The Civility Message

Scroll through the theory and some of the evidence we believe makes the message of civility and the impact of incivility so important.

What is incivility?

Incivility can be anything ranging from mild to moderate rude or unsociable speech or behaviour.

Importantly, it is as interpreted by the recipient.

There are many examples:

Shouting at someone, swearing, aggression (not necessarily towards someone), belittling someone, sending emails while in meetings, talking over others, being difficult over the phone, rolling eyes or tutting at someone. The list goes on!

We will all have different opinions as to what we feel is rude, even differing interpretations of the severity of an action before we see it as rude. But at some point, we all have a line, wherever that might be, and when that line gets crossed, the impacts can be devastating.

What happens when someone is rude?

When someone is rude to us, it reduces our bandwidth; our ability to effectively juggle multiple tasks and conscious thoughts.

For example, on a good day, the average one of us can actively juggle 6-8 things, like remembering to pick up the shopping on the way home, remembering the important birthday next week.

But this also includes tasks for our patients, like chasing the blood results, ordering investigations, being able to consider differential diagnoses, checking physical health observations, making a referral to another MDT for an opinion.

Therefore, rudeness reduces our ability to do our jobs, until all we can focus on is them. They are actively making us worse.

The Impact of Incivility

This impact has a direct impact on the recipient, and this has been measured in the office place by Christine Porath [1]. She found this lined up with the bandwidth concept:

- 61% reduction in cognitive ability

There were also many other impacts:

- 80% lose time worrying about the rudeness

- 78% reduced their commitment to work

- 63% lose time avoiding the offender

- 48% reduced their time at work

- 38% reduce the quality of their work

- 25% took it out on others, including customers

- 12% leave

The impact spreads to others

The impact of rudeness spreads through a team like a ripple in a pond, impacting those who observe the rudeness too:

- 20% decrease in performance

- 50% reduction in willingness to help others

So it is affecting the function of others and their willing to work as a team.

It also impacts customers:

- 75% less enthusiasm for the organisation

- 66% feel anxious dealing with staff

This might prevent a patient asking staff for help, or reporting a symptom.

Medical teams perform worse in the presence of rudeness

Riskin and Erez [2] demonstrated the negative impact of rudeness on clinical outcomes.

They conducted a Randomised Control Trial using neonatal resus scenarios comparing one with rudeness (intervention) within the team to without (control).

When rudeness was present, there was a decrease in team performance. This was seen in the form of a decrease in communication (information sharing), an increase in diagnostic and procedural errors, and a delay to diagnosis. When they analysed what was contributing to this difference, they were able to attribute more than 50% of this to the rudeness.

Katz et al [3] showed how rudeness in a simulated surgical scenario reduced the performance of the anaesthetists. When comparing the performance against a set of standards, 91.2% of the anaesthetists in the present of a polite surgeon met the expected standards, whereas only 63.6% of those in the presence of rudeness met the same standards - a reduction of almost 33%.

Further to this, when asked to rate their own performance, the anaesthetists were not good at recognising that they were performing worse - the impacts were going unnoticed.

When we condone rudeness in our teams, we accept poorer outcomes for our patients.

So what can we do about it?

Reducing incivility at work, in particular in a healthcare setting can feel like an incredibly overwhelming task. It can feel daunting to know where to start and how to change the behaviours of others.

There are many components that we feel come together to improve the workplace culture in our teams:

Understanding the rudeness and where it can come from
Utilising team wide approaches through Psychological Safety and Compassionate Leadership
Applying curiosity and compassion when speaking to others about the rudeness
Taking guidance from approaches such as the Active Bystander Intervention, while utilising a Civility Saves Lives decision making compass
Knowing who can support you when you do not feel able to deal with the incidents yourself.
Considering how cup of coffee conversations can support this.

We ultimately aim to improve individuals and teams abilities to have productive, honest and challenging conversations when we perceive rudeness or incivility.

Having Conversations to Improve Outcomes

A huge part of what we hope to achieve through the CSL Message is based on a couple of assumptions, that we hope holds out true in most cases;

We don't come in to work in a healthcare setting to intentionally be rude to each other
We are all in the healthcare profession in order to do the best for our patients

Therefore, if we are not always aware of the impact of our behaviour (even considering if our behaviour changes in very specific situations), if we are helped to see these impacts, we can be motivated to change. If we can catch it before it happens next time, we can potentially reduce the impacts described above, and potentially improve patient outcomes!

We therefore need to feel able as a team to give each other this feedback!

If we feel able to do it ourselves

Being able to go directly to someone to let them know you believe they have been seen to be rude is the most efficient path here, but how many of us feel able to do this? It takes a certain type of person to even consider it!

If this is you, and you can go to someone this way, fantastic, but we need to consider how we approach it, to maximise the beneficial impact (ie what we hope, which is the behaviour changes).

Instead of: "You were rude"

Try: "After we spoke, this is how I felt"

The simple shift in phrasing, can completely rewire the response you get. It's not an attack on the other person as being rude, it's a way to help they see the impact they had. If this was me you came to, I would be mortified and would be desperate to want to understand why and look to change. It really can be that powerful.

If we don't feel able to do it ourselves

If we don't feel able to go to that other person directly, it can be helpful for there to be other options. Is there a system in place to help others feel able to step up and say something (Active Bystander Intervention), or is there an advocate that can have the conversation for me (Cup of Coffee Conversations)?

Both of these systems need other things in place that sit within our workplace team culture to help us get the best out of them and ensure they are being used appropriately - to understand when rudeness occurs and to look to deal with them in a way that allows us to learn and improve.

Psychological Safety can be really important to understand and implement within our teams in order to do just that. We all have an awareness of why we are raising the issues, and all feel able to discuss it in a way that allows us to learn and improve, not decide who to punish! A recent systematic review [4] of Psychological Safety in Healthcare agreed that it improves patient safety and outcomes, boosts team performance and underpins successful team leadership.

Cup of Coffee Conversation models, such as that suggested by Gerald Hickson et al [5] demonstrate the benefit of simple, but clear feedback systems to allow individuals to be informed when they have been seen to be rude. When given the professional gift of how our behaviour impacts others, we can take the opportunity to reflect and change without being told what to do.

How do I bring Civility Saves Lives to my healthcare team?

We understand that even when we are aware of what we might need to do, it can still feel an uphill, even impossible task of where to start.

This is where speaking to us can help.

Joe, Chris and the wider Civility Saves Lives community have years of experience in bringing this to healthcare team settings.

Running a team workshop can be all it takes to spark a change. Let us share our experience and knowledge, while engaging and inspiring those amazing people in attendance to take it forward.

Get in touch to find out more!

References

1. The price of incivility. Christine Porath. https://www.ncbi.nlm.nih.gov/pubmed/23390745

2. The impact of rudeness on clinical team performance. Riskin and Erez et al. Paediatrics. 2015.

3. Exposure to incivility hinders clinical performance in a simulated operative crisis. Katz et al. BMJ Quality and Safety. 2019.

4. Essential elements and outcomes of psychological safety in the healthcare practice setting: A systematic review. LaPlante et al. Applied Nursing Research. Volume 83, June 2025.

5. Promoting professionalism by sharing a cup of coffee. Hickson et al. American Nursing Today. Volume 12, Number 5, May 2017.