Unmasking incivility: the healthcare industry’s hidden culture clash

3 minute read

Within the healthcare sector, tension exists between organisations' stated corporate values and frontline workers' lived experiences.

While healthcare institutions may tout their cultural strategies on their websites, the reality of the day-to-day interactions can be quite different. Unfortunately, incivility in the healthcare industry has become all too common, including behaviours such as answering phones with curt responses or silence, using signs and sarcasm and displaying microaggressions. Our healthcare culture, possibly based on the misapprehension that it fosters quality, frequently succumbs to using condescension, public criticism and blaming to ‘coach’ junior medical members.

These subtle discriminatory behaviours have become some of the learned behaviours that our medical culture has inadvertently cultivated to survive incredible stressors, but which incongruently undermine the very fabric of our teams and the professionalism of our industry. I have seen these behaviours frequently throughout my career, working in many different health services and across international borders. I freely admit there have been times under pressure when my own behaviour has fallen short.

According to Civility Saves Lives, 38% of employees who experience rudeness in the workplace tend to reduce the quality of their work, while 48% reduce their time at work. Moreover, 25% of these employees take their frustration out on patients.

As a result, incivility at work has been associated with increased work distress, job dissatisfaction and withdrawal behaviours. Indeed, the impact of incivility extends beyond individual experiences, affecting patient care, organisational effectiveness and costs.

Even bystanders are not immune; those who observe but do not directly receive incivility show a 20% decrease in performance and a 50% decrease in willingness to help others.

In recent years, healthcare organisations have grappled with rebuilding their organisational culture after the long and arduous years of Covid-19 wreaked havoc on healthcare worker morale and retention. No organisation, particularly in the healthcare field, ever intend to create a toxic environment. Still, despite corporate strategies and values workshops, many find themselves inadvertently in that situation or, worse, unaware of what’s happening on the ground.

As those who operate on the frontline, we are familiar with the constant pressures and demands that mark our daily routines. Despite tight budgets and unwavering performance expectations, we must acknowledge that our conduct in the face of such intense stress will define the principles that shape our future interactions, the attitudes of those around us and our collective welfare.

What steps can we take to advance and encourage a culture of empathy and collaboration where discourteous conduct is not tolerated? How can we guarantee that we don't stay silent when confronted with inappropriate behaviour or harassment but instead engage in constructive and courteous debates and differences of opinion? How do we learn to disagree better?

We now know that incivility is rife and it erodes trust, undermines collective efforts and hampers collaboration. These are the very elements that form the essence of a team and the cornerstone of a positive organisational culture. As our pressures continue to mount in the coming decades, we will look to our leaders to take ownership of this challenging and complex issue and proactively take steps to influence their organisations for the better.

As we contemplate our leadership abilities and organisational strengths during the initial months of the MSc in Global Healthcare Leadership, I now appreciate that the culture of our institutions goes beyond the principles stated on our website. Professor Sue Dopson from Saïd Business School aptly noted, ‘It's more than mere lip service. It's about how we present ourselves at work and cultivate motivational qualities. It's about achieving more than the collective abilities of a team.’ I have the potential to do more to initiate change in my workplace, both by leading my team and by actively guiding others in their efforts to improve.

Oxford MSc in Global Healthcare Leadership