2024 Lightning Talk:  Civility Matters –   Dr Yann Brierley, Pathologist, Medical Laboratory Director for the North Okanagan, Chief of Staff and Vernon Jubilee Hospital Physician Society Vice-President

The impact of incivility in health care workplaces

Uncivil behavior such as negative, disrespectful, and degrading remarks, or tone of voice can take its toll.

It can result in staff errors that ordinarily would never occur, and negatively affect teamwork and patient care. It can further reduce staff time at work, contributing to workforce shortages.

The evidence 

Incivility has many negative impacts.  When exposed to rude behaviour, people can:

• experience a 60% reduction in cognitive capacity 
• become 30% less creative
• lose mental processing power for up to eight hours after the event
• lose time worrying about that event 

It’s not only the recipient who suffers. Witnesses to incivility also experience a 20% reduction in cognitive capacity and 50% reduction in pro-social behavior, such as helpfulness and sharing of resources and time.

The positive power of civility 

On the flip side, civility in work environments reduces stress and errors, and fosters excellence:  

• A 30% reported increase in productivity and performance in teams and improved team orientation.
• A 60% reported increase in engagement and improved psychological safety. 
• A 90% reported increase in job satisfaction and enjoyment at work. 

Three steps to building a more civil health care culture



Dr. Brierley’s “Civility Matters” project takes a threefold approach:

• Develop awareness around the impacts of mild to moderate forms of incivility on people.
• Highlight how civility benefits health care teams.
• Provide staff with a civility toolkit of life skills and techniques to use when confronted with incivility. 

Education and skills building  

• 10 sessions facilitated by an expert in civility training.
• Team huddles to maintain civility as an ongoing effort.
• Civility affirmation cards such as “assume good intent,” and “practice the art of the pause,” pulled and briefly discussed among teams to avoid slipping back into old patterns. 

Measuring impact: physicians and hospital staff

After a four-month intervention, a survey among 23 physicians and 53 non-physician hospital staff found:

• 50% of respondents reported a noticeable decline in general forms of rudeness, such as sighing, huffing, belittling comments, and dismissive gestures. 
• 80% of survey respondents responded “yes” to the statement: “I am treated with dignity and respect on a daily basis – an increase from 65%.
• 82% of respondents responded “yes” to the statement: “The Civility Matters training provided had a positive impact at work. 

Lessons and success factors:

• Staff motivation is key for culture change, that it is worthy of the necessary time and effort involved.  
• Strong support at a senior operational and medical levels is needed.
• Persistent and varied messaging helps maintain momentum: brochures, posters, team huddles, civility affirmation cards.
• Metrics are elusive with culture change: can be challenging to get data points with survey fatigue.
  
   

“It's been wonderful to see that people have done this together and have a common way of showing up and approaching those difficult conversations now. Teams thrive and patients survive when civility matters. It's catchy, but it's true.. How we show up at work, and how we react in the moment does matter.” – Dr Yann Brierley
 

ADOPT THIS STRATEGY: RESOURCES YOU CAN USE

• Listen to Dr Brierley's presentation
   
• Get evidence and resources at Civility Saves Lives: Health care professionals raising awareness about the impacts and power of civility for teams and patient care
   
• When Civility Turns Deadly – TedTalk