Dear Crucial Skills,

We have two young new surgeons on our team. One of them is quite rude during morning rounds. He questions and challenges my treatments and diagnoses in a very rude manner. His negative attitude has leached onto the other surgeon. Last week, they both attacked me verbally in front of students, interns, clients, and staff. They were loud, aggressive, and accusatory. I attempted to respond to their concerns. I am pretty angry at them. They behave like bullies, and it’s taking a toll on my mental health. I need to address this to promote a safe working environment. Any tips and tricks would be greatly appreciated.

Signed,
Bullied

Dear Bullied,

Bullying isn’t unique to healthcare, but there are many things about the healthcare environment that proliferate bullying behaviors, such as high-stakes situations, rigid power differentials, and challenging schedule demands. And while bullying is harmful everywhere, it has devastating impacts in healthcare.

According to our study Silence Kills, half of all nurses and four out of five physicians in our survey said they work daily with a colleague who breaks rules, makes mistakes, fails to offer support, or appears critically incompetent. However, only one in ten speak up when facing these kinds of concerns—and far fewer speak up when the concern is with a physician. The most alarming finding is that people’s failure to speak up when they have these concerns is highly related to quality of care, employee morale, productivity, and retention.

The study further identified seven categories of conversations that are especially difficult, and yet especially crucial for healthcare professionals to hold. One of the most common of these Crucial Conversations is disrespect and abuse. So, how do you speak up to an abusive surgeon—someone who holds the cards in terms of rank and power? Success in such a difficult Crucial Conversation takes preparation. Here are a few ideas to consider before you engage in dialogue.

Begin by defining the problem. The most common mistake people make is to confront a single incident of abuse as if the incident were the only problem—in your case, that would be last week’s verbal attack. Most likely, the problem is not that single incident. It’s a pattern of abuse. If you focus on the incident, you’re likely to get bogged down in the details of who said what and why.

Find Mutual Purpose. You will be much more successful if your approach to the conversation solves the other person’s problems as well as yours. We call this finding Mutual Purpose and there are a few questions you can ask yourself to find your Mutual Purpose.

• Ask the humanizing question. Ask yourself, “Why would a reasonable, rational, and decent person get angry and abusive like this? What is he trying to achieve and why is he so frustrated?”
• What is it you really want? Ask yourself what it is that you really want, long-term, from the conversation and not just for yourself, but for the other person and the relationship. Asking this question will help you take the high road. You want to find a win-win solution, not get even.
• What do you respect about the surgeon? You can always find things you don’t respect. But you can’t have a productive discussion unless you can focus on elements you do respect. We call this Mutual Respect. Respect is like air, as soon as it’s absent, it’s all anyone can think about. So, ensure productive dialogue by establishing respect in the relationship.

This personal preparation will ensure you set the stage for a productive conversation. And it’s important because finding Mutual Purpose and Respect won’t come naturally when you’re on the blunt end of abusive behavior.

Once you’ve got your head and your heart right, ask to have a private conversation with the surgeon. Share the facts of the recent abuse as you experienced them and then describe the consequences of his actions. Explain how it made you feel, how it impacted the culture, how it put patients at risk, and how you would like to work differently together in the future. Then ask him how he sees it. At this point, your job is to listen. Perhaps you’ll learn something about the situation you weren’t aware of, perhaps you’ll get an idea of your own or others’ role in his frustration, or perhaps you’ll learn that he is a risk to the culture, staff, and patients. If the latter is the case, it would be wise to escalate the abuse to HR. But whatever the outcome of the Crucial Conversation, you’ll better understand your options and the best way forward.

Our clients at the Research College of Nursing in Kansas City, Missouri, turned to the Crucial Conversations skills to address abusive behavior—it can be done.

Leaders at the college trained their teams in Crucial Conversations, giving their physicians and staff the skills to speak their minds honestly and respectfully. They documented their success in a report published in the AORN Journal.

To measure the impact of the Crucial Conversations skills, leaders administered a scale that measured training participants’ degree of confidence in addressing disruptive behavior in ten situations. They administered the scale before, immediately after, and four weeks after the training.

By comparing the pre- and post-test scores, leaders found a statistically significant increase in participants’ confidence and ability to address bad behavior both immediately after and four weeks after the training. In the post-test administered four weeks after training, nurses reported 123 episodes in which they encountered disruptive physician behavior. However, using their newly learned Crucial Conversations skills, they also reported that they spoke up and addressed the bad behavior in 87 of those episodes—or 71 percent of the time.

Best of luck in addressing your abusive surgeon. It’s so important you feel empowered and able to speak up, both for your own well-being, as well as the well-being of your colleagues and patients.

Brittney