Toxic employees in healthcare can undermine patient and worker safety while driving off your best and brightest employees, a corporate psychologist tells Hospital Employee Health.

Mitchell Kusy, PhD, a professor in the Antioch University Graduate School of Leadership and Change, addresses the issue in his new book Why I Don’t Work Here Anymore: A Leader’s Guide to Offset the Financial and Emotional Costs of Toxic Employees.

We asked Kusy to field a few questions about toxic employees and the healthcare workforce.

HEH: Your book addresses this issue beyond healthcare, but you also cite specific data relating to the clinical work culture.

Kusy: Yes, in a study that a colleague and I did with 400 leaders throughout the U.S. on toxic behaviors, 39% of them came from healthcare. Much of the consulting I do is in healthcare, so I am quite familiar with the research and literature in healthcare.

HEH: You cite in your book a study that found 71% of more than 4,000 healthcare professionals associated disruptive behaviors with medical errors. That is certainly a patient safety issue in addition to losing good employees. How do these toxic behaviors manifest in individuals?

Kusy: In our research study I conducted with Dr. Elizabeth Holloway, we found that there were there categories of toxic behavior. One is shaming, two is passive hostility, and the third is team sabotage. The one that is most associated with healthcare is shaming.

HEH: You mention the story of a nurse who could not read a medication order, but went to co-workers to see if they could read it rather than face a toxic physician.

Kusy: She believed he would bite her head off, so she went to three other people to interpret the medication order. Those are the kinds of things we are talking about in healthcare. I’m not here to demonize physicians. It happens everywhere in healthcare — nurse to nurse, lab tech to lab tech, an administrator to direct reports. Some of the research in both healthcare and nonhealthcare indicates when a customer witnesses a disruptive interchange between two employees, 80% of them will not return. We have a lot of places that we can go for healthcare. It’s really important that people start recognizing that this affects patient safety and patient satisfaction, and the overall business as well.

HEH: Is shaming behavior a way for people to feel better about themselves?

Kusy: That is certainly one explanation — to make oneself look better. Another reason is that it is sort of a form of micromanaging, if everybody has to go to a certain individual to get answers to their questions. Another reason is that this is a behavior that they have learned in the past, and they have gotten away with it. There are individuals, as I say in the book, who “knock down and kiss up.” Their boss may think, “I understand this person is tough on people, but he or she gets results.” When people start leaving because of this person, the boss may think, “They can’t hack it.” But these could be very highly competent people who say “enough is enough” and they are not going to take this anymore. So they quit.

HEH: This is one of the main negative outcomes — toxic employees drive their co-workers off?

Kusy: In our research study of over 400 people, we found that 51% would likely quit as a result of a toxic individual. Some of these people that quit are some of your top performers. One healthcare study reported that 31% of nurses quit as a result of this kind of treatment. The cost of bringing in new people is incredible. Human resource studies have found that to replace an entry-level individual, it is about 50% of their annual salary. To replace a mid-level professional, it is about 150%, and to replace a high-level or highly specialized professional it is anywhere from 300% to 400% of their salary. We’re talking about recruiting costs, training, opportunity costs, and lost work. We have to do something about this problem.

HEH: You also note that a perfectionist can be a toxic employee. Why is that?

Kusy: I was doing a presentation to healthcare professionals and talking about how sometimes perfectionism could be a form of toxic behavior when it does not allow people to speak up. A surgeon raised his hand and said, “Would you want to go to a surgeon who isn’t perfect?” I said, “Doctor, I would want to go to surgeon, who — if he or she is about to make a mistake — someone feels comfortable enough to tell them.” Human beings are not perfect, and in healthcare we make mistakes. If someone is not going to be comfortable enough to say to them, “I just noticed something here that may need correcting,” then mistakes are going to happen.

HEH: How can employee health professionals use this information to help address toxic employees and help colleagues?

Kusy: First of all, feedback to people who are toxic often fails without an understanding of how toxic people function. Many times, they are clueless about the impact of their behavior on others. This can be done by talking colleague to colleague. Talk to them in a respectful way and do not use the words “always” and “never.” These words often put people on the defensive. Tell these individuals how their behavior affects others. For example, say, “When you do this, these are the kinds of things that occur among the team.” Do not look at intentions. They may say, “The reason I do that is [some rationale for the behavior].” You know what, the rationale often doesn’t matter. The impact of the behavior is the reason that it needs to stop. It impacts people negatively and employees are quitting.

HEH: Just to clarify, are you saying that the person that is being affected by the behavior talk to the toxic employee?

Kusy: Yes, if possible talk with the person directly. If that is not possible, then a supervisor or a qualified human resources professional can deal with this as well. The one thing you don’t want to do is talk about it in a gossip kind of way. With gossip, there is a lot of what I call “secondary gain.” If you work with someone who is highly toxic and you talk with other team members about how terrible they are, you get a lot of energy and reinforcement. There is a negative to that that I’ve seen in my consulting practice. Let’s say the toxic individual is fired or finally leaves on their own — suddenly, the nontoxic team members don’t know how to relate to each other. So much of their focus has been on the toxic individual. You want to deal with this in a positive way because gossip gets you nowhere.