Bad Apple Theory in healthcare

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We know how bad apples can spoil the barrel, i.e. negative members can cause dysfunctional groups. I came across Will Felps work on it, will be very interesting to check out.

Felps et al say that there are 3 types of ‘bad apples’ (negative member of a group)

- withholders of effort

- being affectively negative,

- interpersonal deviants (violating important interpersonal norms)

They then go on to describe the groups responses to the negative member as

- motivational intervention (changing the negative person’s behaviour)

- rejection (removing the negative person)

- defensiveness (protecting one’s own self)

Felps says that ‘Each of these three responses have a common foundation; the desire to improve an aversive experience, but their intention varies’ as mentioned in parenthesis above. They  say that if motivational intervention or rejection were successful then a negative member never becomes a bad apple.

The work is mainly analytical rather than aiming for any resolution of the issues but they do touch on how the bad apple effects are moderated by determining perceived impact severity –

(1)    intensity of the negative behaviors exhibited

(2)    the group’s interdependence,

(3)    whether outcomes are successes or failures,

(4)    and the team mates’ coping abilities.

They also talk about the group’s ability/inability to cooperate and how low power groups looking to leadership to resolve the issues.

Here is the interesting radio link for an introduction to the work http://www.thisamericanlife.org/radio-archives/episode/370/ruining-it-for-the-rest-of-us

This is the link for the full academic paper http://books.google.co.uk/books?id=RKkxJnn73UoC&pg=PA175&lpg=PA175

My short commentary:

While the bad apple theory is very attractive I would reflect on whether the 'bad apple' behaviour and effect is topic dependent or person dependent. It is possible that a particular topic brings about a genuine principled disagreement from a team member who is so affected by the inability to influence the team hence shows 'negative' behaviours resulting in negative effects. History is equally full of examples where entire groups and even nations have been wrong and at that time any voice of wisdom would have been identified as a classic bad apple. A 'bad apple' in one topic might be the best bet team player on a different topic. However, the negative behaviour may not be topic dependent but entirely person dependent; this brings to fore a new set of issues on why such a person was employed or brought into the group; if the behaviour is recent/new an exploration of the team dynamics that brings forth such behaviour from individuals would be worthwhile.

I also caution that sometimes 'bad apples' can be early lone warriors too. These often tangential maverick thinkers and doers are also important for any societal or organisational progress.

Felps description of the 3 types of bad apples and the 3 ways in which groups respond to negative members are certainly seen in healthcare including amongst clinicians. The peculiarity with healthcare arises from the need to practice evidenced based medicine in the face of lack of good evidence by these precious resources called clinicians. This conundrum is compounded by rigidly hierarchical structures and high regulation in healthcare posing very unique and highly complex leadership challenges. Bad apple behaviours and effects as described by Felps are very naturally observed but allowing it in healthcare or dealing with it by either motivational intervention, rejection or defensiveness as we may be currently doing is likely to have as yet not understood exaggerated negative outcomes. Throw in the highly individualistic style of practice amongst doctors and mix becomes even more unstable. That cannot be good for healthcare.

Felps does not attempt to resolve it, quite rightly so, as this is more complicated than it seems.

There are times when system issues would be exhausted and a purely personal behavorial issue remains. The problem comes when bad apples do not recognise themselves despite well meaning evidence and advice. More worrying is when they recognise it within themselves but fail to acknowledge it - that will be breath taking arrogance usually leading to a big fall.

In democratic groups, due to its political nature the NHS could be called a democratic group, the success of the majority is judged by how well the minority is treated and a quote misattributed to Voltaire is 'I disapprove of what you say, but I will defend to the death your right to say it'. Perhaps these apply to the ‘bad apples’ as well. Real life is full of very mixed people, we could disengage (easy option) and lose valuable opportunities to develop ourselves. We could remain engaged and learn a mature way of thinking. Whichever we chose it will not be easy.

©M HEMADRI 

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