Civility Saves Lives
2 March 2022
Civility is about more than just politeness, although politeness is a necessary first step. It is about disagreeing without disrespect, seeking common ground as a starting point for dialogue about differences, listening past one’s preconceptions, and teaching others to do the same.
Almost all excellence in healthcare is dependent on teams, and teams work best when all members feel safe and have a voice. Civility between team members creates that sense of safety and is a key ingredient of great teams. Incivility robs teams of their potential. Incivility has been shown to reduce team functioning, clinical decision making and patient outcomes. Anonymity breeds incivility - as often seen in social media posts and even over the phone. Incivility negatively impacts performance and - in healthcare - puts patient outcomes at risk.
Evidence shows that rudeness impairs performance, and we're not always good at recognising this at the time! This applies across healthcare settings as well as in many workplaces. Unsafe practices, medical errors, and adverse patient outcomes can be clearly linked to disrespectful behaviours in healthcare. When the culture of a team lacks civility, members of that team are not comfortable to ask questions or speak up even if they are concerned that a direction is not appropriate or incorrect or if they are unsure what to do. Thus, the checks and balances and the support and guidance that teamwork can provide are lost. Morale is also impacted and team members lose their commitment and enthusiasm for providing a high standard of care.
What is rudeness or incivility?
Rudeness is defined by the interpretation of the recipient regardless of intent. It comes in many forms and can be thoughtless or deliberate. Rudeness is disrespectful and can include:
- Talking over someone
- Speaking or behaving in a patronising manner
- Undermining someone, spreading rumours
- Being stubborn or uncooperative
- Insulting someone, making sexist or racist comments
- Nit picking and fault finding
- Shouting or throwing an object
- Belittling or shaming someone
- Exclusion or ignoring someone
- Reluctance or refusal to answer questions
- Not responding to or ignoring communication, whether written (e.g. emails, texts, messaging) or verbal (phone or face-to-face)
- Aggression or physical assault
Creating a civil and kind culture
Culture exerts a powerful influence on individual and group behaviour. Attention to organisational culture is an important aspect of patient safety. Leadership is crucial in establishing a culture which enhances patient safety through civility. Leaders set the tone at the top and make it understood that everybody is responsible for safety. When leaders are credible and communicate and act consistently, individuals begin to develop consistent expectations about what is important and safe behavioural norms can emerge.
Creating and embedding a zero-tolerance policy for harassment and bullying is a good place to start. Australian Army Lieutenant General David Morison famously said “The standard you walk past is the standard you set.”. If we see our colleagues and peers treating others or being treated without civility, it’s our duty to call that behaviour out. It’s our responsibility to raise the issue, and to comfort and support those who are on the receiving end. This can take real courage to do but unless we all take responsibility, there will not be any change. So don’t walk by.
Ensuring civility is about more than just the absence of unacceptable and toxic behaviour. Two words that have a huge impact are “Thank You”. Gratitude is known to improve self-esteem and motivation, increase happiness, increase sensitivity and empathy and build resilience. From an early age, we are taught by our family to say thank you and yet as adults we often forget to use these two important words when we interact with others.
Everyone benefits from kindness at work. Our actions affect those around us. In addition, kindness and empathy are therapeutic. Kindness benefits us and those we encounter as it brings a psychological reward through an endorphin boost. Being kind creates a sense of belonging and is one of the best ways we create, maintain and strengthen our social connections. Self-compassion includes being kind to ourselves by recognising we are human and accepting that we will make mistakes at times.
Kindness is infectious and generates a chain reaction in others when people pay it forward. Kind acts can create a change in culture as they spread within a workplace. Teams that are kind to each other generally function better. Kindness enhances psychological safety and improved communication. Kindness cultivates trust, harmony and innovation. In healthcare, teamwork is essential for good patient outcomes and kindness enhances team collaboration which reduces errors and enables successful treatment.
AMA Victoria Coordinator of Doctor Wellbeing
- Civility Saves Lives | civilitysaveslives.com
- Survey Suggests Disrespectful Behaviors Persist in Healthcare: Practitioners Speak Up (Yet Again) – Part I | Institute For Safe Medication Practices
- Patient safety: what’s culture got to do with it? | InSight+ (mja.com.au)
- Civility Is Everyone’s Responsibility | Institute for Healthcare Improvement
- Incivility hurts | WRaP EM
- The Price of Incivility | Harvard Business Review
- The Institute for Civility in Government