Toxic work­ers put or­ga­ni­za­tions at risk

Modern Healthcare - - COMMENT - By El­iz­a­beth L. Hol­loway and Mitchell E. Kusy El­iz­a­beth L. Hol­loway is a pro­fes­sor of psy­chol­ogy at An­ti­och Univer­sity. Mitchell E. Kusy is a pro­fes­sor of or­ga­ni­za­tion learn­ing and devel­op­ment at An­ti­och Univer­sity and a Ful­bright scholar in or­ga­ni­za­tion

The day this person left our com­pany is con­sid­ered a na­tional hol­i­day.”

This quote from a par­tic­i­pant in our na­tional re­search study is il­lus­tra­tive of the con­sid­er­able at­ten­tion and pain as­so­ci­ated with toxic be­hav­iors in health­care work­places. While bul­ly­ing has been a com­mon topic, less known are those be­hav­iors that do not reach the thresh­old of bul­ly­ing—of­ten re­ferred to as “toxic be­hav­iors.”

Our sur­vey and in­ter­view study con­sisted of a sam­ple of more than 400 lead­ers (39% from health­care). We asked lead­ers about their ex­pe­ri­ences in work­ing with in­di­vid­u­als demon­strat­ing toxic be­hav­iors, de­fined as a pat­tern of coun­ter­pro­duc­tive work be­hav­iors that se­ri­ously de­bil­i­tate in­di­vid­u­als, teams, and/or the or­ga­ni­za­tion over the long term. Some 94% said they worked with a toxic person.

Three types of toxic be­hav­iors were dis­cov­ered: sham­ing, pas­sive hos­til­ity and team sab­o­tage. These be­hav­iors are sub­tle and hard to iden­tify, there­fore, many lead­ers do not ad­dress them in per­for­mance-man­age­ment pro­cesses or for­mal dis­ci­plinary sys­tems. Con­se­quently, they can slip un­der the radar un­til they have greatly af­fected team per­for­mance.

Dr. Alan Rosen­stein’s re­search in­volv­ing med­i­cal pro­fes­sion­als ( Amer­i­can Jour­nal of Med­i­cal Qual­ity, 2011) dis­cov­ered that par­tic­i­pants felt a strong cor­re­la­tion be­tween dis­rup­tive be­hav­iors and the oc­cur­rence of med­i­cal er­rors and com­pro­mised qual­ity (71%), ad­verse events (67%), com­pro­mises in pa­tient safety (51%), and a con­tribut­ing fac­tor to pa­tient mor­tal­ity (27%). The Joint Com­mis­sion in its anal­y­sis of sen­tinel events found that nearly 70% could be traced to com­mu­ni­ca­tion prob­lems, many of which are a re­luc­tance to in­ter­act with physi­cians or other health­care pro­fes­sion­als who are con­sid­ered to be “toxic.”

Why not just fire these toxic in­di­vid­u­als? It’s not quite that easy. These staffers may be your high­est pro­duc­ers or have spe­cial ex­per­tise not repli­cated else- where. Per­for­mance-re­view cri­te­ria of­ten don’t in­clude be­hav­ioral val­ues. How do you fire some­one who vi­o­lates these val­ues if these are not in­cluded in the cri­te­ria? Even if you “fire” the in­di­vid­ual, you may be left with a dys­func­tional team be­cause toxic be­hav­iors spread like a virus. Once you have a cul­ture of in­ci­vil­ity—back­stab­bing, gos­sip, an­gry out­bursts, con­de­scen­sion and ma­nip­u­la­tion—this can quickly be­come the norm. A sys­tems view is nec­es­sary to solve the prob­lem.

In the typ­i­cal toxic sys­tem, we found two roles that cre­ate and sus­tain it: the “toxic pro­tec­tor” and the “toxic buf­fer.” The toxic pro­tec­tor un­wit­tingly per­mits bad be­hav­ior to con­tinue and feels com­pelled to pro­tect the per­pe­tra­tor from neg­a­tive re­views or ter­mi­na­tion be­cause the pro­tec­tor has a spe­cial in­ter­est in keep­ing the person as a part of the team, of­ten be­cause the toxic em­ployee is highly pro­duc­tive or has a spe­cial skill set.

Un­like toxic pro­tec­tors, toxic buf­fers typ­i­cally rec­og­nize that the toxic be­hav­ior is detri­men­tal to team func­tion­ing. How­ever, the buf­fer be­lieves that the so­lu­tion is to serve as a shield be­tween the toxic person and the team. De­spite good in­ten­tions, the buf­fer en­ables the toxic em­ployee to get away with bad be­hav­ior. While try­ing to ab­sorb the tox­i­c­ity, the buf­fer of­ten be­comes emo­tion­ally dam­aged and un­wit­tingly con­trib­utes to the team’s spi­ral of dys­func­tion. Iron­i­cally, both toxic pro­tec­tors and toxic buf­fers ac­tu­ally fa­cil­i­tate the en­act­ment of a cul­ture of in­ci­vil­ity.

The rise of tox­i­c­ity across the team, team mem­bers’ ac­cep­tance of un­civil be­hav­ior as a norm and hid­den play­ers who en­able a toxic cul­ture to be sus­tained are the rea­sons ef­fec­tive strate­gies must ad­dress the sys­tem of in­ci­vil­ity—not just the in­di­vid­ual.

Reme­dies in­clude pro­vid­ing feed­back to the toxic pro­tec­tor and buf­fer (not just the toxic person) and col­lab­o­ra­tive de­sign of com­pacts for pro­fes­sional be­hav­iors in which all lev­els and dis­ci­plines have in­put and team en­gage­ment in de­vel­op­ing norms to honor the be­hav­ioral com­pacts. Or­ga­ni­za­tional val­ues must be con­crete and be­hav­iorally spe­cific and in­te­grated into per­for­mance ap­praisals for every­one. With these sys­tem el­e­ments in place, ad­min­is­tra­tors will be able to defini­tively doc­u­ment any toxic be­hav­iors that have vi­o­lated the val­ues of the or­ga­ni­za­tion and can­not be tol­er­ated.

For those lead­ers who are leery about fir­ing a high-pro­duc­ing toxic in­di­vid­ual, re­mem­ber the down­falls of not do­ing this. These lead­ers will be cat­a­lysts in other non-toxic high-pro­duc­ers quit­ting. Toxic in­di­vid­u­als put your or­ga­ni­za­tion at risk in terms of re­duced pa­tient safety and sat­is­fac­tion, pro­mot­ing a cul­ture of nas­ti­ness—not a good thing when poor pa­tient sat­is­fac­tion can have se­vere con­se­quences for the bot­tom line. The best health­care or­ga­ni­za­tions model the term we have coined: “Ev­ery­day ci­vil­ity” in which re­spect­ful en­gage­ment is the norm, not the ex­cep­tion.

In­ter­ested in sub­mit­ting a Guest Ex­pert op-ed? View guide­lines at modernhealth­ Send drafts to As­sis­tant Man­ag­ing Edi­tor David May at dmay@modernhealth­

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