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Rudeness Impacts Team Performance

March 8, 2017

Short Attention Span Summary

That’s so rude!
In this neonatal ICU simulation study, there were 4 arms: 1. no rudeness, 2. teams exposed to rude comments from the patient’s parent, 3. teams exposed to rude comments but with prophylactic cognitive bias modification (CBM), 4. teams exposed to rude comments with a narrative intervention (they wrote down their experience after rudeness exposure).  Effects on team performance were measured by independent judges.  The rude comment from the mother was, “I knew we should have gone to a better hospital where they don’t practice Third World medicine!”  Rudeness had adverse effects on multiple aspects of team performance.  CBM prior to exposure to rudeness (a computer game to help participants feel less threatened by mildly angry faces) mitigated most of the adverse effects of rudeness, but the post-rudeness exposure narrative intervention had no effect on improving teamwork.  We can’t control rudeness in patients or caregivers.  What we can do is cognitively prepare ourselves in advance to optimally perform as a team even in the face of rudeness.

Spoon Feed
Sometimes caregivers or patients are rude.  The best thing we can do is anticipate it and mentally prepare before the encounter so we can still perform well as a team.


Pediatrics. 2017 Jan 10. pii: e20162305. doi: 10.1542/peds.2016-2305. [Epub ahead of print]

Rudeness and Medical Team Performance.

Riskin A1,2, Erez A3, Foulk TA3, Riskin-Geuz KS4, Ziv A4,5, Sela R5, Pessach-Gelblum L5, Bamberger PA6.

Author information:

1Coller School of Management, and arik.riskin@gmail.com.

2Neonatology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.

3Warrington College of Business Administration, University of Florida, Gainesville, Florida; and.

4Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel.

5Israel Center for Medical Simulation, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.

6Coller School of Management, and.



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.


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.


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.


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.

Copyright © 2017 by the American Academy of Pediatrics.

PMID: 28073958 [PubMed – as supplied by publisher]

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