Why behaviour matters: Civility Saves Lives

“I can’t believe that 96% of student and newly qualified veterinary nurses agreed or strongly agreed that bullying and incivility was a serious problem in your profession -  that’s shocking!”

Chatting to Helen Martyn, a senior staff nurse and human nursing lecturer from Civility Saves Lives, after her lecture at BVA Congress at the London Vet Show it is clear that the conversation about why behaviour matters in the veterinary profession is only just getting started. Recent research by VetLed and University of Aberdeen, and by the RCVS Mind Matters Initiative (MMI), has shone a spotlight on an uncomfortable truth; almost all of those working within the veterinary profession have heard, seen, or been subjected to rude or uncivil behavior.

Having worked in the veterinary profession for over 20 years and having delivered training in recognising and challenging incivility in the workplace, it is clear that this is (sadly) not an issue confined to human healthcare. Thankfully, there is increasing amount of research, and proven practical solutions available.

What is incivility and why does it matter?

Incivility (defined as rude or unsociable speech or behaviour) can be blatant or insidious and has many guises: verbal aggression, blaming, labelling or stereotyping, public humiliation, inappropriate humour, inconsistent expectations and microaggressions are just some of the actions that come under the term incivility. Fundamentally, incivility or rudeness is defined by the interpretation of the recipient, regardless of the intent. Whilst incivility is often considered a lower-level behaviour than bullying or harassment it is no less detrimental to the individuals, teams and organisations who experience it.

Listening to Helen’s lecture and stories of the incivility experienced in healthcare it was impossible not to reflect on similar experiences I had witnessed in my veterinary career, and I wondered if indeed there was anyone in that room who wasn’t feeling the same: anyone who had escaped incivility. I felt grateful that since discovering the Civility Saves Lives campaign I no longer felt unsure of how to advise others on how to manage incivility.

Unfortunately, in many workplaces currently, rudeness or incivility is normalised to the extent that it is often perceived as “just part of the job”.

The facts surrounding incivility are alarming:

• Porath and Pearson found that 80% of recipients of incivility lose time worrying about it, 38% reduce the quality of their work deliberately, 78% reduce their commitment to work and 25% take it out on their patients.
• Rosenstein and O’Daniel found that 75% of doctors and nurses surveyed identified bad behaviours within their teams which lead to medical error, and a worrying 25% were convinced that these behaviours contributed to the death of their own patients.

Preliminary findings from the recent VetLed and University of Aberdeen research project suggest that incivility is significantly linked to job satisfaction and correlated with job turnover intention and burnout.

These statistics highlight that developing, promoting, and embedding civility into the culture of veterinary practice is critical to performing at our best, providing the highest standards of patient care, and ultimately saving lives.

Call out with compassion: the “cup of coffee” approach

Starting the conversation about how we turn the tide and begin to address this thorny issue, Helen Martyn went on to speak about ‘Calling it out with Compassion’ in her lecture. Calling it out with Compassion (also known as a “cup of coffee” conversation) is the method described by Civility Saves Lives and is proven by researchers at the Vanderbilt Center for Patient and Professional Advocacy (USA) to be highly effective at reducing instances of incivility in workplaces. (It should be noted that it is not appropriate to address bullying and harassment with “cup of coffee” conversations.)

These informal, undocumented, co-worker-initiated conversations were found to result in behaviour improvements approximately 95-96 per cent of the time. At the heart of this approach is compassion: the desire to recognise and alleviate another person’s suffering by seeking to understand their stressors and the reasons for their behaviour. By starting from the position that nobody sets out to be uncivil we can begin to understand our colleagues and identify and mitigate the stressors that they encounter which could potentially have led to an instance of incivility.

In my experience when leading training for practices on incivility, the concept of “cup of coffee” conversations is well received and often what people would like to do, but they have not understood the importance of – nor had a suggested structure and rationale for – pursuing this route, rather than a more traditional, disciplinarian route.

Additionally, it is suggested that establishing a social contract or understanding within veterinary organisations can help us pave the way to addressing permissive environments where antisocial behaviour has been normalised and therefore not only reduce the incidence of incivility but improve workplace culture as a whole. By recognising that everyone experiences days when they are not their best selves, establishing a commitment to talk about it and being given the opportunity to correct our behaviour if it is interpreted as uncivil, we know that we can reduce incidences of incivility and therefore improve the safety of patients under our care.

Helen’s lecture inspired reflection, questions and comments and left the audience wanting to explore and understand more about how we could begin to change the tide, how we could ensure that the message reached every corner of our profession. Behaviour matters… Civility Saves Lives.

If you would like further information on the VetLed Civility Saves Lives campaign including free to download posters and resources, please visit the VetLed website or contact the blog author Helen Silver-Macmahon.