As healthcare professionals, we often pride ourselves on being part of high-performing teams. We work under immense pressure, striving for excellence in environments where even the smallest misstep can have life-altering consequences. Yet, amidst the chaos, there’s a subtle, insidious force that can undermine our efforts: bad behaviour.
From an eye roll to a dismissive comment, these seemingly minor actions can ripple through a team, affecting morale, trust, and, ultimately, patient safety. In this post, we’ll explore what constitutes bad behaviour, its impacts, and practical steps we can take to create healthier team environments.
Listening Time – 18.14
What Is Bad Behaviour?
When we think of bad behaviour in the workplace, we often envision overt actions like shouting or blatant disrespect. However, bad behaviour can be far more subtle and pervasive. It can manifest as:
- Physical actions: Throwing items, gesturing dismissively, or even a small shove in the hallway.
- Material neglect: Ignoring a phone call, refusing to collaborate, or withholding opportunities from colleagues.
- Verbal cues: Sarcasm, backhanded compliments, or openly expressing displeasure about working with someone.
- Digital misconduct: Sending passive-aggressive emails or texting during meetings to gossip about others.
- Discrimination: Racial, gendered, or prejudicial behaviours that create barriers to inclusion and safety.
These actions might feel trivial in the moment, but their effects can be profound.
The Impact of Bad Behaviour on Teams and Patients
Bad behaviour doesn’t just harm individuals—it corrodes the fabric of the team. Research shows that environments lacking psychological safety lead to:
- Delays in escalation of care: Junior staff are less likely to raise concerns, potentially compromising patient safety. In fact, one study revealed that after experiencing dismissive behaviour, team members might wait up to 27 minutes before voicing a concern again.
- Increased cognitive load: A hostile work environment forces individuals to focus more on avoiding conflict than on their actual tasks, increasing the risk of errors.
- Decreased collaboration and creativity: When people don’t feel safe, they stop sharing ideas and seeking feedback.
- Higher absenteeism and turnover: Toxic environments push good team members out the door.
- Generational harm: Bad behaviour cascades down the hierarchy, perpetuating a cycle of mistreatment from consultants to registrars, junior doctors, and ultimately, patients.
In healthcare, where lives are at stake, we cannot afford the consequences of unchecked bad behaviour.
Psychological Safety: The Bedrock of Effective Teams
Psychological safety, a term popularized by Harvard professor Amy Edmondson, is the belief that a team is safe for interpersonal risk-taking. It’s what allows someone to admit they’ve made a mistake, ask for help, or offer a differing opinion without fear of ridicule or retribution.
To build psychological safety, teams need:
- Trust in competence: Colleagues must feel confident in each other’s skills.
- Consistency: Unpredictable behaviour undermines trust.
- Authenticity: Leaders and team members must genuinely care about their work and each other.
- Empathy: This doesn’t mean hand-holding, but rather a basic level of understanding and consideration for others.
Without these pillars, psychological safety collapses, leaving teams vulnerable to dysfunction.
Self-Awareness: The Rare Skill We All Need
Here’s a humbling statistic: fewer than 10% of people have high self-awareness. This means most of us aren’t as in tune with how our actions affect others as we’d like to believe.
For example, you might think you’re approachable and supportive, but if colleagues avoid you or hesitate to ask for help, it’s time to reassess. The truth is, being right or skilled isn’t enough—how we make others feel is just as important.
Simple Self-Awareness Exercises:
- Ask for feedback: Encourage colleagues and family members to share honest impressions of your behaviour. Questions like, “Do I have a face that shows frustration?” can be surprisingly illuminating.
- Observe reactions: Pay attention to how people respond to your words and actions. Are they comfortable opening up to you?
- Reflect on conflicts: In tense situations, consider your role. Are you a victim, rescuer, or perpetrator? Understanding your default stance can help you adapt and improve.
The Triangle of Trust: Competence, Authenticity, and Empathy
Effective teamwork relies on three key attributes:
- Competence: We all want to work with people who know their stuff. However, competence alone isn’t enough if paired with arrogance or dismissiveness.
- Authenticity: Being genuine fosters trust. But authenticity doesn’t mean excusing bad behaviour under the guise of “that’s just who I am.”
- Empathy: Empathy is about caring enough to listen, understand, and respond appropriately. Even a blunt acknowledgment like, “I heard you left your husband—are you okay?” can show empathy in its own way.
Balancing these traits creates a foundation for trust and collaboration.
Recognising and Addressing Bad Behaviour
So, how do we tackle bad behaviour in our teams? It starts with recognition and accountability.
Common Forms of Bad Behaviour:
- Incivility: Eye rolling, sarcasm, or dismissive gestures.
- Bullying: Persistent criticism or exclusion.
- Cliques: Forming exclusive groups that alienate others.
- Passive aggression: Deliberately delaying tasks or withholding information.
