How Not to Issue an Ebola Quarantine

The nurse in the Ebola quarantine flap is a reminder that it hurts when decisions go against us, but it hurts a lot more when you feel you’ve also been disrespected in the process.

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A colorized transmission electron micrograph (TEM) of the Ebola virion.

CDC Global

The nurse returning from West Africa after treating Ebola patients created quite a stir when she wrote to the Dallas Morning News, complaining about how she was treated when the decision was made to quarantine her. Whereas Kaci Hickox has been accused of being a “whiner” and “self-centered,” critics are missing her point. She was not upset simply for being quarantined, although clearly that is something that most of us would not relish. She also was upset about the way she felt she was treated by authorities in the process.

We all have been on the receiving end of decisions we don’t like. When that happens, most of the time we suck it up and move on; as Mick Jagger put it, “You can’t always get what you want.” We find it much harder to suck it up, however, when we also believe that the process accompanying the decision is unfair. In fact, there even is an expression for decisions we don’t like when the accompanying process is unfair: “adding insult to injury.” We are injured by the decision and insulted by the way in which it was handled.

Social science research shows, however, that the expression “adding insult to injury” actually underestimates how angry or aggrieved people feel when they get a bad outcome with an unfair process. It’s more like “multiplying insult times injury.” If the unfavorable decision is worth three units of pain and the unfair process also is worth three units of pain, what people experience is not six units but rather nine units of emotional anguish.

What goes into making a decision process unfair? It’s many things, and Kaci Hickox believed several described her experience, such as when authorities: (1) do not make the decision on the basis of accurate information, (2) do not provide a clear and adequate explanation of why the decision was made, and (3) do not treat people with dignity and respect.

Regarding accuracy, there was some question about the extent to which she showed signs of being ill. Initially, a scan of her forehead suggested that she had a temperature of 101. Hickox claimed that her reading of 101 was due to the aggravation she was experiencing. In fact, when retested a little later, she had a temperature of 98, at which point a doctor told her, “There’s no way you have a fever. Your face is just flushed.”

Regarding explanation, the following was reported in the October 26 edition of the New York Times: “She described being held in isolation for about seven hours … left alone for long stretches and given only a granola bar when she said she was hungry.” The nurse herself said, “I was upset at being held with no explanation.”

There also was evidence of the nurse perceiving that she was not being treated with dignity and respect. In addition to the granola bar incident, Hickox reported that the officer was smug when telling her, “You have a fever now.” The nurse’s mother said that her daughter called her saying, “She felt like you would treat a dog better than she’s been treated.” And, on the front page of the October 27 issue of the Times, there is a picture of Hickox in the isolation tent, underneath it saying that she is calling “her treatment in mandatory quarantine inhumane.”

It is no surprise that Hickox is considering taking legal action. This is a predictable response when people are on the receiving end of an unfavorable decision accompanied by an unfair process.

Research shows that when people lose their jobs, one of the strongest predictors of whether they will sue for wrongful termination is how much they felt that they were treated in a dignified and respectful way at the time that they were given the unwelcome news. Those who felt “dissed” were 17 times more likely to sue than were those who believed they were treated respectfully. Same thing when patients sue for medical malpractice: a botched surgical procedure is much more likely to lead to a lawsuit when it is accompanied by “bad bedside manner.”

So, imagine how Hickox would have reacted if she perceived that the identical decision to have her quarantined was implemented more fairly, that is, based on accurate information, with clear explanations, and in ways that preserved her dignity and respect. She may not have been happy, but I bet she would have been a lot less angry. And, more generally, a lesson for all of us is that when we find ourselves being particularly angry when decisions go against us, one likely explanation is that it wasn’t only what was decided, but also the unfair way(s) the decision was planned and implemented; the toxic mix of multiplying insult times injury.

This article originally appeared in Fortune. Used with permission.

About the researcher

Joel Brockner

Within the broader field of organizational behavior, Professor Brockner is well known for his work in several areas, including the effects of organizational downsizing...

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