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Combined data from three hospitals in answer to the question: How much does this behaviour affect your experience of the working day at the hospital? Visually represented are all respondents' answers expressed as a percentage. DNA = did not answer.
Source publication
Destructive communication is a problem within the NHS; however previous research has focused on bullying. Rude, dismissive and aggressive (RDA) communication between doctors is a more widespread problem and underinvestigated. We conducted a mixed method study combining a survey and focus groups to describe the extent of RDA communication between do...
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Background: The path between patients and health care providers has adopted new advanced information technologies. However, opinions vary about the digital care meeting. Physicians have expressed concerns about increased workload, changes in working methods, and information security. Purpose: To explore physicians’ experiences and satisfaction of d...
Citations
... These antisocial behaviours have been widely investigated in various professional environments, including healthcare. More recently, low-intensity negative interactions have also become a concern for organisational researchers. 1 Rude, dismissive and aggressive (RDA) communication, 2 as well as insensitive and disrespectful behaviours, are some of the manifestations of 'workplace incivility' 3,4 or 'interstaff incivility'. 1 Typical examples include belittling comments or dismissive gestures (eye rolling, lip sounds, sighs and muttering), skipping greetings, gossip, social exclusion, unavailability, impatience with questions, and condescending language or voice intonation. Workplace incivility has been defined as 'a low-intensity deviant behaviour with ambiguous intent to harm the target, in violation of workplace norms for mutual respect'. ...
... Following broad and narrow screening, 13 peer-reviewed papers were considered suitable for inclusion in the review (Fig 1). 2,5,6,14,[29][30][31][32][33][34][35][36][37] The findings are reported here in a narrative format, with descriptive results of the studies presented first, followed by separate discussions of the impact of incivility on medical performance and service, and on patient care. ...
... This study further highlights the pervasive issue of mistreatment of residents [57][58][59][60][61]. Experiencing or witnessing this behaviour negatively impacts on health and wellbeing, with reports of psychological distress, posttraumatic stress disorder, professional demotivation, burnout, dissatisfaction with the job and with training, and thoughts of leaving [57,59,60,[62][63][64][65][66][67]. Patient care is also adversely affected, with an increase in errors, disruption to collegiality and communication and diminished teamwork and morale [57,59,60,[62][63][64][65][66][67][68][69]. ...
... This study further highlights the pervasive issue of mistreatment of residents [57][58][59][60][61]. Experiencing or witnessing this behaviour negatively impacts on health and wellbeing, with reports of psychological distress, posttraumatic stress disorder, professional demotivation, burnout, dissatisfaction with the job and with training, and thoughts of leaving [57,59,60,[62][63][64][65][66][67]. Patient care is also adversely affected, with an increase in errors, disruption to collegiality and communication and diminished teamwork and morale [57,59,60,[62][63][64][65][66][67][68][69]. Mistreatment often remains unreported by residents [59-61, 64, 70-72]. ...
... Mistreatment often remains unreported by residents [59-61, 64, 70-72]. Senior doctors from other departments were cited as perpetrators of mistreatment towards participants in this study, which has been reported previously [62,73]. This reluctance to challenge seniors may indicate fear, or vulnerability in the medical hierarchy, or residents' socialisation into the culture of medicine as transmitted by the hidden curriculum, with the acceptance of mistreatment as a way of signifying their worthiness for the profession [43,64,[74][75][76]. ...
Context
The challenging nature of the transition from medical student to doctor is highlighted by the associated negative consequences to new doctors’ mental health and wellbeing. Enhanced understanding of the lived experience of recent medical graduates as they move through the stages of transition over the first year of practice can inform interventions to ease the difficulties encountered.
Methods
Using interpretative phenomenological analysis (IPA), a novel approach to this topic, we explored the lived experience of transition from student to doctor over the first year of practice after graduation. Twelve new graduates were purposively recruited. We conducted semi-structured interviews at the end of their first year of practice with respect to their experience over the first year.
