Toxic workers put organizations at risk

“The day this person left our company is considered a national holiday.”

This quote from a participant in our national research study is illustrative of the considerable attention and pain associated with toxic behaviors in healthcare workplaces. While bullying has been a common topic, less known are those behaviors that do not reach the threshold of bullying—often referred to as “toxic behaviors.”

Our survey and interview study consisted of a sample of more than 400 leaders (39% from healthcare). We asked leaders about their experiences in working with individuals demonstrating toxic behaviors, defined as a pattern of counterproductive work behaviors that seriously debilitate individuals, teams, and/or the organization over the long term. Some 94% said they worked with a toxic person.

Three types of toxic behaviors were discovered: shaming, passive hostility and team sabotage. These behaviors are subtle and hard to identify, therefore, many leaders do not address them in performance-management processes or formal disciplinary systems. Consequently, they can slip under the radar until they have greatly affected team performance.

Dr. Alan Rosenstein's research involving medical professionals (American Journal of Medical Quality, 2011) discovered that participants felt a strong correlation between disruptive behaviors and the occurrence of medical errors and compromised quality (71%), adverse events (67%), compromises in patient safety (51%), and a contributing factor to patient mortality (27%). The Joint Commission in its analysis of sentinel events found that nearly 70% could be traced to communication problems, many of which are a reluctance to interact with physicians or other healthcare professionals who are considered to be “toxic.”

Why not just fire these toxic individuals? It's not quite that easy. These staffers may be your highest producers or have special expertise not replicated elsewhere. Performance-review criteria often don't include behavioral values. How do you fire someone who violates these values if these are not included in the criteria? Even if you “fire” the individual, you may be left with a dysfunctional team because toxic behaviors spread like a virus. Once you have a culture of incivility—backstabbing, gossip, angry outbursts, condescension and manipulation—this can quickly become the norm. A systems view is necessary to solve the problem.

In the typical toxic system, we found two roles that create and sustain it: the “toxic protector” and the “toxic buffer.” The toxic protector unwittingly permits bad behavior to continue and feels compelled to protect the perpetrator from negative reviews or termination because the protector has a special interest in keeping the person as a part of the team, often because the toxic employee is highly productive or has a special skill set.

Unlike toxic protectors, toxic buffers typically recognize that the toxic behavior is detrimental to team functioning. However, the buffer believes that the solution is to serve as a shield between the toxic person and the team. Despite good intentions, the buffer enables the toxic employee to get away with bad behavior. While trying to absorb the toxicity, the buffer often becomes emotionally damaged and unwittingly contributes to the team's spiral of dysfunction. Ironically, both toxic protectors and toxic buffers actually facilitate the enactment of a culture of incivility.

The rise of toxicity across the team, team members' acceptance of uncivil behavior as a norm and hidden players who enable a toxic culture to be sustained are the reasons effective strategies must address the system of incivility—not just the individual.

Remedies include providing feedback to the toxic protector and buffer (not just the toxic person) and collaborative design of compacts for professional behaviors in which all levels and disciplines have input and team engagement in developing norms to honor the behavioral compacts. Organizational values must be concrete and behaviorally specific and integrated into performance appraisals for everyone. With these system elements in place, administrators will be able to definitively document any toxic behaviors that have violated the values of the organization and cannot be tolerated.

For those leaders who are leery about firing a high-producing toxic individual, remember the downfalls of not doing this. These leaders will be catalysts in other non-toxic high-producers quitting. Toxic individuals put your organization at risk in terms of reduced patient safety and satisfaction, promoting a culture of nastiness—not a good thing when poor patient satisfaction can have severe consequences for the bottom line. The best healthcare organizations model the term we have coined: “Everyday civility” in which respectful engagement is the norm, not the exception.