title: Rudeness and Medical Team Performance.
abstract: OBJECTIVE
  Rudeness is routinely experienced by medical teams. We sought to explore the impact of rudeness on medical teams' performance and test interventions that might mitigate its negative consequences.
  
  
  METHODS
  Thirty-nine NICU teams participated in a training workshop including simulations of acute care of term and preterm newborns. In each workshop, 2 teams were randomly assigned to either an exposure to rudeness (in which the comments of the patient's mother included rude statements completely unrelated to the teams' performance) or control (neutral comments) condition, and 2 additional teams were assigned to rudeness with either a preventative (cognitive bias modification [CBM]) or therapeutic (narrative) intervention. Simulation sessions were evaluated by 2 independent judges, blind to team exposure, who used structured questionnaires to assess team performance.
  
  
  RESULTS
  Rudeness had adverse consequences not only on diagnostic and intervention parameters (mean therapeutic score 3.81 ± 0.36 vs 4.31 ± 0.35 in controls, P < .01), but also on team processes (such as information and workload sharing, helping and communication) central to patient care (mean teamwork score 4.04 ± 0.34 vs 4.43 ± 0.37, P < .05). CBM mitigated most of these adverse effects of rudeness, but the postexposure narrative intervention had no significant effect.
  
  
  CONCLUSIONS
  Rudeness has robust, deleterious effects on the performance of medical teams. Moreover, exposure to rudeness debilitated the very collaborative mechanisms recognized as essential for patient care and safety. Interventions focusing on teaching medical professionals to implicitly avoid cognitive distraction such as CBM may offer a means to mitigate the adverse consequences of behaviors that, unfortunately, cannot be prevented.
authors.affiliation: Coller School of Management, and arik.riskin@gmail.com.|Neonatology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Arieh
authors.initials: A
authors.lastname: Riskin
authors.affiliation: Warrington College of Business Administration, University of Florida, Gainesville, Florida; and.
authors.forename: Amir
authors.initials: A
authors.lastname: Erez
authors.affiliation: Warrington College of Business Administration, University of Florida, Gainesville, Florida; and.
authors.forename: Trevor A
authors.initials: TA
authors.lastname: Foulk
authors.affiliation: Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel.
authors.forename: Kinneret S
authors.initials: KS
authors.lastname: Riskin-Geuz
authors.affiliation: Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel.|Israel Center for Medical Simulation, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
authors.forename: Amitai
authors.initials: A
authors.lastname: Ziv
authors.affiliation: Israel Center for Medical Simulation, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
authors.forename: Rina
authors.initials: R
authors.lastname: Sela
authors.affiliation: Israel Center for Medical Simulation, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
authors.forename: Liat
authors.initials: L
authors.lastname: Pessach-Gelblum
authors.affiliation: Coller School of Management, and.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Bamberger
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000523:psychology* / Q000628:therapy*; D007318:Inservice Training; D007363:Intensive Care Units, Neonatal; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D007557:Israel; D008297:Male; D009035:Mothers / Q000523:psychology*; D062525:Narrative Therapy; D010348:Patient Care Team; D010817:Physician-Patient Relations; D011787:Quality of Health Care