Are you OK?

10/12/2018

I was privileged and humbled to listen to a talk (today) by an EM consultant with an interest in compassionate governance. After presenting a devastating account of error in a paediatric case, we all answered that the root cause of the error was system or process. He argued during the next 20 minutes that just being civilised could perhaps reduce many errors in our daily practice.

We all know that there are many factors that influence an action at any one point in time, and if they all line up there is potential for error (Swiss cheese analogy). We create processes and systems to try and mitigate the opportunities for errors, but it is very difficult to take the human factor out of the equation. We are only human, after all.

Civility saves lives

Incivility affects everyone. How does it make you feel when someone is rude to you? Research shows that mild to moderate rudeness results in 60% reduction in cognitive ability (your bandwidth) following the event. A fine example of this effect is the delayed reaction by your brain when you think about how you should have reacted in the moment when someone was rude to you about half an hour later. And then you feel disappointed that you couldn’t think of this sharp reaction at the time!

Incivility also affects on-lookers. 20% of on-looking staff have a decrease in performance and 50% will have a reduction in willingness to help others. When patients and relatives in the area witness incivility between staff members, 75% will have less enthusiasm for the organisation and 65% will be anxious in dealing with the staff.

Civility saves lives

Our natural reaction as human beings are to react defensively, perhaps we think of it as protecting ourselves. So, next time when you are trying to refer a patient to another team and you have a rude response, think about your reaction. Before you are rude in return, think about the effect of incivility on the individual and on-lookers and ultimately on patient care and patient safety. Rather than rising to the same level of rudeness, we should appreciate that there may be a reason for the other person’s behaviour and perhaps ask them “Are you OK? You don’t seem like yourself”. Perhaps offer them a cup of tea...

We should not expect rudeness in our day to day professional interactions, and we should certainly not be rude to others. If you're rude, you automatically make your team perform worse.