Incivility in Healthcare
Interpersonal communication between healthcare providers may take different forms, from friendly to tense. The resultant conflict and emotional strain produce impaired clinical performance, compromising patient safety (Katz et al., 2019). In cases when such communication leans on the side of aggression, it may result in far-reaching impacts, which go beyond the personal emotional damage, such as reduced motivation, reciprocal rudeness, or the ability to deliver proper care. Furthermore, these impacts may accumulate, resulting in institution-wide issues with healthcare delivery due to high staff turnover, compromised patient safety, and financial losses. Given that incivility has become a well-established problem in the healthcare sector, its impacts on patient care quality should be critically evaluated and addressed.
Before evaluating the impacts of this behavior, the nature and origins of unpleasant interactions should be discussed. Workplace incivility is defined as “low-intensity social behaviors that are generally considered unacceptable in the workplace” (Armstrong, 2018, p. 403). Whether intentional or not, such behavior is usually reoccurring and aims to undermine or intimidate a subordinate or a colleague (Armstrong, 2018; Bar-David, 2018). Over three-quarters of nursing professionals have dealt with it in some form: “belittling comments or dismissive gestures… skipping greetings, gossip, social exclusion, silent treatment, sarcasm, and even the rude use of mobile devices” (Armstrong, 2018; Bar-David, 2018, pp. 1-2). Incivility results from the following beliefs: a high-pressure environment does not leave time for polite communication; by signing up for the job, one signs up for the stress of it; word-picking is unnecessary in tight-knit communities (Bar-David, 2018). Therefore, incivility is a pervasive phenomenon that affects nearly every professional medic in many ways.
Impact on Nurses’ Clinical Judgement
One of the most important effects that workplace incivility may have in the clinical setting is on the professional judgment of healthcare personnel. The resulting emotional distress may distract the providers to where patients’ health is endangered (Armstrong, 2018). Exposure to such disruptive behaviors compromises diagnostic and technical performance (Katz et al., 2019). When nurses are under stress resulting from previous rude interactions, they may be focusing on that rather than paying full attention to the patient. Some of the patient needs may be misinterpreted and unmet for that reason. Another mechanism behind this phenomenon is the reduction in “information-sharing and help-seeking behaviors” between colleagues, which, in turn, leaves more room for individual errors (Bar-David, 2018, p. 2). The lack of consultation and communication may impair the staff’s ability to work as a team, which is crucial in delivering quality healthcare.
High-level clinical judgment is used throughout diagnosis and treatment, so the possibility for disruption is ample. Incivility may increase patients’ risk of an iatrogenic injury – damage caused by the treatment procedure rather than the original disease (Bar-David, 2018). One of the potential effects of experienced rudeness on judgment is the subsequent failure of a medical professional to take into account new information and adjust the initial diagnosis accordingly (Bar-David, 2018). This may occur due to a lack of attention or excessive stress levels, which compromise one’s ability to think flexibly and clearly.
Resulting Issues
The issues that incivility may cause may manifest on institutional and personal levels. Healthcare personnel that faces rude behaviors or snide remarks may feel less motivated to perform their tasks with as much care and attention as usual. Meta-research demonstrates that 48% of employees in different industries put less effort into their jobs after enduring harsh treatment (Bar-David, 2018). Armstrong (2018) confirms these findings by reciting a statistically significant relationship between incivility and loss of motivation. This phenomenon may be related to the fact that incivility in the workplace correlates strongly with decreased job satisfaction for practitioners (Han, Harold, Oh, Kim, & Agolli, 2021). Hence, even if the diagnosis was correct, a lessened effort in providing patient care may result in slower treatment or, in worse cases, negligence.
The compromised capacity to do one’s job may have hospital-wide implications. There is a significant relationship between job performance and incivility exposure, specifically among healthcare professionals (Han et al., 2021). Thus, incivility in the workplace commonly increases the chances of making erroneous decisions or performing the procedures less safely. For instance, young professionals are more likely to administer medication in an unsafe way after being exposed to incivility, resulting in adverse patient outcomes (Armstrong, 2018). If the offense is systemic, more patients may suffer due to incorrect treatment procedures, damaging the hospital’s reputation and putting others’ employment at risk.
Further, the stress may change the way providers communicate with patients. Around 25% of providers admitted transferring their frustration onto a patient, which, depending on the nature of the interaction and patient needs, may worsen both patient outcomes and experiences (Bar-David, 2018). In addition to the hospital’s reputation, there may be financial implications as the patients may sue the establishment for the incurred damages (Armstrong, 2018). As a result of incivility, hospitals may face an increase in cases of patient dissatisfaction, provide less effective treatments, and receive more lawsuits.
Lastly, the environments where abrasive communication is the norm may lose members. Across the “public-facing” professions, there is a higher tendency to turnover (leave the workplace) where incivility is prevalent (Han et al., 2021). Outside of permanent leave issues, long-term absences due to illness were much higher in nurses who were subjected to clinical site incivility (Armstrong, 2018). Thus, the additional pressure of incivility between the healthcare team members may be the ‘final straw’ that convinces some to leave. Given that staff shortages create a reduced capacity of the facilities to handle the patient influx losing professionals at a higher rate is highly undesirable for the hospitals. Overall, the instances of workplace incivility induce stress on the providers, reduce collaboration, and, ultimately, compromise healthcare delivery on individual and institutional levels.
References
Armstrong, N. (2018). Management of nursing workplace incivility in the health care settings: A systematic review. Workplace Health & Safety, 66(8), 403–410.
Bar-David, S. (2018). What’s in an eye roll? It is time we explore the role of workplace incivility in healthcare. Israel Journal of Health Policy Research, 7(1), 1–3.
Han, S., Harold, C., Oh, I.-S., Kim, J., & Agolli, A. (2021). A meta‐analysis integrating 20 years of workplace incivility research: Antecedents, consequences, and boundary conditions. Journal of Organizational Behavior.
Katz, D., Blasius, K., Isaak, R., Lipps, J., Kushelev, M., Goldberg, A., … DeMaria, S. (2019). Exposure to incivility hinders clinical performance in a simulated operative crisis. BMJ Quality & Safety, 28(9), 750–757.