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 valmyers@umich.edu

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 valmyers@umich.edu

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 valmyers@umich.edu

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 valmyers@umich.edu

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 valmyers@umich.edu

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 valmyers@umich.edu

• 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 valmyers@umich.edu

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 valmyers@umich.edu

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 valmyers@umich.edu

• 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 valmyers@umich.edu

InterventionWhat to do now. . .

Valerie Myers, Ph.D. Nov ‘11 valmyers@umich.edu

• 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.