Results
The experience of transition was characterised by overlapping temporal stages. Participants’ initial adjustment period was characterised by shock, coping and stabilisation. A phase of development followed, with growth in confidence and a focus on self-care. Adversity was experienced in the form of interprofessional tensions, overwork, isolation and mistreatment. Finally, a period of reflection and rationalisation marked the end of the first year.
Discussion
Following initial anxiety regarding competence and performance, participants’ experience of transition was predominantly influenced by cultural, relational and contextual aspects of clinical practice. Solutions to ease this challenging time include stage-specific transitional interventions, curricular change at both undergraduate and postgraduate levels and a re-evaluation of the clinical learning environment to mitigate the difficulties endured.
... One example is the crowded hospital Emergency Department (ED), due to the stress of responding to the emergency treatment needs of multiple patients rapidly and effectively. Issues related to incivility in EDs have been reported globally, including in the US, Switzerland, the United Kingdom and Australia (Klingberg et al., 2018;Shetty et al., 2016;Bradley et al., 2015;Rosenstein et al., 2008). Cited examples of incivility include abrupt retorts or comments, unreasonable demands on colleagues, arbitrary assertions of power, shifting responsibility, blaming others, and hiding personal insufficiencies. ...
Civility is an essential feature of health care, as it is in so many other areas of human interaction. The article examines the meaning of civility, reviews its origins, and provides reasons for its moral significance in health care. It describes common types of uncivil behavior by health care professionals, patients, and visitors in hospitals and other health care settings, and it suggests strategies to prevent and respond to uncivil behavior, including institutional codes of conduct and disciplinary procedures. The article concludes that uncivil behavior toward health care professionals, patients, and others subverts the moral goals of health care and is therefore unacceptable. Civility is a basic professional duty that health care professionals should embrace, model, and teach.
... 14 The literature also shows that personality traits are related to choice of specialty. 15,16 As a result, different specialties exhibit different types of behaviour; for example, some are more likely to engage in nonconstructive behaviour or have different conflict styles for resolving issues. 17,18 The unique cultures of specialties and characteristics of medical specialists can cause miscommunication and tension that inhibits interphysician collaboration. ...
... Hierarchy and a large workload seem to be inhibiting factors for collaboration between physicians. A high workload or perceived stress makes people more likely to exhibit rude behaviours, 15 creates time constraints for communication, 49 and makes the communication atmosphere more negative. 26 Physicians with a higher position in the medical hierarchy are more likely to express negative behaviours, and for those lower in the hierarchy, it is harder to speak up to someone at a higher level. ...
... 26 Physicians with a higher position in the medical hierarchy are more likely to express negative behaviours, and for those lower in the hierarchy, it is harder to speak up to someone at a higher level. 15,34,60,61,73 For a physician to communicate with other physicians, he should feel responsible and see the added value of sharing information, for example, because it improves patient safety or it has a learning effect. 15,49,73 In eight studies, a difference between medical specialities was found, with some being more prone to collaborate or rated higher for collaboration and others more likely to express negative behaviours. ...
Anoek Braam, Martina Buljac-Samardzic, Carina GJM Hilders, Jeroen DH van Wijngaarden Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the NetherlandsCorrespondence: Anoek Braam, Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle Building, P.O. Box 1738, Rotterdam, DR 3000, the Netherlands, Email braam@eshpm.eur.nlAbstract: Health care today is characterized by an increasing number of patients with comorbidities for whom interphysician collaboration seems very important. We reviewed the literature to understand what factors affect interphysician collaboration, determine how interphysician collaboration is measured, and determine its effects. We systematically searched six major databases. Based on 63 articles, we identified five categories that influence interphysician collaboration: personal factors, professional factors, preconditions and tools, organizational elements, and contextual characteristics. We identified a diverse set of mostly unvalidated tools for measuring interphysician collaboration that focus on information being transferred and understood, frequency of interaction and tone of the relationship, and value judgements about quality or satisfaction. We found that interphysician collaboration increased clinical outcomes as well as patient and staff satisfaction, while error rates and length of stay were reduced. The results should, however, be interpreted with caution, as most of the studies provide a low level of evidence.Keywords: systematic review, interphysician, collaboration, Physician, medical specialist, hospital
... When incivility is not addressed it contributes to emotional exhaustion and burnout amongst healthcare professionals [17,18]. A systematic review by Zhu and colleagues [5] found that incivility in nursing education was linked to loss of self-esteem, self-confidence and symptoms of stress and anxiety which relates closely to findings within this study. ...
