The failure to deal with interpersonal conflicts among the people tasked with taking care of patients adversely affects patient safety and quality of care, according to a new study by VitalSmarts.

More than 1,200 physicians, nurses and other healthcare professionals were asked about personnel problems in their organizations. The results, says VitalSmarts VP of Research David Maxfield, show that silence about slackers, timid supervisors, toxic peers and arrogant doctors is the real problem.

The survey found that these issues involving communication, cooperation and initiative were pervasive and destructive.

Poor initiative: Team members who take shortcuts and excessive breaks and don't do their fair share of the work. While 61 percent said poor initiative was common and nearly three-fourths said it dramatically affected safety and care, 75 percent described it as "undiscussable." The result: a widespread belief that laziness is the standard.

Difficult peers: Colleagues who gossip, spread rumors, give people the cold shoulder, and are rude, sarcastic and mean. Over half said this behavior is common and two-thirds described its damaging effects. And yet, 78 percent confessed it could not be discussed in their culture.

Failure to hold others accountable: Managers who neglect to hold people to the required safety and culture standards. Three out of four said persistent management weakness undermines safety and quality of care and two-thirds said it is an open secret that cannot be addressed.

Unresponsive physicians: Physicians who ignore phone calls, pagers, emails and are often late. While this concern was described as "common" by only 38 percent—a relatively lower frequency than other issues—when it happens 70 percent say it is "unsolvable" because it is also "undiscussable."

Managers who play favorites: Managers who give better hours, assignments and opportunities to a select a few. Just under a third of respondents said this is a frequent occurrence and almost three-fourths declared it undiscussable.

Why it matters

Maxfield and company co-founder Joseph Grenny determined that these five challenges are a powerful predictor of the most important leading indicators in healthcare. How well or how poorly an organization masters these issues also predicts the rigor of their patient safety (.47 correlation), the quality of their patient care (.47 correlation), the quality of patient and family experience (.42 correlation) and staff and physician engagement (.57 correlation).

"You can adhere to strict checklists, surgical pauses and other safety tools, but if people can't talk about behavioral lapses in how those tools are used, they lose their effectiveness," Maxfield concluded.

Maxfield and Grenny, who have published two acclaimed studies documenting the impact of communication breakdowns in healthcare—in partnership with the American Association of Critical Care Nurses and the American Association of periOperative Registered Nurses—say these results make a strong case for improving the culture in healthcare and the interpersonal skills of physicians, nurses and staff."

"If you can't talk..."

"Healthcare is not immune to workplace drama," says Grenny. "If anything, the stress and complexities introduced by long and difficult hours, power differentials among colleagues and mounting regulation ensures healthcare professionals will face interpersonal strain and frustration at every turn. What this research confirms is that if you can't talk about high stakes staff issues, you can't deliver great healthcare."  

The research also identified "positive deviants" who managed these challenges better than others.

"It turns out, having a manager who demonstrates strong and positive interpersonal skills can eliminate the impacts of workplace drama," says Maxfield. "Employees with skillful bosses rated their departments higher on patient safety, quality of care, patient and family experience and staff and physician engagement."

Grenny concludes, "These five problems aren't the problem. The problem is that in most hospitals, few address them. The finding that the influence of a manager can change the dynamic suggests a great place for healthcare executives to invest attention."

About VitalSmarts: Named one of the Top 20 Leadership Training Companies, VitalSmarts, a TwentyEighty, Inc. company, is home to the award-winning Crucial Conversations®, Crucial Accountability®, Change Anything®, and Influencer Training® and New York Times bestselling books of the same titles. VitalSmarts has consulted with more than 300 of the Fortune 500 companies and trained more than 1.8 million people worldwide.