Strategies to Address It:
- Set clear expectations: Outline acceptable behaviours and consequences for violations.
- Lead by example: As a leader, your actions set the tone. If you’re approachable and respectful, your team is more likely to follow suit.
- Encourage open communication: Create an environment where feedback flows both ways. Team members should feel safe addressing issues without fear of retaliation.
- Focus on education: Provide training on emotional intelligence, conflict resolution, and effective communication.
Homework: Improving Team Dynamics
To cultivate better behaviour, consider these actionable steps:
- Identify your ‘face’: Ask colleagues or family members if you unconsciously display emotions like frustration or impatience. Work on maintaining a neutral or supportive expression, especially during stressful moments.
- Evaluate your listening skills: Ask yourself, “Am I really listening, or am I just waiting for my turn to speak?”
- Shift perspectives: In conflicts, try stepping out of your usual role. For example, if you’re a natural rescuer, let others solve their own problems. If you tend to critique, focus on offering constructive solutions instead.
- Foster inclusivity: Actively involve quieter team members in discussions and acknowledge everyone’s contributions.
Breaking the Cycle of Bad Behaviour
It’s easy to justify bad behaviour by pointing to stress, fatigue, or past experiences. But every time we allow our frustrations to spill over into our interactions, we chip away at our team’s cohesion and effectiveness.
Remember, high-performing teams aren’t just about technical excellence—they’re about how we treat each other. By addressing bad behaviour head-on, we can create workplaces where everyone feels valued, respected, and empowered to deliver their best.
Conclusion: Be the Change
Bad behaviour is like a toxin—it seeps into every corner of a team, affecting relationships, performance, and patient outcomes. But the good news is, we have the power to change. By fostering psychological safety, practicing self-awareness, and holding ourselves accountable, we can build healthier, more effective teams.
So, the next time you catch yourself rolling your eyes or dismissing a colleague’s concern, pause and reflect. Small changes in how we behave today can make a world of difference tomorrow—for our teams, our patients, and ourselves.
Podcast Transcription
It’s so embarrassing to get up and talk about bad behaviour in a group of such high performing teams because in my whole career, I’ve never seen people who really excel at their skills behave badly.
That’s a joke. and so I’m sure that there are no lessons for you individually, but something that you might like to take home to wherever you work. The objective of the talk today is first of all, what constitutes bad behaviour? Then what are the impacts of bad behaviour? And this whole thing around self awareness is actually very rare.
So I know that you’re already sitting there and thinking, this has nothing to do with me. I am a model employee. I am the person that everyone wants to see on shift. So again, just take this home, and see if you can apply it to your team. So we’ve just written a paper on this, and the findings are mind blowing.
So first of all, when it comes to patient safety, what we found was, wait for this, eye rolling. is as dangerous for patient safety as sexual harassment. Let me say that again. Eye rolling, which I’m sure no one in this audience has ever done, is as dangerous for patient safety as sexual harassment. And the reason for this is because if I am a junior staff member or just a peer and I go up to someone and I say I know you just saw this patient, but I feel like they’re going off.
I feel like something’s going wrong. And the person says, your perfume smells really good. I’m no longer thinking about my patient. I’m thinking, creepy as hell. And I’m taking a step back. Equally, if I go up to the same person and say, Look, I know you just saw this patient, but I’m actually really worried about them.
Would you mind coming and having another look?
And they go, Oh, for God’s sake. There’s nothing to worry about. Thanks. I’m just going to quietly go back to my patient. People will then wait 9 to 27 minutes before escalating another concern. That’s someone’s brain. And this whole thing about psychological safety that people go on and on about is true.
So once someone doesn’t feel safe to talk to their colleagues, to ask a question, to say that they’re a bit concerned they’ve done something wrong, we know that creativity stops, collaboration stops, that people have a higher cognitive load, that people are more likely to leave the organisation, they’re more likely to call in sick.
So this has, this doesn’t matter if you work in the police or the SAS, wherever you are, if there is bad behaviour, it impacts the organisation. everybody in the team. Can any of you here ever remember having someone in the team shame you, question you?
Has anyone ever had that happen at work? Put your hand up. Even if that happened ten years ago, when you go to approach that person, put your hand up if you still think about that occasion. This is a life lasting injury that happens to us. We are all capable of an eye roll.
We are all capable of being tired, frustrated, annoyed. I constantly in my job am asked to see people who have communication difficulties. Interestingly, everyone who comes to see me doesn’t have communication issues. When they sit on my couch and splay themselves and say, So what exactly are your qualifications?
Because I’m a transformational leader. This could be part of the problem. In that we don’t know sometimes how our behavior impacts others, how we are perceived by others.
