Rankism in Healthcare Valerie L. Myers, Ph.D. Assistant Professor of Management & Organizations...
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Transcript of Rankism in Healthcare Valerie L. Myers, Ph.D. Assistant Professor of Management & Organizations...
Rankism in Healthcare
Valerie L. Myers, Ph.D.Assistant Professor of Management & OrganizationsUniversity of MichiganDept. of Health Management & Policy (SPH) & Ross Business School
An Empirical Study of Michigan Hospitals
[Nov 1, 2011 Excerpt]
• Background: – Bad Behaviors & Consequences in Healthcare– What is rankism?
• Mechanisms: How does rankism operate?• Measurement: How do you monitor it? (omitted)
• Intervention: What can be done to eliminate it?
Overview
Valerie Myers, Ph.D. Nov ‘11 [email protected]
The Problem
Bad Behaviors• Bullying• Disruptive Behavior• Incivility
Consequences• Low Psychological Safety Edmondson, 1999
• Silence/Not Speaking up Maxfield, Grenny, McMillan, Patterson,
Switzler, 2005
• Preventable Errors• Human & Financial Costs Sutton, 2007
Valerie Myers, Ph.D. Nov ‘11 [email protected]
Sutton, 2007; Potera, 2008 AJN ; Grenny, 2009; Cortina, 2008; JCAHO, 2009
Damage to VictimsBattered BystandersA#@holes SufferImpaired OrganizationHuman Costs (e.g., distraction, mistakes, stress illnesses, disengagement)
Financial Costs (e.g., sick days, law suits, attrition,)
The Cost of A#@holesFrom “The No Asshole Rule” by Robert Sutton, Ph.D. 2007
Valerie Myers, Ph.D. Nov ‘11 [email protected]
Add chart for cost of As#holes
Sutton’s Calculated Attrition Costs ONLYNumber of Employees 1000Avg. Rate of Bullying Nationally 15% 15025% of Victims that are bullied quit 37.5Replacement cost for each worker is ~$20,000 per worker x37.5 $750,000Average of 2 bystanders for each 1 victim x 37.5 7520% of Bystanders quit 15
Replacement cost for each worker is ~$20,000 per worker
$1.2 million
Total Annual Cost of A#@holes ~$2 million~ Total Attrition Cost in 1000 employee organization:
1 victim ($750k) + 2 bystanders ($1.2m)= ~$2million
Often times, disruption is more subtle
Valerie Myers, Ph.D. Nov ‘11 [email protected]
What is Rankism?
Rankism, a phrase coined in Robert Fuller’s (2006) book “Somebodies and Nobodies,” subsumes the full range of overt to subtle interpersonal aggressions that undermine individual and organizational performance.
Valerie Myers, Ph.D. Nov ‘11 [email protected]
It entails so called “somebodies” using their rank to demean, dominate, discriminate, abuse, exploit or otherwise indignify people who have less power because of their real or perceived lower rank in a particular hierarchy.
Rankism is an umbrella term that encompasses all “isms” that are part of identity politics (e.g., sexism, classism, racism, homophobism etc.)
Rankism The Mother of all “isms”
Mechanisms of Rankism
“Indignifying, abusive, discriminatory, or exploitative behavior towards people who have less power because of their lower rank in a particular hierarchy.” Robert Fuller, 2006
Valerie Myers, Ph.D. Nov ‘11 [email protected]
• It involves treating people as the “N” word -- Nobodies
• Somebodies use rankism to put so called “nobodies” in their place, get them to conform, be silent or to submit to being taken advantage of.
• The targets of rankism “kick the dog” by subjecting vulnerable others to rankism, which is why it threatens patient safety.
How it operates
Valerie Myers, Ph.D. Nov ‘11 [email protected]
Nobodies are. . .IgnoredNeglected Excluded Snubbed DemeanedHumiliated Deprived of Resources ExploitedTreated Unfairly
Somebodies . . .Oblivious to PrivilegeDismissive In-group biasOver claim Credit Deny /Minimize other feelings Seek Unearned AdvantageHoard ResourcesAbuse PowerAvoid Responsibility
Valerie Myers, Ph.D. Nov ‘11 [email protected]
Extreme HierarchyAmplifies Rankism
Cloke & Goldsmith, 2002; Ridgeway, 1987; Nembhard, Alexander, Hoff & Ramanujam, 2009
• Freezes power relationships• Distorts and impedes communication• Increases work stress & stress related illnesses• Decreases collaboration and learning needed for quality improvement, which may explain . . .
Rankism In Healthcaremay explain
Valerie Myers, Ph.D. Nov ‘11 [email protected]
• Intractable quality problems, despite quality improvement initiatives (AHRQ, 2005)
• Variations in racial & ethnic disparities in patient care across hospitals. Breslin, Morris, Gu, Wong, Finlayson, Banerjee, Birkmeyer, 2009- Journal of Clinical Oncology
MeasurementSummary of Empirical Results
• Myers’ Rankism & Regard Scale is a robust diagnostic tool that shows: oRankism exists across occupational and racial groups.o Organizational culture, senior leaders and managers
predict individual experiences of rankism• Rankism undermines quality and quality improvement.• Intervention is needed at ALL levels
Valerie Myers, Ph.D. Nov ‘11 [email protected]
InterventionWhat to do now. . .
Valerie Myers, Ph.D. Nov ‘11 [email protected]
• Everybody: Read “Somebodies & Nobodies” to understand how rankism operates.
• Somebodies: – Reduce hierarchy; promote engagement of ALL– Reflect on how you may routinely ignore, underestimate or punish
certain people – STOP IT! – Focus on goals and ways to support everyone in working toward them.
• Nobodies:– Find allies and supportive relationships(personal and professional)– Manage your health and well-being.