Organizational culture affects the quality of decisions that are made by people who work in those MC900438706 environments. No place is this as obvious and as critical (life and death decisions) then in a hospital. Theresa Brown, oncology nurse and author, writes about the impact of hospital culture in a blog post titled, "Physician, Heel Thyself". She describes a recent situation in which a doctor blamed her for slow test results in front of a patient and how that kind of "bullying" is detrimental to patient care. She writes:

When a doctor thoughtlessly dresses down a nurse in front of patients or their families, it’s not just a personal affront, it’s an incredible distraction, taking our minds away from our patients, focusing them instead on how powerless we are.

That said, the most damaging bullying is not flagrant and does not fit the stereotype of a surgeon having a tantrum in the operating room. It is passive, like not answering pages or phone calls, and tends toward the subtle: condescension rather than outright abuse, and aggressive or sarcastic remarks rather than straightforward insults.

This kind of subtle workplace bullying, although acceptable behavior in many hospitals (and many other organizations), creates a culture of fear and intimidation that results in poor patient care and increased costs. Nurses are reluctant to share vital information they know about individual patients and their treatments. Then doctors make decisions based on incomplete data. And nurses are reluctant to confront doctors even when treatment decisions might be harmful to patients. Hospitals don't condone this doctor behavior but they don't do much to stop it either. Eventually, it becomes so ingrained in the way doctors work with staff that the behavior is accepted as the norm and rarely gets reported as abuse.