... High workload and working in high pressure environment have been identified as triggers for incivility [2,6]. Bradley and colleagues [18] reported that incivility as a coping strategy for stress is counterproductive within healthcare teams. Whilst stress was posited as both a causative factor for, and an outcome of incivility, participants in this study identified that uncivil behaviour from colleagues could also in itself be a "cry for help". ...
Background
Incivility in healthcare teams is a widely recognised phenomenon. The impact of incivility is far-reaching with consequences for healthcare organisations, individuals and patient care. To date there has been little research into the effects of incivility on physiotherapists, with the extant literature focussed on nurses and physicians.
Purpose
To explore the impact of incivility on physiotherapists working in the acute hospital setting
Methods
A qualitative design using Interpretative Phenomenological Analysis was used. Semi-structured interviews were conducted with a group of physiotherapists (n=6).
Analysis
The transcripts were analysed using six-step analysis common to interpretative phenomenological analysis. Member checking was used to enhance the quality of the study.
Results
Two superordinate themes were identified. Superordinate theme one, impact of incivility on the professional self and superordinate theme two, impact of incivility on the emotional self were identified as novel.
Conclusion and Implications
The impact of incivility on physiotherapists, professionally and personally, should not be underestimated and further qualitative and quantitative research is required to identify and implement strategies which may mitigate the effects on individuals and the profession as whole.
... Attending physicians are no more immune than their junior colleagues, with one study stating 1 in 3 experience rudeness, dismissiveness, and aggressive behavior multiple times a week. Seven percent state that this behavior has led to medical mistakes [10]. ...
Background
Mistreatment of health care professionals by patients is an ongoing problem. We aimed to construct and evaluate a curriculum that would prepare health care professionals for mistreatment by patients.
Methods
Lessons learned from 15 interviews and 2 focus groups with health care professionals were distilled into a multi-modal curriculum including didactics, simulation videos and role-play scenarios aimed to improve confidence in addressing mistreatment. This curriculum was disseminated at five educational workshops to health care professionals of various training groups and experience levels. Pre- and post-surveys were distributed to assess changes in participant’s perspectives on readiness to address mistreatment. The signed-rank test was implemented to compare pre- and post- data.
Results
Participants were more likely to agree post-workshop that they had the right words to say, had a plan for what to do, and were more willing to speak up when they themselves or someone else was mistreated ( p < .001). They were also more likely to agree post-workshop that there was something they could do to address patient mistreatment ( p < .001).
Conclusions
Participant familiarity and confidence in responding to patient mistreatment increased. Our curriculum may serve as a foundation for institutions seeking to equip their educators, health care professionals, and trainees with strategies for addressing this important issue.
... 1 2 In a 2015 survey of 606 doctors across three teaching hospitals in England, 31% of doctors described being subject to rude, dismissive or aggressive behaviour a few times a week or more, with junior doctors and registrars being twice as affected as consultants. 2 Similarly, in a recent systematic review, 3 high rates of bullying and undermining behaviour were found to be experienced by nurses, allied health staff, medical students and doctors worldwide. Though the high prevalence of these behaviours within the healthcare sector has been demonstrated, their impact on clinical performance and patient outcomes is less well characterised. ...
... 2 7 It also impacts mental health, which in turn affects physical health, 14 in part due to victims engaging in potentially harmful behaviour. 2 Thus, unacceptable behaviour in healthcare appears to be common and is potentially associated with a range of negative consequences for HCWs, patients, families of patients and the broader healthcare system. In this context, our primary objective was to perform a systematic review of the published evidence on the impact of exposure to unacceptable behaviour between HCWs on clinical performance. ...
