A Culture of Civility, A Culture of Safety

by Heather Hylton, PA-C

Heather Hylton

Heather Hylton

It is well-established that an array of drivers can lead to professional burnout in healthcare providers.  Tait Shanafelt and John Noseworthy have described seven dimensions into which the drivers can be grouped, including culture and values, control and flexibility, and social support and community at work.  The culture of an organization sets the stage for how individuals of that organization interact and work together.  In addition, organizational culture directly impacts both the work performance of employees as well as the employees’ well-being.  Control and flexibility in healthcare are continuously challenged for a host of reasons including access, productivity pressures, and technology burdens.  Healthcare delivery is contingent upon coordinated work effort from a team, thus underscoring the importance of professionalism, mutual respect, and harmony as essential to the success of the team.

In general, the healthcare environment is highly stressful, making it more vulnerable to disruptive behaviors and incivility within this environment.  Examples of disruptive behaviors and incivility can range from overt actions such as berating or shaming staff in front of patients to more subtle actions such as impatience with or refusing to answer staff questions.  These behaviors can lead to communication problems and patient safety issues as those who are on the receiving end of or who are the target of intimidating behaviors may be reluctant to share information critical to the delivery of safe care to the patient.  This issue has commanded the attention of the Joint Commission who, in July 2008, issued a Sentinel Event Alert (SEA) on the topic of “behaviors that undermine a culture of safety.” Within the SEA, a new leadership standard was announced which requires organizations to have both a code of conduct and a process for managing disruptive and uncivil behaviors.  In addition, the American Medical Association has language specific to disruptive behaviors within its Code of Medical Ethics.

Unfortunately, incivility has been known to beget further incivility, thus compounding the problem.  Microaggressions, which may be subtle, are noted by Narjust Duma and colleagues to “represent enduring institutional and systemic imbalances of privilege and power.”  If unaddressed, microaggressions can insidiously become part of workplace culture. 

In their Toxic Organization Change System model, Elizabeth Holloway and Mitchell Kusy propose organizations implement highly-coordinated strategies at the individual, team, and organizational levels.  Christine Porath notes from her research that 98% of workers she has surveyed over the course of two decades have directly experienced uncivil behavior, and 99% have directly observed uncivil behavior.  While organizations should set standards for behavioral norms, teams can supplement this with their own code of conduct whereby all within the team are accountable to each other.  Christine Porath also offers guidance on how to interview for civility, which is an indispensable part of building a team that embraces the principle of mutual respect.   

Weeding out and addressing behaviors that undermine a civil work environment is not only essential to optimizing patient safety but can also positively impact employee engagement and retention.  Furthermore, a civil and respectful workplace must value inclusivity and seek to mitigate disparities.  Lastly, civility in the workplace can help address burnout in healthcare through enhanced professionalism, collegiality, and cultivating greater support among the team.  

JOP DAiS encourages discussion and welcomes your comments. Please note that comments are moderated; inappropriate remarks will not be tolerated.

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