This blog was written by Queen’s Nurse Suzanne Turner. She is a Civilian Nurse for the MOD. Suzanne recently gave a presentation to the Q Community on the importance of civility in health and social care.
Have you worked in an organisation or team where people’s behaviour goes unchecked. You may have been made to feel belittled, experienced eye rolling, tutting, being shouted and sworn at. Where change is maybe taking place and people become fractious, teams seem to be less cohesive.
Last year in our organisation we were undergoing change. There was uncertainty as to what the future held, and we had staffing issues. People were feeling stressed, fractious and some particularly angry. That’s just human behaviour though, right? We know interpersonal relationships can be difficult – that’s just life – right? Wrong!
I did a bit of research and stumbled upon the Civility Saves Lives website. I printed off some infographics, read some articles and became interested in the topic as a whole, especially how incivility can impact on patient care and patient safety.
Working in safety critical areas such as health care, the evidence shows that civility does matter. When we treat each other in a civil manner and with respect, we enable people to be the best versions of themselves. When staff are the best of themselves, we have the best outcome for both patients and staff.
So, what does incivility look like – it can be described as the low level every day negative workplace behaviours that we encounter. It is not intended to cause harm. However, it can be the drip! drip! drip! effect. It can reduce confidence, make people feel unimportant, and can spill out into family lives. It shouldn’t happen but it does. Shockingly, within the NHS, 98% of staff reported having experienced it in one way or another. I am sure we have all experienced these, both as a recipient or as the initiator. I know I certainly have.
What causes it? Lack of self-awareness or insight as to how your behaviour or what you say affects other people. It can also be caused by lack of staff, poor leadership and personal stress which is brought into the workplace. How we treat each other is fundamental.
What are the effects of incivility?
If someone makes us feel as though they have been uncivil – it feels uncomfortable. Cognitive resources get diverted. How we treat each other is actually measurable. For example, if someone is mild to moderately rude to us our bandwidth/cognitive ability is reduced on average by 61%. What does this mean. It means that we don’t perform at the level we are capable of because our bandwidth is being taken up. When we carry the frustration because of the way we have been treated it takes our focus away from patient care.
80% of recipients lose time worrying, 38% experience a reduction in quality of work, 25% are reported to take it out on service users directly. For those who witness incivility there is a 20% decrease in performance and cognitive ability, and a 50% reduction in willingness to help others. Errors and bad clinical judgement are made. It affects how you approach your next patient. Finally negative workplace culture is one of the most common reasons that staff leave the profession. Shocking figures, aren’t they?
Healthcare is a team business in complicated and complex environments. Incivility can lead to reluctance in open discussions. When people feel valued and respected it can encourage the flow of information.
How do you promote civility as a priority? Leading by example. Having an environment that allows us to talk openly about this. It’s not expecting everyone to be perfect all the time as that is impossible.
How to tackle Incivility?
- Firstly listen. Notice what is said, how it’s said, and who it is said in front of.
- Call it out but appropriately with compassion – bring it to the attention of the initiator, without judgement.
- Don’t respond in the same tone.
- Ask a peer or manager to deal with it if you do not feel able to do so.
- Build trust in your teams.
In essence, how can we move from rudeness and incivility to civility.
How can we promote an everyday culture of compassion and kindness – where bullying and incivility is not an everyday event.
How can we ensure we are not bystanders but able to challenge without detriment.
It’s about changing culture and we need to start with ourselves. Let’s hold a mirror up to ourselves and ask – can we do better? Consider how your incivility affects others. Role modelling behaviours is a good place to start and nudges others within our circle of influence. A thank you, an act of kindness, gesture of support, even just asking ‘how are you today?’
Learn to challenge poor behaviour and rudeness. It can help strengthen your courage to take those daunting first steps in starting to move from bystander (making an active or passive choice to do nothing) to understander (recognising there is a choice to do something).
The worst thing we can do is to just pass it off as them “oh that’s just xxxx. That’s just how they are”. Does xxxx know how their behaviour impacts others. We have a professional responsibility to let others know when their behaviour is causing others to be distressed. That means we need to find ways to hold those conversations. Those conversations are essential. How and when we do it becomes much more important and nuanced. There will be times when you want to call it out in the moment and there are times when that would be a disaster. However, there are absolutely occasions to call it out when it needs to be. Conversation should not be about getting someone to change but solely to let that person know that they left other people feeling uncomfortable.
I challenge you all to challenge incivility
I challenge you all to refresh your mind with what your professional code says
I challenge you all to be civil
I challenge you all to make the workplace better, not only for ourselves but for our patients
Are you lifting people up or are you holding them down?
How we treat each other really does matter! Civility saves lives.