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Incivility in Healthcare Settings: Manifestations, Root Causes, and Downstream Effects on Patient Care and Productivity Theresa P. Yeo1, Anne Belcher2, and Charles J. Yeo3 Thomas Jefferson University Schools of Nursing & Population Health & Dept. of Surgery1,3 , Johns Hopkins University School of Nursing2 PURPOSE: To investigate the prevalence and effects of incivility in healthcare and educational settings METHODS: Review of the literature SEARCH STRATEGY: CINAHL, PubMed, Joint Commission sites searched using terms: incivility, workplace violence, disruptive behavior, bullying . ABSTRACT This poster describes the prevalence and effects of incivility in healthcare settings. The causes of incivility are protean. Concerns about the prevalence of unprofessional behavior led the Joint Commission to designate management of disruptive behavior a National Patient Safety Goal in 2007. Prevalence: • Limited epidemiologic data RECOMMENDATIONS & STRATEGIES: MANIFESTATIONS • Environmental re-design & Uncivil Behaviors: Complaining • Lying • Gossiping • Innuendo • Mocking • Yelling • Using profanity • Abusive language • Inappropriate gestures • Insubordination • Backstabbing • Scapegoating • Rumor mongering • Unfair sanctions • Sexual harassment • Violence: fighting/hitting • Impatience: colleagues & patients • Physical or verbal intimidation • • US Bureau of Labor (2005): non-fatal violent occupational Barriers to Reporting Incivility: injuries common among nurses •“Nothing Will Change” attitude •Fear of retaliation 83.7% experienced workplace •Culture of Silence violence •Lack of confidentiality in system • Vessey et al. (2009): 303 RNs, 70% reported bullying Institutional Strategies: INCIVILITY IN THE WORKPLACE • Bountiful anecdotal evidence • Hader (2008): 1,400 RNs, ROOT CAUSES •Lack of administrative support Downstream Effects On: Quality & Safety: • Job dissatisfaction • Poorer patient outcomes • Ineffective RN - MD interactions • Coordination of care declines • Valued employees leave institution • Take out dissatisfaction on patients Productivity: • Decreased effort at work • Apathetic attitude • Not engaged or disengaged • Lost work time to avoid perpetrator Health: • Risk for mental illness • Risk of cardiovascular disease • Stress-related disorders Work Environment: • Anonymous, inappropriate threatening phone calls, letters, emails, texts • Disrespectful body language & remarks • Not giving colleague credit for work Potential for Unlawful Behavior: • Sexual misconduct • Physical or verbal abuse / threats • Potential for criminal activity Situational: • Lack of self-restraint • Decline of courtesy • Exclusionary behavior • Endless work stress • Feeling powerless Horizontal: • Pressure to succeed • Anger and frustration • Don’t respect co-workers • Generational differences Vertical: • Abuse of power • Negative role modeling • Work culture tolerates bad behavior Personal: • Differing from group norm in age, gender, race, personality, education • Mental health disorders: Alcohol and/or substance abuse security technologies (OSHA) • Enforceable institutional policies and procedures • Code of Conduct • EAP requirement • Real penalties for repeaters • Proactive approach • Critical incident debriefing for target and perpetrator Professional Strategies: • Be supportive of colleagues • contributed Foster professionalism to increase in violence • Display inclusive behavior • Role model positive behaviors • Support colleagues who report incivility / violence • Deal directly with conflict Personal Strategies: • Personal resilience strategies • Don’t take it personally! • Resist temptation to gossip • Leave management to management contributed to increase in violence • Self-Assessment: : AM I GUILTY OF INCIVILITY? WHO ME? Conclusions Evidence suggests that failure to communicate effectively and an uncivil work environment contribute to increased medical errors, patient mortality, job dissatisfaction, personal discontent and high attrition rates among nurses, faculty, and other health professionals.