Dealing with Toxic Employees
Ask yourself: “If this behavior continues, could it be a patient safety issue?”
Everyone has met him or her — and would prefer not to meet them again. But there they are when you arrive for duty: The toxic co-worker.
The Association of Occupational Health Professionals in Healthcare (AOHP) recently recorded a podcast1 on this topic, featuring speakers Steven Wiesner, MD, and Mitch Kusy, PhD. The latter is an organizational psychologist at Antioch University and a consultant with the Healthy Workforce Institute. Recently retired, Wiesner is experienced in human resources and three decades of clinical work in occupational health, physical medicine, and rehabilitation.
Generally, there are two types of disruptive behavior at the workplace: The covert and the overt.
“In general, we are seeing more of the overt — yelling and slamming doors,” Kusy said. “But we’re also seeing more of the covert types of incivility and disruptive, toxic behaviors. My guess, as a psychologist, is that we’re seeing more [covert] because of the pandemic, when we were all behind screens and people say things in the chat function.”
As with so many issues, the problem of toxic employees predates the pandemic. “It’s not a different negative outcome; it’s just been highlighted to a degree that we had not experienced,” Wiesner added.
Not only do toxic employees drive their co-workers from the job, but those who remain may have a disillusioned affect that is a kind of “presenteeism.”
“Presenteeism can also have a very significant impact on the productivity and the ability of that team to work effectively,” Wiesner said. “These are people who are still at work, but they are going to have less of a committed job effort. They may try to take some time off just to get away from that negative environment. They also may show a decline in their own professional performance. It’s not just the people leaving the workforce — it’s how do we support those people who are still there if they are working in an environment that is really not respectful and civil?”
There are three general benchmarks to determine if toxic behavior is directed at you or your colleagues, regardless of whether it is overt or covert. “It’s targeted, it’s harmful, and it’s repeated,” Kusy explained. “When you look at something that’s targeted, either one on one or to a group, it’s harmful. When it’s harmful, intention doesn’t matter. ‘I didn’t mean to hurt you’ is not an appropriate response.”
The repetition of the behavior rules out that it is just someone having a “bad day,” he noted.
Shaming and Team Sabotage
Toxic behavior includes shaming, bullying, passive hostility, and team sabotage. “Shaming could include things like humiliating other people, especially in public,” Wiesner said. “Saying sarcastic comments, rolling the eyes, which can actually convey quite a bit of nonverbal information.”
The passive-aggressive types generally are hard to work with, have difficulty accepting feedback, and yet they rarely show outright hostility. “Some of these people don’t even have the insight to see how their behaviors are toxic to others,” Wiesner said.
Some toxic individuals do not focus on the team, and sabotage its effectiveness. “They may belittle people during a meeting, or be quiet during the actual meeting and then afterward say negative, hurtful comments to really undermine what may have been discussed,” Wiesner said.
That does not mean sarcastic comments that may come out a little stronger than intended mean you are a toxic person, Kusy noted, emphasizing the importance of seeing a pattern of behavior over time. “We’re humans,” he said. “At times, we are all uncivil to our partner, to a friend, to a co-worker, to our boss, to our direct report.”
In cases of peer-to-peer feedback, ask yourself these questions, Kusy noted: “Are you giving feedback to prove you’re right? Or are you giving feedback to try to respectfully change behavior? If you’re trying to prove you’re right, step back and start examining that motive, because there is a possibility that that could be perceived as toxic.”
If you feel like you said something that may have hurt a colleague, Wiesner recommended approaching them directly and saying, “Did I offend you? If I did, that certainly is not something that I intended to do. This has been on my mind, I just want to make sure that we’re doing OK in our relationship at work.”
These kinds of conversations and “check-ins” with colleagues will build trust and civility in the workplace, Wiesner added. The workplace culture ultimately affects worker health and patient safety.
“For me as a psychologist and not a physician, I thought that many of the medical errors that are done by physicians and nurses were based on incompetence,” Kusy said.
The problem goes well beyond that. Some errors are caused by communication breakdowns that may be perceived as “uncivil” behavior. A Joint Commission study2 Kusy cited revealed lapses during patient handoffs from one facility to another — a critical juncture to avoid medical errors — often were the result of obstacles encountered by both the sending and receiving parties.
