Hospital Culture of Silence Puts Patients at Risk

Physician holding up finger of one hand to shush and holding up the other as an oversized fist

Nurses know it. Doctors know it. Attorneys for people who sue for medical malpractice know it. But it’s seldom discussed publicly. What is it? The culture of intimidation and silence among hospital staff that protects incompetence, ignores shortcuts and fosters disrespect among co-workers.

According to a study conducted by prestigious nursing associations, this kind of “doctors and nurses behaving badly” has a direct impact on patient safety.

According to the national study, “The Silent Treatment: Why Safety Tools and Checklists Aren’t Enough to Save Lives,” 85 percent of health care workers reported a safety tool warned them of a problem that otherwise might have been missed and could have harmed a patient. And yet, more than half (58 percent) of the participants said while they got the warning, they failed to effectively speak up and solve the problem.

Why not? The respondents said it was “either unsafe to speak up or they were unable to get others to listen.” The study was based on surveys of operating room and critical care nurses by the American Association of Critical-Care Nurses (AACN), the Association of periOperative Registered Nurses (AORN), and VitalSmarts, a global consulting firm.

In my own legal cases, I have seen time and again where a nurse might notice a laboring mother in trouble, but is afraid to “bother the doctor” or to alert other colleagues up the line. The key word here is “afraid.”

The study, meant to identify communication barriers that contribute to avoidable medical errors, included these key findings:

  • More than four of five nurses have concerns about dangerous shortcuts, incompetence and disrespect demonstrated by their colleagues.
  • More than half say shortcuts led to near misses or harm, and only 17 percent of those nurses shared their concerns with colleagues.
  • More than a third say incompetence led to near misses or harm, and only 11 percent spoke to the colleague considered incompetent.
  • More than half say disrespect prevented them from getting others to listen to them or respect their professional opinion, and only 16 percent confronted their disrespectful colleague.

The 2009 report on doctor-nurse behavior from the American College of Physician Executives (ACPE) might offer a clue as to why hospital workers who see patient safety put at risk don’t speak up. One article says that “throwing objects to express frustration is apparently quite common” and that “nurses have ducked bloody chest tubes, scalpels, power tools, telephones, surgical instruments, clipboards, floor mats and more.” Nurses were also brought to task in the report.

According to ACPE CEO Barry Silbaugh, this kind of behavior hurts patients. “The raw emotion expressed in the anecdotes submitted by the survey participants shows just how destructive and pernicious disruptive communication is to the health care workforce in this country — and to the safety of patients,” he writes of the study results.

The government already notes that medical error is a leading cause of death in this country. A culture of silence that protects those who risk patient lives is unacceptable and should be addressed openly and aggressively by the medical community.

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