Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions. 

Unleashing Mindful Civility in Medicine

5/3/2016 5:39:36 PM | 3 comments

Welcome to Mindfulness in Medicine, an ongoing column by best-selling author Anne Bruce, designed to cultivate leadership and collaborative relationships among hospital leaders, nurses, providers, and ancillary staff. Mindfulness is a powerful leadership tool that enhances emotional intelligence. It is a tool that, when practiced, can help us develop and implement emotional intelligence in medicine. It is a tool that, when practiced, can help us develop and implement relational coaching skills and illuminate various ways to improve hospital operations and cross-departmental performance. Mindfulness also improves our capacity for decision-making and participatory medicine, all while enhancing our own health and well-being. Your comments and insights on these postings are greatly valued.
Joining me for this month’s column is civility expert and author Diana Damron, who has been engaging healthcare professionals in thoughtful discussion about civility in the workplace for years — most recently in her book, Civility Unleashed.

Does Your Practice Practice Mutual Respect and Courtesy?

A PA asks the receptionist if he has any new messages. She sighs heavily and says, “If you have a new message, you’ll be the first to know because I’ll hand you one of these cute little pink papers. OK?”
A busy emergency physician sees a technician approaching with an ECG that needs to be signed immediately. With a heavy sigh, the physician signs the paperwork, and then hands it back to the technician without a word.
A hospitalist group bickers constantly over who should cover shifts when a colleague is ill or goes on vacation.
All of the above are examples of workplace incivility — rude behaviors that violate the norms of mutual respect and courtesy. In today's post, we'll explain what incivility means for healthcare organizations and offer tips for cultivating conscious civility in the workplace.

What Is Incivility?

Incivility can make its debut at any time and in all forms of behavior — sometimes overt, but often subtle. Here are a few examples that are common in healthcare:
Blatant incivility:
  • Criticizing others in public or in front of a patient and family
  • Interrupting patients’ and coworkers’ conversations
  • Belittling, name-calling, or putting others down
  • Raising your voice to a team member
  • Rolling your eyes in disgust or exhaling loudly at someone’s suggestion         
  • Ignoring reasonable requests from supervisors and teammates
  • Arriving late for appointments and meetings
More subtle incivility:
  • Gossiping about the hospital and its staff
  • Doing the bare minimum when it comes to group responsibilities like vacation coverage and paperwork
  • Not being accountable for themself or holding others accountable for their actions
  • Playing favorites
  • Ignoring requests for communication
  • Conveniently disappearing when a problem arises
  • Taking credit for others' work

Why Civility Matters and Incivility is Likened to Cancer

In many healthcare settings, incivility buzzes like a swarm of yellow jackets — annoying some, scaring others, and even stinging a few. But just like a yellow jacket sting, one encounter probably won’t cause too much damage. (It takes about 1,500 stings from a swarm of yellow jackets to kill a human who is not allergic.)
It’s the same with incivility. Most people can handle a few instances of rudeness or demeaning behavior now and then. But over time, repeated "stings" can erode job satisfaction — and eventually, patient experience, patient safety, and the hospital's reputation.
Incivility can also be likened to cancer. Not only do emotions spread, but behaviors do as well. Undetected, it’s not long before the entire patient’s body is in pain and weakened.
Think about how you feel working with that upbeat, fun, positive person who sees every obstacle as an opportunity. Now consider working closely with someone who hasn’t smiled since her fifth-grade birthday party and grumbles constantly about her job and patients. You might be able to maintain a spirit of compassion and optimism for a while, but over time, her negativity will wear you down.
Incivility kills the spirit of medicine, the drive it takes to practice in today’s world, and the energy and compassion required to deliver quality care to patients. It can chase away good people from our field just when we need them the most.
If you think that financial repercussions of incivility are unique to big corporations, think again. Research shows that incivility costs American businesses — including hospitals and healthcare companies — more than $380 billion a year.

How Rudeness Takes Root

So where does incivility come from?
Sometimes a personal issue can be a catalyst. One person's divorce, personal illness, or financial setback can impact the entire team. Anger, fear, and frustration seep into the atmosphere, no matter how professional everyone else tries to be.
Sometimes incivility is a product of job stress or compassion fatigue. Caring for acutely ill patients can be grueling work. We get so focused that we stop thinking about how our words and behaviors impact others.
Pressure within our industry can also play a role. The drive to meet new mandates and metrics can strain established relationships. Turnover among providers, clinical leadership, support staff, and administration can also shift the organizational culture.
The key thing for leaders to realize is that toxic environments don’t just materialize. They're created. If your organization or team is not planting and nurturing seeds of civility among staff and weeding out incivility quickly and unapologetically, it’s possible for a toxic environment to take root.

