I don’t know about you, but I’m up to my eyeballs in “patient experience” focus, metrics and nomenclature. Of course, we all get it and are committed to taking great care of our patients, but, with all due respect, what about us? The caregivers, the clinicians, the physicians. Does anyone care about our experience? I do. In fact, it’s pretty much what I spend most of my waking hours thinking about. And much as my partners and I are committed to improving it, sometimes if feels like we (clinicians) conspire against ourselves even in what may seem to be the simplest ways - like lack of kindness and respect. “Who cares about that?” you might say. Well, other than occasionally being irked by it, I did some digging and it turns out incivility in the workplace, including healthcare, goes against that which we are seeking: improved patient AND physician/clinician experience.
Here’s a personal story that kind of called this to my attention. In general, I like to greet people when I see them. Call me crazy, but I feel good saying “hi” or “good morning” and rather enjoy the same when it’s tossed my way. It just seems like common sense, but as we all know, common sense is often not that common. Case in point: “Brian.” By most measures, a decent physician; bright and clinically astute. But, frankly, kind of a jerk. I’d see him at the hospital nearly every shift I worked. I’d say “hi,” as usual, and then…silence - as if he were either deaf, or I didn’t matter. Groans and harrumphs. Sometimes I remember walking into the workroom to start my day and shouting out a “hi” to the group, only to be met by silence. This pattern continued, and frankly continues to this day. “What have I done?” I’ve often thought to myself. Other times, Brian, or his ilk, would have sidebar conversations while I would lead a meeting, or outright ignore e-silent policies we, as a department, had “agreed” to. Did they not read Robert Sutton’s classic, The No A**hole Rule? Obviously not.
So, come on people! If we want to all feel better in the workplace - the hospital, clinic, OR, ER etc. - can’t we just show a little love? And oh, by the way, failing to do so has some significant side effects. Georgetown Professor, Christine Porath, notes that close to 100% of workers have experienced or witnessed uncivil behavior, and nearly half report being treated badly at work at least once a week. Rude behavior decreases information uptake, impairs short-term memory, and damages the immune system. Not only does if feel lousy when treated badly or facing incivility, but there are real operational and organization costs: decreased work effort, decreased time spent at work, worry, decreased morale and turnover, or taking out one’s feelings on the “customer” - the patient or your colleague. I must say I’ve seen this happen, whereby frustrated or irritated physicians then transfer that behavior onto patients, or onto us, their colleagues. I’ve done it myself.
So what can we do? Well, my first instinct, of course, is to call them out on their apparent lack of civility and simple manners. Leadership 101 taught me to, a) Define the behavior: “Hey man, I noticed you don’t reply to my salutations;” and, b) Define the impact it has on us/me/the team, colleagues, and of course patients: “It kind of bums me out and makes me wonder if you’re intentionally ignoring me, which puts some distance between us that I’d rather not be there.” Sounds good, and is good. But, in reality, this is tough to do with colleagues. If you are the boss, then yes, marginalizing bad behavior using the right tactics is critical for optimizing patient care and colleague performance. But I’m not talking about that. I’m talking about clinician to clinician, mano y mano - strike one. Alright, so I figure I’ll just avoid this person/these people. But we know that’s not likely possible – not as physicians where our bench is fixed and where collaboration, for better or worse, is part and parcel to what we do - strike two. And as I learned, and Dr. Porath notes, “more than 85% of people who avoid or confront perpetrators were unsatisfied with how the situation ended.”
What can we do then to ensure the culture and climate that we, as physicians, seek which makes us feel better and improves our experience? How do we get through this without ruining our day...or month. If confrontation and/or avoidance are out, then what?
First of all, we’ve got to lead by example - first me, then thee. We know this, but perhaps it’s worth a reminder. Back to kindergarten and the golden rule - what we give is what we get. Be nice. Another tactic: grab a trusted colleague or friend. He or she may be able to help you navigate both the political and social climate of your microsystem and attune and attend to yourself just by listening and dishing out some wisdom. In addition, talking with your colleagues can help elevate the conversation around the attributes of a good colleague and a commitment to what that looks like. Because if “Brian” and his ilk act like this to other people, who is going to help him or depend on him when things go south with a patient? Finally, an ounce of prevention, and focusing inward here, is well-serving for the cure. Working to improve one’s overall sense of well-being or thriving helps make us less adversely impacted by bad behavior. Dr. Porath notes, “high thrivers burned out less than half as often as their peers.” Thriving, resilience, or even well-being serves as immunization against collegial negativity and incivility. Of course being physically and emotionally depleted like we, as busy physicians can get, only makes us more vulnerable and susceptible to incivility. Our fuse is shortened when we are tired. And who the heck has time, or the energy, for thriving. Pay now or pay later. We have to own our well being.
Yes, you’ve heard all of this before, but it bears repeating and we can now frame it in the context of incivility or the antidote. Exercise so as to “immunize” yourself against incivility by reducing muscle tension and enhancing cognition. Restful sleep and “sanity” breaks serve to lengthen your fuse. And make sure to hang out with people who energize you - a lot! Research has shown that “negative relationships have four to seven times as much impact on an employee’s sense of thriving as do…positive ones.”
I’m not trying to brush off the human response to being treated badly - which, of course, hurts. So, feel hurt. Feel outraged. But then get over it. Ruminating on an incident makes it hard to move forward. Visit the ”pity party,” but don’t stay for long.
Yes, there are jerks in our workplace, including our physician colleagues. We can do things to marginalize and even improve their behavior. However, what we most control is ourselves, and it’s good to remember that most of how we end up feeling and responding to those unpleasant encounters is up to us. The physician experience is up to you, the physician.
Porath, C. (April 2016). An antidote to incivility. Harvard Business Review, 94(4), 108-11.