Toxic teams disrupt patient care and our jobs. Recognizing and removing yourself from the environment is the best thingfor everyone.
It's no secret that we deal with a lot of stressors in our field, no matter what position we hold on the veterinary team. As we try our hardest to keep clients happy and patients healthy, we have to handle a heavy workload, attempt to run a fiscally sound business, and foster relationships with other team members, all while coping with the loss of life.
Author Christine ScarboroughIt shouldn't be a total surprise, then, when toxic behaviors start to creep into our day. But the magnitude of the psychological and physiological effects of these behaviors on our team, and ultimately our patients, cannot be ignored.
My cautionary tale
From emotional and verbal abuse to physical aggression, unfortunately I've just about seen it all. While not every hospital I worked at was toxic, there were enough to make me realize these behaviors were more prevalent than I'd ever imagined. Here's why I decided to quit working on toxic teams.
Emotional and verbal abuse. I once worked with a doctor who referred to our team as “useless idiots” to a client and called us “stupid” in front of the rest of the team. I've worked with doctors who would yell at us routinely, and I even had a coworker tell me I was a bitch during a one-on-one meeting. There were also doctors and team members who would ignore attempts at conversation or refuse to work with someone else. Of course, there was plenty of gossiping going on as well. In the hospitals where the practice owners, associates and managers participated in the gossip, you could be sure the rest of the team did too.
Sexual harassment. I'm thankful I only experienced this at one hospital, but that was still one too many. The person who initiated this behavior was in a leadership role, so some of the people on his team thought it was acceptable and joined in as well. What made it worse was that the main person involved was very close to the practice owner, so I felt completely powerless.
There were times when I would walk by and the males on this team would whistle or, worse yet, make moaning noises. During conversations it was hard to ignore the fact that they were scanning me up and down with their eyes. I often felt disgusted, sick to my stomach and unsafe. Looking back now, I get upset with myself for not having the courage to speak up. Why did I let my fear of being trivialized or losing my job stop me? I wonder how many other women experienced the same thing. Would it have made a difference if I had reported the problem?
Physical aggression. At one particular hospital the practice owner was known for his angry outbursts. One morning when he was already fired up about something, he came into the treatment area, picked up an empty cat carrier and threw it across the room. At other times, if he got angry during surgery, he threw instruments.
But the worst experience at this practice by far was a deeply personal one for me. On this particular day I was turning in my resignation, and I was already nervous about his reaction. While he was calm initially, his attitude changed throughout the day; I could tell he was becoming angry. He started to ignore me and give me the cold shoulder. I was walking on eggshells waiting for him to explode like I'd seen him do in the past.
Before he went to lunch he came up to me at my desk, grabbed my arm forcefully, spun my chair around in his direction and started yelling at me for resigning. I was in complete shock that this man had just put his hands on me! Minutes after the confrontation ended, I put my keys on his desk and left. There was no way I was going to work out a notice after what had just happened.
After quitting all of these toxic practices over the years, I am now fortunate enough to be part of a team where people are treated respectfully and the need for healthy communication is emphasized. The environment is supportive and inclusive, ideas and feedback are encouraged, and collaboration takes place regularly. But in looking back and comparing previous work situations to the present, I have a pretty good idea of the harm toxic teams can do.
Insight from conflict guru Shawn McVey, MSW
"Most practices that suffer from [conflict problems] live in denial and think it's this thing that can't be managed. But it can. Conflict can go from this mysterious thing that happens when people's boundaries are pushed to something that happens in order to be able to change things for the better. Conflict is not a bad thing. It's good thing that can really help out a clinic.”
The impact on our teams
The impact of toxic behaviors on our teams is far-reaching. Some people may experience sadness, while others experience frustration or anger. In my experience, some team members may become physically sick with headaches or gastrointestinal issues. There are also those who may suddenly find themselves reliving traumatic events from their childhood.
