected information sharing within the team, and on whether the team  members sought help from each other.

I must say I have been exposed to rudeness, sometimes much more direct and biting than the comments in this research, at many times during my career, and have, to be honest, also occasionally been rude to others myself. Sometimes a transient irritation or annoyance can lead to comments or attitudes that are negative and to "incivility". In a very high stress environment like the NICU, making snarky comments when things don't go well is a common reaction.

I think that we should all try even harder to avoid such responses, not just because they may hurt feelings and harm morale, but because it actually looks like they can have adverse effects on the medical care that our patients receive.

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Excellent blog.


Rude behaviour is detrimental to patient safety and to patient outcome. It builds obstacles in effective communication within the NICU team.


I think we have to take lessons from the airline industry about communication strategies.

Crew Resource Management and removing hierarchy while communicating is very important.

Motivated staff are a great resource for achieving optimal patient outcomes



Rude staff are usually disruptive to the NICU staff. Staff with attitude issues should initially be politely counseled. If still no change in behavior will necessitate disciplinary action and ultimately removal for the team.  A single rude disruptive person is enough to upset the whole NICU team.




Edited by JACK
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