One of the annual rituals that many of us go through at the holidays is a personal inventory of what we want to do in the coming year. The list can be endless: lose weight, exercise more, save money, get a better job, finish that novel, et cetera. In organizations, we call these strategic goals; that list, too, can be endless: increase productivity by 10%, cut costs by 7%, increase employee diversity by 5%, and so on. What about the intersection of personal and organizational goals? Where does that list go? What should it include? I have a suggestion: less anger.
Aside from the emotional costs associated with being the target for or witness of anger and verbal abuse, there are financial costs, too. These costs include, but are not limited to: “damages to victims and witnesses, such as distraction from tasks, absenteeism and turnover, loss of motivation and energy, stress induced psychological and physical illnesses; woes of perpetrators, including retaliation, job loss, and career damage; management consequences, such as time spent counseling employees, cooling out victimized customers and co-workers, recruiting, interviewing, and training replacement employees, and management burnout; legal and HR costs, such as anger management courses, legal costs, settlement costs, compensation for consultants, and health insurance costs; and negative impact on the organization, such as reduced innovation and creativity, cooperation and cohesion, discretionary effort, and ability to recruit the best talent for the organization” (Sutton, 2007, pp. 49-51).
Despite extensive education and training, healthcare professionals, including physicians, nurses, allied health practitioners, and administrative staff have not been found to be impervious to angry behaviors. A Norwegian researcher interviewed a cross section of healthcare professionals and found that physicians were, by their own and others’ accounts, involved in the most hostile expressions of anger, including “yelling, scolding, public criticism, provocative humor, name-calling, slamming doors, and dominating conversations and meetings” (Skjørshammer, 2003). Nurses in the UK identified “dealing with an extremely confrontational patient” and “conflict with other health professionals” as two of the top five precursors of feelings of anger and anxiety (Bennett & Lowe, 2008). In the US, O’Neill (2009) found that fear of leaders’ anger caused groups to continue on a failing course of action because they did not feel they were psychologically safe to speak up.
Recognizing the importance of this issue to patient safety, The Joint Commission directly addressed disruptive and inappropriate behaviors.
Effective January 1, 2009 for all accreditation programs, The Joint Commission has a new Leadership standard (LD.03.01.01)* that addresses disruptive and inappropriate behaviors in two of its elements of performance:
EP 4: The hospital/organization has a code of conduct that defines acceptable and disruptive and inappropriate behaviors.
EP 5: Leaders create and implement a process for managing disruptive and inappropriate behaviors.
In addition, standards in the Medical Staff chapter have been organized to follow six core competencies (see the introduction to MS.4) to be addressed in the credentialing process, including interpersonal skills and professionalism (The Joint Commission, para. 8, 2008).
While we cannot change all the pressures employees feel in healthcare today, we can empower each person to learn how to manage their anger—and how they express it. Contrary to folk wisdom, it is not good to blow up. In fact, temper tantrums only increase an individual’s feelings of being out of control, leading to more anger and aggression. Some people come to the work setting with low frustration tolerance and are more prone to bouts of rage (American Psychological Association, n.d) Even with these innate tendencies, people can be retrained to identify triggers and to use strategies to de-escalate, if not defuse their anger. Some of these include “breathing techniques, cognitive restructuring, better communication, using humor, and changing the environment” (American Psychological Association, n.d, p. 4). The Mayo Clinic (2009) offered ten tips, including: “taking a timeout, getting some space, and expressing anger when calm.”
In his best-selling book on anger management, Hightower (2005) identified sixteen specific behaviors to ABSTAIN from when angry. This is good because it is focused on controlling one’s own behaviors:
1. Stop speaking when angry.
2. Stop staying when angry.
3. Stop staring when angry.
4. Stop interrupting when angry.
5. Stop cursing when angry.
6. Stop name-calling when angry.
7. Stop threatening (including implied threats) when angry.
8. Stop pointing when angry.
9. Stop yelling, raising voice, or talking in a mean tone when angry.
10. Stop being sarcastic/mocking when angry.
11. Stop throwing things, slamming doors, or banging walls when angry.
12. Stop ALL non-affectionate touching when angry.
13. Stop telling “hero stories” (how you stood up to someone) when angry.
14. Stop sighing, clucking, rolling your eyes when angry.
15. Stop criticizing and lecturing when angry.
16. Stop speeding. (Hightower, 2005, p.68)
At this time of good cheer and holiday parties, it’s easy to forget angry incidents and bad behaviors and to think that they will go away with the tincture of time. It is important to remember that we need to practice new behaviors for at least six months before they become automatic. So this year, as we sing “Auld Lang Syne,” let’s put “I RESOLVE TO BE LESS ANGRY” on the top of our list of New Year’s Resolutions for a happier, healthier 2010.
Sharon B. Buchbinder, RN. PhD
Professor and Chair
Department of Health Science
Sharon Buchbinder is an Adjunct Professor of Nursing at Stevenson University in the Graduate and Professional School , and former chair of the Association of University Programs in Health Administration (AUPHA). She is also the author of two books from Jones & Bartlett: Introduction to Health Care Management and Career Opportunities in Health Care Management.
Here are some references if you are interested in this topic.
American Psychological Association. (n.d.). Controlling anger before it controls you. Retrieved on December 18, 2009
Bennett, P. & Lowe, R. (2008). Emotions and their cognitive precursors: Responses to spontaneously identified stressful events among hospital nurses. J. Health Psychology, 13(4), 537-546. DOI:10.1177/1359105308088526.
Hightower, N. (2005). Anger Busting 101: New ABCs for Angry Men and the Women Who Love Them. Houston (TX): Bayou Publishing.
Mayo Clinic Staff. (n.d.) Anger management tips: 10 ways to tame your temper. Retrieved on December 18, 2009
O'Neil, O.A. (2009). Workplace expressions of emotions and escalation of commitment. Journal of Applied Social Psychology, 39(10):2396-2424. DOI: 10.1111/j.1559-1816.2009.00531.x.
Skjørshammer, M. (2003). Anger behaviour among professionals in a Norwegian hospital: antecedents and consequences for interprofessional cooperation. Journal of Interprofessional Care, 17(4):377-388. DOI: 10.1080/13561820310001608203
Sutton, R.I. (2007). The No Asshole Rule: Building a Civilized Workplace and Surviving One That Isn’t. NY (NY): Warner Business Books.
The Joint Commission. (2008, July 9). Behaviors that undermine a culture of safety. Retrieved on December 21, 2009