Incivility and Patient Safety: A Longitudinal Study of Rudeness, Protocol Compliance, and Adverse Events

Arieh Riskin, Peter Bamberger, Amir Erez, Trevor Foulk, Binyamin Cooper, Ilana Peterfreund, Janna Sheps, Mira Wilhelm-Kafil, Yarden Riskin, Kinneret Riskin-Guez, Ellen Bamberger

Research output: Contribution to journalArticlepeer-review


Background: Little is known about the impact of social interactions on iatrogenesis and lapses in patient safety. Methods: This field-based experience-sampling study of primarily nurses in a general hospital explored the impact of rudeness on patient safety performance, state depletion (that is, exhaustion of mental energy for reflective behavior), and team processes (for example, information sharing). Objective measures of performance were compliance with hand hygiene and medication preparation protocols, as well as archival reports of adverse events. Data were analyzed by department shift (480 shifts [15 days] in 16 departments). Results: A total of 231 rudeness incidents were reported in 98 shifts, most stemming from a patient or family. Compliance with hand hygiene was significantly lower up to 24 hours after rudeness exposure (p = 0.03). Rudeness significantly increased team members’ state depletion (p = 0.002) and was associated with decreased information sharing (p = 0.046) but was not directly associated with adverse events or level of compliance with medication and hand hygiene protocols. However, the adverse indirect effect of shifts’ temporal proximity to rudeness on poor compliance with medication preparation and team members’ information sharing via state depletion was significant. Rudeness exposure was also associated with increased rate of adverse events in the subsequent 24 hours, although this association was not statistically significant. Conclusion: Rudeness exposure was associated with reduced team member compliance with infection control and medication protocols via greater team member state depletion and diminished information sharing.

Original languageEnglish
Pages (from-to)358-367
Number of pages10
JournalJoint Commission Journal on Quality and Patient Safety
Issue number5
StatePublished - May 2019


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