Recently in Behavior and Misbehavior Category

When I first read the October 15 New York Times article "Suit Accuses S.E.C. of Failing to Detect Madoff Scheme" I noticed a welling up of "justice deserved" sentiment coupled with admiration for the victims who had found a novel way to circumvent apparent obstacles to suing regulators for compensation as they attempted to recover losses that may, in part, have been enabled by regulatory incompetence. And then came the pause and unease. Diana Henruiqes' discussion of the SEC's immunity - and its potential limitations as claimed by the plaintiffs - made me think of the protection afforded hospital QI and peer review processes. And its potential vulnerability under similar circumstances.

How Toxic Colleagues Corrode Performance is a short sidebar article with a big impact by Christine Porath and Christine Pearson in the April 2009 Harvard Business Review. The authors also wrote the upcoming book: The Cost of Bad Behavior: How Incivility Is Damaging Your Business and What to Do About It. The article is a 3 minute read, at most. But it provides data that drives home a haunting point for health care leaders - and more specifically physician leaders. Namely that the misbehavior of physicians, executives, and managers extracts a far greater toll on organizations than the pain felt when complaints are made.

Porath and Pearson have made a study of incivility in the workplace for years. The results of their poll of several thousand organizations revealed that common "benign" misbehaviors such as rumor mongering, berating management, unfairly taking credit for the work of others, blaming others for one's shortcomings, etc. take a severe toll on co-workers. The article states the following results:

• 48% decreased their work effort,
• 47% decreased their time at work,
• 38% decreased their work quality,
• 66% said their performance declined,
• 80% lost work time worrying about the incident,
• 63% lost time avoiding the offender, and
• 78% said their commitment to the organization declined

As we all know, health care workplace settings are far from immune from these. We see incivility by physicians, nurses, and clerical employees in office, hospital, and corporate settings. The bar for intervention into benign misbehavior is high. It is largely seen as the result of "personality quirks" that are grey areas for managerial intervention since they fall outside of the ethical and professional guidelines set up to deter and correct "malignant" misbehaviors such as dishonesty, sexual harassment, overt intimidation, falsification of data or documentation, discrimination, etc.

But these results suggest that "mere" incivility is far from a benign condition. Given the increasing pressures we are under to maintain an efficient and productive workplace, it is critically important for health care leaders to be aware of the measurable collateral damage that can result from these behaviors.

Then comes the challenging task of developing awareness, behavioral guidelines and both peer and managerial intervention strategies that result in a culture of civility. And doing this in a fashion that avoids two undesirable situations: (1) the creation of a juvenile code of behavioral rules; and (2) failure to clearly set limits on destructive "benign" behaviors.