These effects erode the foundations of the veterinary team. Team members begin to lose trust either in each other or those in leadership roles. Individuals may lose confidence in themselves and their ability to perform tasks or make decisions. People no longer feel comfortable voicing their concerns or opinions, and collaboration ceases to exist. The underlying theme to all of this, which is perhaps the most detrimental impact, is a complete breakdown in communication.
The impact on our patients
Once our veterinary teams are unable to communicate, our patients are at risk. After all, patient care centers around the transfer of information-orders from doctors, results from technicians and assistants, client questions or concerns from receptionists, the admission of mistakes and discussions about how to prevent them, and so on. If we can't transfer information because of our inability to communicate and function as a team, our patients will suffer in the long run.
When a toxic environment exists, team members may miss or skip treatments, take shortcuts or hide medical mistakes. If they no longer feel psychologically safe due to toxic behaviors and they end up hiding their errors, what kind of harm is that causing our patients? Wouldn't we rather be aware of the mistakes so they can be addressed and prevented in the future? Doesn't that actually result in improved patient care?
Lessons from human healthcare
Amy Edmondson, PhD, a professor at the Harvard Business School, frequently lectures on building a psychologically safe workplace. In 2006, Edmondson, along with Ingrid Nembhard, PhD, from Yale, studied 1,100 human healthcare clinicians in 26 different hospitals, focusing on the effects of leadership inclusiveness on psychological safety.
Results of their study showed that in the hospitals where teams felt psychologically safe, there was an 18 percent reduction in mortality rates compared to those hospitals where teams felt less comfortable and valued. These teams felt safe because leadership was inclusive, they were accessible, and they asked for their teams' input.
In another study of 4,500 healthcare workers, more than three-quarters of the respondents reported physicians exhibiting toxic behaviors, and more than half reported nurses exhibiting toxic behaviors. Sixty-seven percent said they believed these toxic behaviors were linked to adverse events, including medical errors and patient mortality.
Insight from conflict guru Shawn McVey, MSW
“That's not necessarily true. I think the employee's feelings shouldn't be judged, but they need to back it up with more than just, ‘This is bullying' or ‘This is toxic.' The person crying “Toxic!” is usually part of the toxic problem. People can be too sensitive for the real world or not understand their own defense mechanisms that are escalating minor problems.”
> “We have a doctor who is the bad apple in the bunch, and the practice owner agrees. But she'd rather have her arm cut off than discipline anyone in our practice. So the situation just drags on and on.”
> “One assistant is extremely argumentative with others and rough with certain clients. Everyone has to act a certain way to avoid conflict.”
Where do we go from here?
From my experiences and observations, it seems we have a long way to go, but at least we're starting to move in the right direction. For individuals, teams and representatives of our profession, there are some steps we can take now to combat these behaviors and the effects they have on our teams and our patients.
Cultivate self-awareness. Look inside of yourself and be honest about any toxic behaviors you bring to the table. Self-awareness is the first step to any change, and if you're guilty of toxic behaviors, the change has to start with you.
Implement a plan and develop policies. Create a plan that includes a zero-tolerance stance, a code of conduct and a process to manage toxic behaviors.
Educate yourself and others. We all need to do our part to learn and to teach others not only about toxic behaviors but about the effects as well. Our technician and veterinary schools should incorporate lectures and even classes that better prepare students for interpersonal conflict. We should also develop more CE programs that focus on this topic.
Commit to eliminate. Let's “be the change we want to see.” We need to require more of ourselves and each other. We can learn to speak up and stop these behaviors when they occur. Think about how much our work environment and patient care would improve if we all committed to eradicating toxic behaviors from our veterinary practices.
Christine Scarborough, RVT, CVPM, has been in the veterinary field for more than 20 years. She is the manager at the Atlanta Humane Society's Veterinary Center and is the owner of Scarborough Veterinary Consulting. She enjoys outdoor activities like gardening, hiking and standup paddle boarding and seeks thrills through riding roller coasters and motorcycles.