“Barriers to effective handoffs experienced by receivers include incomplete information, lack of opportunity to discuss the handoff, and no handoff occurred,” the study authors wrote. “Senders identified too many delays, receiver not returning a call, or receiver being too busy to take a report as reasons for handoff failures.”
Intimidation
Intimidation can take various forms, but invariably the target is likely to avoid contact and communication with the toxic person.
For example, if a physician is critical of a nurse, the nurse might be reluctant to clarify an order with the physician, Kusy explained. During a speaking engagement, a man raised his hand and said his wife was a nurse, who went to two different physicians to clarify the medication prescribed because she refused to return to the doctor who gave the order.
“If someone is intimidated, they’re not going to go, in this instance, to a provider who initiated the order because they don’t want to be dressed down in public or one on one,” Kusy said. “They’re going to go to somebody else.”
At another talk on the issue, a surgeon told Kusy she had to be intimidating because she demanded perfection.
“She said to me, ‘Do you want to go to a surgeon who isn’t perfect?’” Kusy recalled. “My response to the doctor is that I want to go to a surgeon that — if they were about to make a mistake — someone would feel comfortable enough to call them on that error.”
Toxic behavior need not be hierarchal; it can be nurse-to-nurse or physician-to-physician. For instance, someone might feel intimidated in a meeting and does not want to speak up, Kusy said. “This could definitely be toxic if it’s targeted, harmful, and repeated.”
The Script
Is the intimidation directed toward you and coming from the same person who, for example, interrupts you when you attempt to speak in a meeting?
“Let’s talk about an occupational therapist or a nurse out there, who may say, ‘I’m experiencing these toxic behaviors, what do I do?’” Kusy said. “One of the things I do is teach people how to have a conversation with someone about this as your first step.”
One could approach a colleague, but if you decide to have “the courageous conversation” with the toxic source, use a scripted approach and know exactly the points you are going to make.
“Write it ahead of time, and there are four key elements to the script,” Kusy said. “These are the intro, the behavior, the impact of the behavior and then the ‘toss back.’ Say, the past three times they’ve interrupted you at a meeting and not given you a chance to speak.”
Here is the script Kusy recommended for this scenario, with the targeted party saying the following four things from the script, with his comments in parenthesis.
- Intro: “Something just happened in this meeting that bothers me, and I’d like to talk about it.” (“It’s as simple as that.”)
- Behavior: “I tried speaking three times, and I’ve not been able to finish my sentence.” (“Notice how concrete that is.”)
- Impact: “I don’t know if I’m able to express myself in these meetings.”
- Toss back: “When can we talk about it? Is this a good time?”
Realizing this confrontation will be uncomfortable to some, Wiesner favors reporting the behavior to human resources and teaching all employees that it will be reviewed as part of their performance record.
“It gets back to the cultural importance — that these are clear expectations that are part of each individual’s performance evaluation,” Wiesner said. “If someone is showing behaviors that are not consistent with our policies and culture, we can ask this person: ‘What is it about this policy that you may be having a hard time understanding?’ Because going back to [our values of] self-compassion and compassion for others, if there was a misunderstanding, we want to provide them with resources, training, coaching, counseling in a positive way. We’ve invested a lot in that employee, and we want them to be successful.”
Bottom-Line Question
Whatever course the target of the behavior takes, Kusy recommended asking one bottom-line question. “If this behavior continued, could it be a patient safety issue?” he asked. “If there’s any possibility that it is, then you need to do something about it.”
Signs that toxic behavior may be in afoot in your workplace are rumblings and expressions such as, “I’m never working with him or her again.”
“With those kinds of cues, individuals are calling it out,” Kusy said. “Actually, they’re calling for help, but they don’t know they’re doing that.”
REFERENCES
- Association of Occupational Health Professionals in Healthcare. AOHP’s Caring for Healthcare Professionals Podcast — Episode 35 — Dr. Steven Wiesner and Dr. Mitch Kusy on toxic behaviors and what to do about them. April 31, 2022.
- Monegain B. Joint Commission confronts deadly miscommunications. Healthcare IT News. Oct. 22, 2010.
Everyone has met him or her — and would prefer not to meet them again. But there they are when you arrive for duty: The toxic co-worker.
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