Incivility in Healthcare Settings: Manifestations, Root Causes, and Downstream Effects on Patient Care and Productivity Theresa P. Yeo 1, Anne Belcher 2, and Charles J. Yeo 3 Thomas Jefferson University Schools of Nursing & Population Health & Dept. of Surgery 1,3, Johns Hopkins University School of Nursing 2. contributed to increase in violence RECOMMENDATIONS & STRATEGIES: INCIVILITY IN THE WORKPLACE 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 ROOT CAUSES 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, s, 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 Institutional Strategies: Environmental re-design & 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 Foster professionalism 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 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. Barriers to Reporting Incivility: “Nothing Will Change” attitude Fear of retaliation Culture of Silence Lack of confidentiality in system Lack of administrative support 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 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 Prevalence: Limited epidemiologic data Bountiful anecdotal evidence US Bureau of Labor (2005): non-fatal violent occupational injuries common among nurses Hader (2008): 1,400 RNs, 83.7% experienced workplace violence Vessey et al. (2009): 303 RNs, 70% reported bullying ABSTRACT 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 MANIFESTATIONS