I have worked with a team where they told me when their nurse unit manager has her hair in a braid and a coffee, you can speak to her. And when her hair is down, you hide from her. This is how much we watch your behaviour. For those of you who are any sort of ranking, people come to work and the first words out of the mouth is, who is on?
Anyone ever said that? Why are we saying that? Because that is how we will know what sort of day we will have. What sort of shift? Is it going to be fun? Educational? Thrilling? Is it just going to be hell? Has your soul died a little bit inside? And how do you know where you sit in terms of the rest of the team?
So what’s bad behaviour? There’s a number of ways we can categorise it. You might think, I’ve never sworn at anyone, I’ve never thrown anything, I don’t misbehave. But physical bad behaviour can be gesturing, can be a little shove as you walk past someone in the hallway, throwing a chart or something else down, throwing a kidney dish at someone.
It can be material, and this is really where it’s much more subversive, where we’re going. I’m just not going to pick up this phone call. I’m not going to answer this page. I’m just going to take my time to go and help this person. I’m not going to ask them to collaborate. I’m not going to let them know we’re doing research in this area.
I’m not going to give them any exciting shifts or any good jobs. It can be verbal. And it does, again, it doesn’t have to be something huge, it can just be like, Oh, you’re on. Yay. It’s a very clear message that someone is not welcome, not part of the gang. And today we can do it in all sorts of subtle ways, via email, we can do it via text, you can sit in meetings sometimes and you know that this person here is texting this person here about this person.
You can watch it unfold in front of you. And it can also be more sinister, and it can be racial, gendered, it can be discriminatory, prejudicial, all These are all bad behaviours, that whether you like it or not, it impacts the team.
Now in our research, what we found was, is that at the moment lots of people are talking about harassment, or incivility, or, something else.
And by breaking it up into different sorts of bad behaviour, all it does is dilute the problem. Because on the whole, the people who misbehave are the people who misbehave. And despite the fact that we all live in workplaces that have folders this big around code of conduct about what we can and can’t do, and a zero tolerance we all know that’s a load of crap.
And actually, our research found that if you are a very powerful person in your organisation, or if you have a unique skill set, the organisation will not touch you. And the harm is universal. And the harm is also generational. We’ve just done a junior doctor research piece, and so many of the junior doctors said, it cascades down like a waterfall.
If the consultant treats the registrar or the nurses bad, they then treat us bad, and then we treat our patients bad. Some of us have an attitude where we were treated badly, so therefore we should treat the next generation badly, because we didn’t come out too bad at all. We just want to harm people the same way we were harmed.
I don’t care what you tell yourself, if you behave badly at work, you harm the team. You are not the team. You will never be the good as the sum of the team. So every time you do something that breaks the trust of the team, that says there’s a clique and you’re not part of the team, you are harming the team.
You are teaching bad behavior. You are encouraging bad behavior. Now Amy Edmondson speaks a lot about psychological safety, but this is my sort of simplified version of what she says. That it is a triangle, and there is no point on this that is more important than any other. So first of all, if you need trust amongst a team, amongst behaviours, the first thing you must see is that person is competent.
We can have someone who’s really sweet, and But if they’re thick as two bricks and they have no idea what they’re doing, you do not want to work with them. They are dangerous. You can have someone who’s exceptionally competent, really talented and skilled, but if they’re an arsehole, you do not want to work with them.
Authenticity is important. Be who you say you are but don’t say I’m a psychopath and then be a psychopath. This is not good for behavior, this is not good for teens. But also you don’t get to say I’m a really lovely person just as long as I’m well fed,even I’m under completely zero amount of stress, right?
You have to be authentic in what you’re doing. You have to be consistent. has anyone ever worked or lived with someone who’s extremely moody? Every day we have to brace ourselves for the worst of that person, not the best. And lastly, you’ve got to be empathetic. And that doesn’t mean you have to hold them to your breast and rock them gently, right?
That just means just care. Just care. I’ve had bosses who I would not call particularly high in emotional intelligence. I have a very close friend who’s a director of paediatric intensive care. And when I got divorced, he said, Hoi, come here. I said, what? He goes, heard you left your husband.
I said, I did. And he goes, you’re not going to cry at work are you? I said, no, I’m not gonna cry. Are you sure? I said, yes. He goes, can I still give you shit? I said, yes, and he’s like, all right, we’re good. I said, we’re good. I found that very empathetic for him. It was very warm and fuzzy. So empathy can look like all sorts of things.
It’s the way the person receives it, right? Equally, you don’t get to call a debrief or call someone in and say, This is a very safe space. If you’ve been a psychopath for the last 16 years, you don’t get to smile warmly and tell the team they’re safe because they don’t believe you. You’re a psychopath, and they know the second they turn their back, you’re gonna shaft them.
So the problem is that all of you, no doubt, like me would say I’m very self-aware. I’m not that person. People are very excited to see me when I come on shift. But how do you know? What is your data? Is it just that you feel that deep down inside? That you’re pretty cool? The research shows that self awareness is exceptionally rare.
