Incivility in the Health Care Workplace - TMED 801

TMED Blog

| 5 November 2024

By: Tommy Rollin, MSc ’26 (Candidate) and TMED 801 Student

On October 23, 2024, the Queen’s Department of Medicine welcomed Dr. Heather Murray and Christopher Gillies to present at the Medical Grand Rounds on Incivility in the Health Care Workplace. Dr. Murray is a Physician Advisor with the Canadian Medical Protective Association (CMPA), and Mr. Gillies is the Vice-President of Medical & Academic Affairs at KHSC.

On the surface, workplace incivility may be difficult to pin down. Is it unprofessional behaviour? Rudeness? Disruptive actions? In reality, incivility can be any words, actions, or inactions that undermine collegial working relationships and impact the ability of people to get along in the workplace. These behaviours are not uncommon yet are widespread and underreported; Dr. Murray described that 75% of healthcare workers report witnessing unprofessional behaviour from MDs and that 9% of physicians have had at least one report of unprofessional behaviour, with 1% having multiple reports [1, 2].

There are many reasons for incivility occurring, though predicting factors may involve issues in the personal lives of physicians, high workload, or potential patient risk [keller]. Similarly, high-stress environments can cause healthcare workers to tolerate incivility more than normal. Physicians may also shield their incivility by claiming they are advocating for their patients, but Dr. Murray explained how that has direct negative downstream effects on patient care [3].

Incivility can significantly impact the healthcare workplace environment, as it can disrupt teams and divert attention from patient care. Mr. Gillies shared how incivility can affect individuals in a healthcare team by decreasing job satisfaction, increasing stress, and reducing the staff retention rate. He stressed the importance of support groups and offering peer support to help others deal with personal issues and potential incivility they have experienced.

Finally, Dr. Murray shared three effective strategies that listeners could use to reduce incivility in their workplace. First, she suggested improving your personal conflict management skills using tactics like managing emotions, staying curious, and having an exit strategy [4]. The second strategy she described was to remember that you are a leader; people who foster environments of positive behaviours and remain approachable are the ones who set the tone for others in the workplace [5]. Third, Dr. Murray described the importance of being open to having challenging conversations. A simple “Hey, are you OK?” can go a long way in helping individuals recognize acts of incivility and work towards improving their behaviour.

Following the presentation, Dr. Murray and Mr. Gillies discussed with the TMED students their inspirations behind combatting incivility and how they achieved their current roles. They highlighted how the CMPA gets legally involved in incivility cases through physician representation and the legal implications of severe incivility instances. They also focused on the future of incivility in the healthcare workplace and how optimism should be kept due to the large progress made over the last 20 years. While small instances will always occur, many egregious behaviours of the past are no longer tolerated, and patients are given much more respect to prevent incivility that may arise.

References

1. Cooper, O.W., et al., Physician Specialty Differences in Unprofessional Behaviors Observed and Reported by Coworkers. JAMA Network Open, 2024. 7(6): p. e2415331.

2. Keller, S., et al., Predictors and triggers of incivility within healthcare teams: a systematic review of the literature. BMJ Open, 2020. 10(6): p. e035471.

3. Hicks, S. and C. Stavropoulou, The Effect of Health Care Professional Disruptive Behavior on Patient Care: A Systematic Review. Journal of Patient Safety, 2022. 18(2): p. 138-143.

4. Kennedy, K., et al., Six steps to conflict resolution: Best practices for conflict management in health care. Journal of Hospital Medicine, 2023. 18(4): p. 360-363.

5. Pack, R., et al., “Maybe I’m not that approachable”: using simulation to elicit team leaders’ perceptions of their role in facilitating speaking up behaviors. Advances in Simulation, 2022. 7(1).

Incivility in the Health Care Workplace - TMED 801

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Incivility in the Health Care Workplace - TMED 801

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