The Common Language of Civility

If you’ve ever traveled to a country where you don’t know the language or culture well, you know it’s more difficult to navigate, check things off your “to do” list, and distinguish between a joke, compliment, or insult.
Yes, you can get by, but the trek takes much longer, is more doubtful, and can include unnecessary detours. Things definitely run more smoothly when you understand both the language and the cultural context from which it flows.
It’s no different in a hospital setting or medical practice. When healthcare professionals speak the same language (that of mindful civility) and understand the culture (one that’s built on respect), trust grows, the medical community prospers, and relationships with patients flourish.
In the language of trust, respect is the common denominator. This is true whether or not you agree with a colleague, whether or not that person is your leader or your direct report, and no matter whether you like the person.
More often than not in a dysfunctional workplace, everyone is speaking their own language of civility. They may think they're behaving acceptably when they're actually hurting others. The result is dissonance and disharmony.
However, when everyone commits to speaking the same language of civility, it can begin to sound like a beautiful symphony. Everyone is playing their own instrument, some more skilled than others, but together they make beautiful music. And patients and the community reap the benefits.

Fostering Mindful Civility in Healthcare

Here are some steps you can take to nurture civility within your organization:
Act quickly and decisively. Incivility is easiest to stop before it spreads — when it's isolated in a few individuals. As a leader, take rude behavior very seriously, and empower your reports to do the same.
Create a common language. Work with team members to define exactly what respectful behavior looks like and sounds like. Leaders should then model these behaviors and provide consistent feedback to their teams.
Make civility a habit. People under stress tend to lose sight of their words and actions and focus on the problem at hand. This is why practicing mindful civility on a regular basis is so critical. It forces us to be in the moment, present for others, and less zeroed in on ourselves.
Be realistic. Accept that some people will never change their uncivil behavior — no matter what incentives apply. If you're truly committed to creating a positive workplace culture, you may need to assist them in finding a more appropriate position.
Hold team members accountable. One of the best ways to nurture civility in your organization is to make your expectations explicit. Dan Wilford, a former CEO of Memorial Hermann Healthcare System, implemented a “No Jerks” rule. This meant that he did not tolerate workplace incivility under any circumstances. When he discovered it, he took swift and appropriate action. It was his strong belief that the important work of healthcare professionals could not be accomplished with “jerks” overpowering the extraordinary efforts that needed to take place.
Get help. Many excellent books have been written on the subject of workplace civility. If you'd like to involve your entire team in the change process, consider working with a consultant.
Above all, persevere. Maintaining a civil workplace in today’s healthcare industry is no easy task. But your toughness will pay off for both your patients and those high-flying employees who value a positive workplace culture.

About the Authors

Anne Bruce has provided training and performance coaching for MedAmerica and CEP America. She also serves as MBSI's Employee Development Coach and Leadership Facilitator. Anne is a bestselling author with more than 20 books published by McGraw-Hill Publishing, New York. Her next book on mindful behavior is titled Conscious Engagement and is scheduled for release in 2017. She considers her award-winning life-coaching book, Discover True North: A 4-Week Approach to Ignite Passion and Activate Potential (McGraw-Hill Publishing) to be one of her most "mindful" books to date. She also leads a popular Discover True North Expedition group on LinkedIn. Anne can be reached at 214-507-8242 or by writing to her at, or visiting her on LinkedIn or Facebook.
Diana Damron is the author of Civility Unleashed: Using Civility to Survive and Thrive in the Workplace. She is a speaker and trainer who helps healthcare organizations and businesses move from toxic to trusting. You can reach her at or visit her on LinkedIn and Facebook.

Diana Damron
Hi David - I love your comment, especially:"preaching to myself"! That's one of the most critical pieces of initiating and maintaining civility - understanding that it's not our job to point the finger at the other guy because of his or her incivility, but to realize that WE are the source of civility. Civility, not only flows out from us, but is contagious to others! (And, unfortunately, incivility is contagious as well.) It's up to us to make that choice to engage with civility - even under trying conditions. And you're correct - we have to consistently remind ourselves to unleash mindful civility. Thank you so much for your comment, David.
5/4/2016 5:16:50 PM

Anne Bruce
Thank you David for your response to our article. You are right on when you talk about the stress we all endure day-to-day in this breakneck speed world we live and work in. The healthcare community seems to really absorb the punches when it comes to demonstrating courteous communications and appreciating the cornerstones of workplace happiness...or as Diana calls it, the 3 Cs: civility, communication and character. For me it's been a mindfulness thing. Just stopping to be in the moment and consider what the other party is trying to convey and why they feel the way they do. Thank you for your comment.
5/4/2016 1:59:48 PM

David Carter
Thank you for this very pertinent reminder. We are all under stress in many ways in our jobs, not to mention our personal lives. It's easy to lose sight of "The Golden Rule" and the lessons we all learned in Kindergarten. So important (preaching to myself) to remember as "grown ups".
5/4/2016 12:48:49 PM