Article
Almost everyone has experienced receiving feedback from colleagues that is delivered in an uncivil or condescending manner. We need to put an end to this.
As a newly qualified junior doctor, I was called on because an epidural pump was giving a high-resistance warning. I checked the pump and inspected the insertion site but was unable to identify the problem. I asked a senior consultant for assistance, and they discovered that a closed three-way tap had been placed mid-line between the pump and the patient. I immediately realised that this was something I should have noticed myself, but I was taken into an office and reprimanded for 20 minutes. I was left feeling like a failure.
As a qualified specialist, I still encounter colleagues using a condescending tone to me or others, often under the guise of clinical authority. I find this behaviour unacceptable. In my experience, healthcare personnel receive no training on how to handle such situations.
Leads to poorer outcomes
Leads to poorer outcomes
A colleague from a surgical specialty told me that being reprimanded is something we simply have to get used to; it is part of our education. But should we accept this as the norm? Should we speak up? And if so, how?
A study of multiple organisations in the United States and Canada found that 98 % of staff had experienced uncivil behaviour, and half of these reported reducing their effort at work (1) . Thirty-eight per cent reported a decline in the quality of their work, and 78 % felt less engaged with their organisation. A simulation study among junior anaesthetists showed that the proportion performing at the expected level fell from 91 % in the control group to 64 % among those exposed to uncivil behaviour (2) . The quality of medical decision-making can be compromised by uncivil behaviour.
Being reprimanded is something we simply have to get used to; it is part of our education. But should we accept this as the norm? Should we speak up? And if so, how?
A further simulation study among staff in paediatric intensive care units showed that teams performed less effectively when exposed to rude comments immediately prior to the simulation (3) . Such comments can also impair staff members' ability to speak up about errors (4) . In other words, uncivil behaviour can adversely affect patient outcomes.
Risks of uncivil behaviour
Risks of uncivil behaviour
In the UK, the Civility Saves Lives campaign has been launched (5) . It collects evidence on how incivility affects patient safety and explores strategies to prevent uncivil behaviour at both the individual and organisational level.
The Norwegian Directorate of Health has noted that 'communication characterised by incivility and rudeness, such as cutting remarks, ignoring colleagues, ridicule, condescension and other forms of unprofessional verbal and non-verbal communication, creates a sense of insecurity. This behaviour, and more serious harassment, impacts on teamwork, concentration, staff health, wellbeing, staff turnover and patient safety' (6) .
Perhaps it is time that we, as doctors, also refuse to accept uncivil behaviour
The Norwegian Healthcare Investigation Board (NHIB) has highlighted the risks associated with uncivil behaviour and noted that these can be mitigated through courtesy and kindness (deliberate actions characterised by respect, generosity and inclusion) (7) .
Not something we should tolerate
Not something we should tolerate
The healthcare simulation standard notes that psychological safety is essential for effective facilitation and learning, and that mutual respect must underpin all simulation activities in health care (8) . There is no reason why this principle should not also apply to clinical teamwork.
In a newspaper article about working conditions of ferries in Norway, crew members said 'Harassment is not something we will put up with' (9) . Perhaps it is time that we, as doctors, also refuse to accept uncivil behaviour.
By learning about uncivil behaviour, discussing it in meetings and lectures, and addressing it on a par with other patient safety measures, together we can create a healthcare environment with zero tolerance for harassment. This can protect our patients and ourselves.