... 54 The high-quality qualitative studies identified in our review demonstrate that the multiple mechanisms by which these behaviours affect HCWs are in keeping with the broader psychological literature, including heightened anxiety, 49 reduced helpfulness 50 and development of avoidance behaviours. 2 This and the mounting evidence of the psychological and physical impact of these behaviours on HCWs 22 27 provide another important motivation to address these behaviours. ...
Background
Recent studies suggest that displays of unacceptable behaviour, including bullying, discrimination and harassment, between healthcare workers (HCWs) may impair job performance, and in turn, increase the frequency of medical errors, adverse events and healthcare-related complications. The objective of this systematic review was to summarise the current evidence of the impact of unacceptable behaviour occurring between HCWs on clinical performance and patient outcomes.
Methods
We searched MEDLINE, Embase, PsycINFO and CINAHL from 1 January 1990 to 31 March 2021. The search results were screened by two independent reviewers and studies were included if they were original research that assessed the effects of unacceptable behaviour on clinical performance, quality of care, workplace productivity or patient outcomes. Risk of bias was assessed using tools relevant to the study design and the data were synthesised without meta-analysis.
Results
From the 2559 screened studies, 36 studies were included: 22 survey-based studies, 4 qualitative studies, 3 mixed-methods studies, 4 simulation-based randomised controlled trials (RCTs) and 3 other study designs. Most survey-based studies were low quality and demonstrated that HCWs perceived a relationship between unacceptable behaviour and worse clinical performance and patient outcomes. This was supported by a smaller number of higher quality retrospective studies and RCTs. Two of four RCTs produced negative results, possibly reflecting inadequate power or study design limitations. No study demonstrated any beneficial effect of unacceptable behaviour on the study outcomes.
Conclusions
Despite the mixed quality of evidence and some inconsistencies in the strengths of associations reported, the overall weight of evidence shows that unacceptable behaviour negatively affects the clinical performance of HCWs, quality of care, workplace productivity and patient outcomes. Future research should focus on the evaluation and implementation of interventions that reduce the frequency of these behaviours.
... [1][2][3] BUH amongst healthcare workers can have a detrimental effect on the mental health of the victim, the training environment, as well as cause workforce attrition and result in lower standard of patient care. [4][5][6][7] A safe training environment is paramount in medical training, 8 yet a culture of bullying is reported to be a familiar setting to people working in the surgical field. 9 Recent reports suggest that at least half of surgical trainees in the UK and abroad experience BUH. ...
... 7 The individual at the receiving end of a negative behaviour may experience anxiety and depression which can eventually lead to substance abuse, burnout and suicide ideation. 4,20,21 This in turn leads to absenteeism and long-term sickness, putting further pressure on an already strained service. 22 A culture of BUH affects teamwork, where not only the victim but also witnesses are reluctant to speak up even when patient care is compromised. ...
Background: Bullying, undermining and harassment (BUH) behaviours are present amongst healthcare workers and have detrimental effects on the victim’s well-being and adversely affect patient outcomes. Although it is known that these problems are prevalent within surgery, there are few data on the extent of the issue amongst UK vascular trainees specifically. Methods: The Rouleaux Club (RC), representing UK vascular trainees, has conducted two surveys which were distributed amongst 137 members of the RC between May and July 2017 and 831 between March and April 2021. Data were collected on demographics and personal experiences of BUH behaviours as well as those witnessed by trainees. Comparisons were made between the responses of each survey. Results: The 2017 survey yielded 71 responses and the 2021 survey resulted in 86 responses, with estimated response rates of 51.8% and 10.3%, respectively. In 2017, 33 (47.1%) respondents reported personally experiencing BUH compared with 57 (72.2%) in 2021 (p=0.002). In 2017, seven (20%) reported witnessing BUH compared with 45 (57.7%) four years later. The most frequent perpetrators were vascular consultants (31 (81.6%) in 2017 and 55 (96.5%) in 2021, p= 0.020). BUH behaviours related to gender or sexual orientation increased from affecting two respondents (5%) in 2017 to 18 respondents (28.1%) in 2021 (p=0.004). Conclusions: BUH behaviours are an ongoing problem within UK vascular training. Despite recent attempts to tackle these issues, there is no evidence of improvement and a signal for possible worsening of the problem. There is a need for further research to understand this issue in more detail in order to plan long-lasting interventions that will minimise detriment to individual trainees, protect the reputation of the specialty and maintain the safety of patients and optimal delivery of care.