Less than 10 percent of people actually have good self awareness, and that self awareness, the only way you can be guaranteed it, is if you do, you fill out something, and then your loved ones fill out something about you, and then your teammates do, and then you get it all together, and it matches and pairs.
That’s the only real way. So ask yourself, how often do people come to you and are vulnerable, or ask you questions, or say they’ve made a mistake? Because if people avoid you, if no one ever wants to have lunch with you, you’re not the transformational person you thought you were. And the other thing is, because there’s so many high performing people in here, the science and the data would say that you are actually at huger risk of having less self awareness because you often are right.
So when you’re wrong, you’re much more likely to miss it. You’re much more likely not to see it. So here’s some homework. Homework number one. Go and ask your family or your team. Do I have a face? If so, what is it? Because I can tell you, after years of providing therapy to people, I have a fairly good poker face and I have one thing that gives me away, and people who love and know me well know it, and I’ll tell you what it is.
My mum came to dinner the other day, and as we were cleaning up, my two boys said to me, Was Nanny annoying you at dinner, Mum? I said, No. They said, There was a lot of nostril flaring going on. Whether you think you’re hiding it or not, there is something about you that’s giving it away. Ask your family and friends, what’s the face?
And then when you feel your nostrils flaring, breathe deeply. You’re not in control of yourself like you think you are. Then, ask your loved ones, what sort of listener am I? And then, you have to listen for the response. Because if you really want to have good behaviour, you have to listen to what people are saying, respond to it fairly, and also listen to what people don’t say.
You can’t go back to your team and say, especially if you carry a gun, how do you find me as a team mate? It’s unlikely that going to feel safe to let you know. We’ve all been in a position where someone says, we just want some feedback, but what they’re really saying is, we just want some praise.
This is a little bit of pop psychology, but it’s fun to think about. So in a conflict or a drama, all of us will navigate towards one of those, right?
So the victim is the person, a bit like Bart Simpson, I wasn’t there, I didn’t do it, I don’t know what happened. The victims are people who really hate conflict. They avoid it at all costs. They also don’t like accountability, and they’re the people who are always saying, Can you help me? It’s not, it wasn’t me.
I don’t know what happened. This wouldn’t have happened if I wasn’t so tired. That’s a victim. The rescuer are people like me, that love striding in on a white horse, and we’re so brilliant, we’ll just solve all of your problems for you, right? Now the problem with the rescuer, because everyone thinks that must be the nice one to be in the Karpman drama triangle, is that people who are always rescuing assume they know everything.
They’re really annoying. they’re terrible, to be married too, because someone might just want to be telling something, and you’re already trying to solve the problem. Rescuers also keep victims where they are. They don’t empower people to make their own decisions. Perpetrators are the people who just like to call it as it is.
We’re not really perpetrators. We’re the truth tellers. We’re the people that keep things going on. So out of those three, have a think about, in a conflict or in a drama, where do you like to sit? Alright, I’m going to start down the bottom. Put your hand up if you have to honestly say, yep, hand on heart, I’m a perpetrator.
There’s nothing wrong with being a perpetrator. You just have to know that in an argument that’s what you do. You have to know that it’s likely in a meeting you’re the shit stirrer. That’s your natural default. And you have to be mindful of that because the rest of the team gets to a point where they’re like, Oh, we’re just going to wait for Derek to now say why this is a dumb idea.
Why they tried it in 1998 and it didn’t work then and it won’t work now. So the perpetrators have to be mindful because you do play a very important part. in getting things done. You are often people who will say what needs to be said, but the flip side of that is you can also just be frigging irritating and love the sound of your own voice.
So put your hand up really high if you’re a rescuer. I’m a rescuer, I’m a social worker for God’s sake, So again, we can be lovely people, we can be very helpful, we can also be martyrs, We can also annoyingly always seem to know the truth and what needs to be, and that what everyone else could do like we don’t have any problems ourselves.
Rescuers can also be a pain in the sense that they take on everyone else’s problems and then they whinge about it. I don’t know why everyone in the neighbourhood tells me their problems, when in actual fact as soon as anyone says anything we’re there for you.
Now the victims. Are there any victims in here? there’s nothing wrong with being a victim. There’s none of these that are better than any others. But you have to realise that you’re conflict avoidant.
You find it easier to blame other people because then you don’t have to blame yourself. You’re the person that would rather lie down and play dead than have any sort of conflict. So when it comes to bad behaviour, all of these can be bad and all of these can be good.
But the difference is that when you are aware. you’re in love with someone, or if you’re just married,have a conversation with them about where they sit, and where you sit, and where you keep positioning yourselves around drama and conflict. And then think about it as a team, and then try playing different roles, or seeing things from different roles.
Thank you very much.
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