Human factors
multiple tasks and conscious thoughts. However, it also impacts the performance of those who witness it.
Further evidence Mark highlighted further research by Katz et al (2019), which found that incivility had a negative impact on performance in a simulated operative crisis. In this study, multiple areas were impacted including vigilance, diagnosis, communication and patient management even though participants were not aware of these effects. The researchers concluded that it is “imperative that these behaviours are eliminated from operating room culture and that interpersonal communication in high-stress environments is incorporated into medical training”.5
William O. Cooper et al (2019) also published a study (spanning a cohort of 13,653 patients) which found that surgeons who had a higher number of coworker reports of unprofessional behaviours had a significantly increased risk of surgical and medical complications. The complication rate was 14.3% higher for patients whose surgeons had 1 to 3 reports and 11.9% higher for patients whose surgeons had 4 or more reports compared with patients whose surgeons had no coworker reports.6 “These papers keep on coming. There have
been over 10,000 of these in the past seven years on incivility alone – and not just within healthcare,” Mark commented. However, another important factor is that
even low-level incivility can escalate if left unchecked, as a large study of seven Australian hospitals, by Westbrook et al (2020) suggests.7 The researchers concluded that: “Tolerance for low level poor behaviour may be an enabler for
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more serious misbehaviour that endangers staff wellbeing and patient safety.”
Civility training So, what can we do about this problem? Civility training programmes in the aviation sector are now well established and Mark believes that there is significant potential for the healthcare sector to also adopt this approach. “We have trained 20 facilitators, with more to come, and have trained around 600-700 staff so far. We expect to train around 1,000 this year… In the aviation industry, if there is the slightest sign of incivility in the cockpit, you are ‘out on your ear’, so why do we tolerate it in the health service?” he commented. “Behaviour, breeds behaviour…too often, we normalise this behaviour and culture is created by the behaviours that we tolerate,” Mark continued. Concluding his presentation, he left the audience with a quotation by Christine Porath: “Incivility is a bug – it’s contagious and we become carriers of it just by being around it…”
CSJ
References 1. My London, ‘Harefield Hospital survey reveals bullying concerns’, accessed at: https://www.
mylondon.news/news/local-news/harefield- hospital-survey-reveals-bullying-5988421
2. Porath C, Pearson C. The price of incivility. Harv Bus Rev. 2013 Jan-Feb;91(1-2):114-21, 146. PMID: 23390745.
3. Accessed at:
https://www.civilitysaveslives. com/
4. Riskin A, Erez A, Foulk TA, Kugelman A, Gover A, Shoris I, Riskin KS, Bamberger PA. The Impact of Rudeness on Medical Team Performance: A Randomized Trial. Pediatrics. 2015
Sep;136(3):487-95. doi: 10.1542/peds.2015-1385. Epub 2015 Aug 10. PMID: 26260718.
5. Katz D, Blasius K, Isaak R, Lipps J, Kushelev M, Goldberg A, Fastman J, Marsh B, DeMaria S. Exposure to incivility hinders clinical performance in a simulated operative crisis. BMJ Qual Saf. 2019 Sep;28(9):750-757. doi: 10.1136/bmjqs-2019-009598. Epub 2019 May 31. PMID: 31152113.
6. Cooper WO, Spain DA, Guillamondegui O, Kelz RR, Domenico HJ, Hopkins J, Sullivan P, Moore IN, Pichert JW, Catron TF, Webb LE, Dmochowski RR, Hickson GB. Association of Coworker Reports About Unprofessional Behavior by Surgeons With Surgical Complications in Their Patients. JAMA Surg. 2019 Sep 1;154(9):828-834. doi: 10.1001/jamasurg.2019.1738. PMID: 31215973; PMCID: PMC6585020.
7. Westbrook J, Sunderland N, Li L, Koyama A, McMullan R, Urwin R, Churruca K, Baysari MT, Jones C, Loh E, McInnes EC, Middleton S, Braithwaite J. The prevalence and impact of unprofessional behaviour among hospital workers: a survey in seven Australian hospitals. Med J Aust. 2021 Jan;214(1):31-37. doi: 10.5694/ mja2.50849. Epub 2020 Nov 10. PMID: 33174226.
Further information
A range of helpful educational resources around incivility can be found on the Civility Saves Lives website at: https://www.
civilitysaveslives.com/resources For further information on NPAG and details of future conferences, visit:
https://www.npag.
org.uk/
Sharne T/
peopleimages.com -
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