... 18,19 Bradley et al report that rudeness is more prevalent in certain specialties, namely radiology, general surgery, neurosurgery and cardiology. 20 Rudeness is more likely to happen when an individual is overworked or under-supported but, interestingly, not all high-intensity specialties have the same prevalence of rudeness. 20 The concept of the 'hidden curriculum' is particularly relevant in this domain, whereby entrenched tribalism and hierarchy in particular specialties may explain different departmental cultures and tolerance of this behaviour. ...
... 20 Rudeness is more likely to happen when an individual is overworked or under-supported but, interestingly, not all high-intensity specialties have the same prevalence of rudeness. 20 The concept of the 'hidden curriculum' is particularly relevant in this domain, whereby entrenched tribalism and hierarchy in particular specialties may explain different departmental cultures and tolerance of this behaviour. 21,22 It is also interesting to note that different personality types are attracted to different specialties, and a complex interplay between these factors may help us understand the inter-specialty differences in behaviour. ...
... 21,22 It is also interesting to note that different personality types are attracted to different specialties, and a complex interplay between these factors may help us understand the inter-specialty differences in behaviour. 20,21,23 We postulate that peer support encourages collaboration and support for colleagues, and the ability to understand how your behaviour influences others in the team, a key skill defined in Good medical practice. 24 Better peer support could lead to more civility, through increased insight into the emotional effects of these acts of incivility and through better staff wellbeing and coping strategies meaning better staff performance and ultimately better patient care. ...
Even before the COVID-19 pandemic, attending to the mental wellbeing of all doctors was high on the political agenda. The quality of patient care is also known to be related to doctors' wellbeing. Now, in the midst of a global pandemic, doctors are having to cope with ever more trauma and moral injury. Group-based peer support and regular reflective practice are interventions known to reduce clinician burnout and optimise wellbeing. Junior doctors are the most likely of all medical groups to be at a high risk of burnout. The NHS Staff and Learners' Mental Wellbeing Commission report advocates establishing explicit peer support mechanisms and the use of peer support as part of the first line of psychological first aid. Peer support is not addressed in the curriculum for the majority of medical specialties. We recommend that regular peer-support reflective groups are provided during protected time for all trainees.
... A small fraction (7%) state that this behavior has led to medical mistakes [9]. ...
Background
Mistreatment of medical professionals by patients is an ongoing problem. We aimed to construct and evaluate a curriculum that would prepare medical professionals for mistreatment by patients. Methods
Lessons learned from 15 interviews and 2 focus groups with medical professionals were distilled into a multi-modal curriculum including didactics, simulation videos and role-play scenarios aimed to improve confidence in addressing mistreatment. This curriculum was disseminated at five educational workshops to medical professionals of various training groups and experience levels. Pre- and post-surveys were distributed to assess changes in participant’s perspectives on readiness to address mistreatment. The signed-rank test was implemented to compare pre- and post- data. ResultsParticipants were more likely to agree post-workshop that they had the right words to say, had a plan for what to do, and were more willing to speak up when they themselves or someone else was mistreated (p < .001). They were also more likely to agree post-workshop that there was something they could do to address patient mistreatment (p < .001).Conclusions
Participant familiarity and confidence in responding to patient mistreatment increased. Our curriculum may serve as a foundation for institutions seeking to equip their educators, providers, and trainees with strategies for addressing this important issue.
