Dissecting Health Care’s Unhealthy Work Environment

By Staff Report

Mar. 7, 2013

At some point, you have to ask yourself: Why can’t health care providers get it right?

In 1999, the Institute of Medicine issued a scathing report, called To Err Is Human, which said almost 100,000 people die each year because of preventable medical errors. Ten years later, a follow-up report found little progress had been made in that regard.

That’s not all that surprising when you see stats like this: A 2009 report revealed that less than half of the workers in intensive-care units and non-ICUs in the U.S. were meeting standards for hand hygiene. Yes, patients can be impatient, but, seriously, go wash your hands.

If that isn’t bad enough, now comes word from the Lucian Leape Institute at the National Patient Safety Foundation in a report titled Through the Eyes of the Workforce that many health care workers—who already are subjected to numerous workplace hazards such as exposure to blood-borne pathogens—often have to deal with bullying, harassment and even physical assault in the workplace.

In one incident detailed in the study released March 4, a physician allegedly grabbed a nurse by the throat and told her not to ask him a question in the delivery room ever again. Eventually the physician was suspended and had to complete an anger-management class to return to work, the report said, but the nurse was subsequently transferred. What kind of message does that send?

And it’s not only doctors picking on other staff members; it’s also nurses picking on nurses. “Nurses eat their young” is a common expression used in health care, according to the report. So do polar bears, but they do it to survive in hostile environments—not hostile work environments.

Bullying is often passed down to underlings; it’s no different from hazing. For some people, the only saving grace of being hazed is knowing that they’ll eventually get the chance to do unto others as was done to them. But that’s nothing new. Hazing can be traced back to the 17th century when schools in Northern Africa and Western Europe required “pennalism” as part of the graduation requirements as a way to “civilize” underclassmen.

So what does an unfriendly work environment do to workers? It causes them to take time off—lots of time off. “More full-time employee (FTE) days are lost in health care each year than in industries such as mining, machinery manufacturing, and construction,” the report states.

Additionally, some burned-out workers take out their frustrations on patients. Worse, burnout can lead to medical errors, the report says.

When I was in an auto accident in 2005, I went to the emergency room to have my back checked out. It wasn’t a life-or-death situation, but I was in a lot of pain. I waited about four hours in the ER before I finally pushed a button to call a nurse to find out when someone would be able to see me. If it wasn’t going to happen shortly, I wanted to leave. When I asked the nurse how much longer she thought it would be, she reprimanded me and said, “The ER isn’t a deli; it’s not first-come, first-served.” Really? A hot corned-beef sandwich would have made me feel better than the medical attention I was receiving.

Now I’m not saying all health care workers act uncivilly at work, but a bad apple can put a bad taste in anyone’s mouth.

When there’s an unhealthy work environment, incivility tends to get passed down the line. But as in any business—and make no mistake about it health care is a huge business—it hurts the bottom line when workers are condescending to customers.

It’s difficult to change a culture based on bullying, but it can be done with a commitment to training and hiring the right people. It starts at the top, but it’s not as simple as it sounds, especially in health care where there aren’t enough workers to begin with. For instance, it takes strong leadership—and excellent documentation—to dismiss a top surgeon who pulls in big bucks for a hospital saving lives while making other workers’ lives miserable. But at some point, you have to say enough is enough if the staff is being threatened and morale is flat-lining.

Health care should take a page out of the Hippocratic Oath’s playbook and teach workers to “First, do no harm“—to each other.

James Tehrani is Workforce’s copy desk chief. Comment below or email Follow Tehrani on Twitter at @workforceJames.

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