The Field Guide › Paper
Katz and colleagues ran the experiment that most discussions of rudeness at work can only gesture at: a multicentre, prospective, randomised controlled trial testing whether incivility actually degrades clinical performance, rather than merely feeling unpleasant. Anaesthesiology residents at three academic centres were randomly assigned to complete a validated simulated operating-room crisis, a scenario of hidden haemorrhage, in either a normal environment or one in which they were exposed to rudeness and disrespect, and blinded evaluators then scored their performance. The result is stark: residents in the rude condition performed worse on every measure that mattered, vigilance, diagnosis, communication and patient management, than those in the civil condition. The most unsettling detail is that the residents did not know it had happened to them: self-assessment scores barely differed between the two groups, so the people whose performance had been impaired by incivility believed they had done just as well. For a corpus about psychological safety this is close to a controlled demonstration of the mechanism. Incivility is the lived opposite of a respectful, safe climate, and here it measurably damages the cognitive and collaborative work on which patient safety depends, unremarked, in the middle of a crisis, without the victims noticing. It converts a claim that is easy to wave away, that being rude to people harms performance and not just feelings, into evidence. Its limits are those of a simulation study: the crisis was staged and the sample was anaesthesiology trainees, so the effect is cleanly identified but its exact size in a real theatre under real stakes is left open. (Text drawn from the 2019 BMJ Quality & Safety paper, 28(9), pp. 750-757.)