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The Impact and Costs of Incivility

Incivility is a term for social behavior lacking in what is thought of as good manners and a respectful attitude towards others. Though incidents of incivility have been noted throughout history, the recent rise in uncivil behavior has become a major concern in the United States. Examples abound – politics, reality television, classrooms, workplaces – and it is getting worse.  A recent poll by Weber Shandwick reported that 65% of Americans say the lack of civility is a major problem that has worsened during the financial crisis and recession.  To begin to address the issue of incivility, the various behaviors classified as uncivil must be identified and their causes understood.

Degrees of Incivility  Incivility is not just a single behavior or attitude, but is actually many troublesome  behaviors that can be arranged along a continuum of disruption:

  • Lack of manners: arriving late, delayed responses, rude comments
  • Disruptive behaviors: losing one’s temper, yelling, withholding information
  • Lateral violence: disrespect, gossiping, back-stabbing, sabotage

Any of these uncivil actions when tolerated can significantly impact a relationship or work environment.

Root Causes of Uncivil Behaviors  What causes a human being to act in such an unproductive manner? There are countless theories, many having to do with the situation or circumstances, including:

  • Feeling of powerlessness
  • Severe work-related stress
  • Lack of knowledge of common courtesies
  • Feelings of exclusion
  • Cultural differences
  • Generational differences around respect
  • Workplace culture tolerates bad behavior
  • Mental health disorders

In general, it is agreed that those who perpetrate incivility use abnormal, aggressive behaviors to gain control and power.

Incivilty in the Workplace  Unfortunately, the growth of incivility in general society has spilled over into the workplace. Research has found that if incidents of incivility are tolerated or conflicts go unresolved in a workplace, both performance and satisfaction are negatively impacted. This is particularly true in Healthcare where uncivil behavior can quickly turn a safe practice environment into a place of potential harm for both patients and caregivers, as well as significantly increase the cost of healthcare delivery.

Until recently, Healthcare has been organized around a patriarchal model, with doctors as the supreme “boss” and nurses and auxiliary staff there to carry out orders without question. The evolution from this practice model to one of team collaboration focused on patients overall care has contributed to feelings of uncertainty, confusion and stress for all involved. It takes time and focused leadership to establish the new “norms” for everyday work throughout any organization.

Also, a potentially devastating form of disruptive behavior is found in the nursing profession. Labeled “lateral violence” and often referred to as “nurses eating their young,” the phenomenon is insidious and costly. According to research approximately 61 percent of newly-licensed nurses will leave their first job within six months and many identify lateral violence behavior as a major factor in their decision to leave.

The Cost of Incivility  The quality and safety of healthcare organizations is literally “life & death” for patients and must be the organization’s primary concern, followed by financial viability.  In an environment where incivility is tolerated, the cost of incivility on quality and safety is enormous and potential costs include:

  • A decline in job satisfaction that could lead to harmful errors or patient abuse.
  • A loss of productivity as staff avoids perpetrator.
  • An increase in absenteeism and staff turnover, causing greater work for remaining staff and additional funds for replacement activities.
  • Ineffective team collaboration resulting in poor patient outcomes.
  • An increase in malpractice suites, followed by a decline in reputation in the community.
  • A loss of accreditation from government or oversight agencies.

For an organization striving for profitability and long-term success, having to replace and then train even a minor portion of their staff each year, the financial impact of turnover can be significant.  For example, if a hospital that employs 2,000 nurses with an average salary of $50,000 per year loses 10% of its staff in a year, the replacement cost would be approximate $15 million. How much better for morale if that $15 million would be divided and an extra $7,500 bonus could be distributed to the current staff!

To measure the potential financial impact of poor patient outcomes, multiple law suits, a decline in reputation and loss of accreditation would be impossible, but the end result would ultimately severely damage the potential for long-term success of a healthcare facility.

At Risk Organizations  When should an organization assess the risk of incivility negatively impacting performance? The general answer would be “at any time of significant change.” And given today’s healthcare environment, change is always present.

Currently, many external forces have the potential to bring about the need for change across the industry, including:

  • An increase in regulations affecting healthcare delivery systems
  • More stringent accreditation requirements
  • Changes in payment allotments for services
  • Greater diversity in patient population
  • Demand for more innovative, though often riskier, cutting-edge treatments and services

Each healthcare provider must determine strategic initiatives necessary to address these forces based on the unique circumstances of the provider’s operations and the specific goals established for future success. Examples of such initiatives include:

  • Restructuring of the workforce so to better align fixed cost with revenue projections
  • Expansion from a community hospital to a regional healthcare system that includes additional hospitals and physician practices
  • Establishing additional high-profile service areas, such as transplant centers, to increase the reputation for innovation and expertise

As would be anticipated, these external and internal changes have caused uncertainty and additional stress for the hospital’s staff at the same time when incivility and disruptive behaviors are on the rise in society and, particularly, in the healthcare profession.

Change in one’s work environment is known to intensify negative human emotions. These emotions include anxiety, confusion, disappointment and abandonment, leading to a potential loss in respect and trust for the organization and co-workers.

Evidence of Incivility  The extent of incivility and the degree of impact within an organization can be difficult to determine without a focused assessment throughout the organization. Early signs that an issue might exist would be:

  • Low staff morale
  • Unsatisfactory patient and employee survey results
  • Significant errors resulting for miscommunications between medical and nursing staff
  • High absenteeism – particularly if concentrated in one area where a perpetrator may influence daily work,
  • High turnover
  • Difficulties in recruiting talented employees
  • Lack of understanding of cultural diversity
  • Unresolved conflicts
  • Unnecessary escalation of conflicts

Addressing Incivility  In the words of the late Stephen Covey, “We cannot think our way out of situations we have behaved our way into.”  Healthcare organizations that have been successful in creating a culture of mutual respect and safety have the following things in common:

…Engaged leaders who are visible and “walk the talk”

…Skilled and empowered frontline managers

…Staff who are trained to identify and appropriately confront behaviors that undermine a culture of safety

…Open dialogue with and feedback from all staff

…Measureable standards of behavior to which all employees are held accountable

In healthcare, extensive and intense training is the foundation to successful outcomes.  Just as technical skills must be learned and practiced, so must the communication skills needed to support a culture of respect and safety be taught and practiced. Without the communication skills to address an incident of incivility or to stand up to a perpetrator, staff can potentially lose confidence in themselves and their commitment to the profession.

The world has changed and for many the need for courtesies has been obscured by what they see around them. By building a common language designed to address incivility and by offering a safe learning environment so that these communication skills can be practiced and refined, an organization can create a “critical mass” of employees “doing the right things” thus “tipping” the culture toward mutual respect, safety and productivity.

For more information about how your organization can build a culture of safety and respect, contact CoMass Group at info@comassgroup.com.