Uneasy alliances

The dreaded eye roll, the agreeing to your face only to disagree behind your back, the gossip and endless bitching - sadly these signs of passive aggression are all too familiar. Think of passive aggression as the guerilla warfare of interpersonal relationships. People who are disenfranchised and powerless are passive aggressive.

There are two types of passive aggressive scenarios that can occur in your hospital: a passive aggressive personality or a passive aggressive culture. Theres a big 'duh' regarding which one you would rather have.

A passive aggressive person is living in a world they do not believe that they control. They will likely have issues in their home life and will create issues in your hospital. At some point, either through trial and error or through an intrinsic aversion to conflict, they realized that a full on approach to conflict was not something that they wanted to address. So they take the end run approach. Like a guerilla warrior, they are out-gunned and out-manned, so they skulk in the shadows and sow confusion and chaos.

Ok, maybe it isn't that bad, but certainly it should not be ignored. Someone who is passive aggressive will do everything in their power to avoid conflict, but that doesn't mean they're happy. Efforts to open the lines of communication and keep them open must be pursued. All instances of passive aggressive behavior need to be "called out" but in a caring way. You have to reinforce this person's belief in their ability to control their environment; you have to hear out their complaints and assure the person that they are being heard and you will act on what you hear. Communication is the key to addressing a passive aggressive employee. You have to help them feel empowered to create change through normal channels.

This brings us to the more awful of the two scenarios: a culture of passive aggression. Sadly I have seen this time and again. Veterinarians are great people. They are largely introverts. Introverts tend to hate negativity in all forms and will do anything in their power to avoid it. Veterinarians who manage their own hospitals or who deny managers the ability to rock the boat through employee feedback both good and bad breed work environments of passive aggression.

Again, think of passive aggressive behavior as the corollary to guerilla warfare. Guerilla warfare often stems from a grassroots effort to change an untenable situation (either open warfare with a stronger force - think Afganistan, or warfare against an ineffectual state - huh, Afganistan? Pakistan?).

A hospital where employees are treated like peons and surrounded by overlord doctors will turn ugly with passive aggression in a heartbeat. Unless management stems the downward aggression from above, things will only continue to spiral out of control until the entire hospital suffers, patient care declines and clients begin to feel the ugly vibe. Turnover will be immense, and as is always the case, you will lose better people faster than inferior workers. Gossips and other passive aggressive personalities will thrive and the system will run out of control.

A more insidious and more common situation that breeds a passive aggressive hospital is management that is non responsive to complaints - usually through an unwillingness to create conflict. Here the staff can largely love their jobs (actually, the poorer performers will love it more than the ones who you really do want to keep happy). The back biting and complaining are often lower key and warfare is subdued and breeds resentment. These hospitals can function in a low level of angst for quite some time. However, eventually certain things will occur that will ultimately drive the owner to effect change. Poor performers will stay and people who work hard will leave. Customer compliance will decline as will customer satisfaction. Everyone will sink into a low level of mediocrity and the hospital will slowly fall behind the curve.

Passive aggressive behaviors cannot be ignored. A single employee can be addressed, but if your hospital seems to be simmering with anger or resentment, action must be taken now to solve the problem now (the problem being management, not employees).

If you are uncertain if your hospital has this problem, ask yourself this: Are there any employees here that absolutely need to be fired because their work is substandard? Does your hospital have fiefdoms and cliques like a high school? Are there different rules of engagement for different levels of staff? If the answer is 'yes' or even maybe, you need to address your management style immediately.