How can a provider leader leverage strengths and opportunities to address incivility in the workplace?

Personal Action Plan: Leveraging Strengths and Opportunities to Address Workplace Incivility as a Provider Leader

As a provider leader, you must establish yourself as a visible champion who builds a culture of safety and civility through clear accountability structures, systematic reporting mechanisms, and ongoing team training—recognizing that incivility directly threatens patient safety, staff wellbeing, and organizational effectiveness. 1, 2

Establish Leadership Accountability and Visibility

Position yourself as the accountable champion who assumes overall responsibility for creating a civil workplace culture. 1

• Make a serious, visible, and ongoing commitment to addressing incivility as a patient safety issue, not merely a human resources concern. 1
• Build alliances and coalitions across disciplines, departments, and hierarchical levels to mobilize talent and resources needed for culture change. 1
• Hold yourself publicly accountable for gaps in workplace civility through regular reporting to stakeholders, accepting both blame for failures and recognition for successes. 1

Create Systematic Reporting and Response Mechanisms

Implement a nonpunitive reporting culture where staff can confidentially report incivility without fear of retribution. 1

• Establish multiple reporting channels (confidential, anonymous, or direct) that are separate from disciplinary functions to encourage frontline staff to report incidents. 1
• Provide timely and useful feedback to those who report incivility, demonstrating that their concerns lead to concrete actions. 1
• Adopt a "just culture" framework that focuses on systems-level contributors to incivility while holding accountable those who intentionally harm or violate established civility policies. 1
• Conduct Safety WalkRounds where you directly engage frontline staff to identify "what will hurt the next patient here," closing the gap between leadership and staff perspectives on workplace safety and civility. 1

Implement Structured Training and Skill Development

Deploy multiple-session training programs that go beyond one-time implicit bias workshops, as short-term training alone is insufficient for lasting behavior change. 1

• Provide cognitive rehearsal training to equip staff with specific scripts and responses to defend against incivility when it occurs, as this approach has shown that 45% of trained nurses respond to incivility and most report improved management ability. 3
• Incorporate ongoing consultation and coaching as the key to sustained behavior change, rather than relying solely on didactic sessions. 1
• Implement team training based on crew resource management principles, teaching that communication and coordination behaviors are identifiable and teachable skills that reduce adverse events. 1
• Ensure training addresses the reality that incivility disproportionately impacts minoritized staff, incorporating antiracism and culturally congruent care into standard workforce development. 1, 2

Address Systemic and Structural Contributors

Recognize that incivility stems from systems-level factors, not just individual bad actors, and redesign work structures accordingly. 1, 2

• Evaluate and modify workload, control, rewards, community, fairness, and values—the six areas of worklife that contribute to burnout and incivility. 1
• Redesign job tasks to reduce incessant demands and provide adequate resources, as the job demands-resources model shows burnout arises from this imbalance. 1
• Improve recognition systems for both teams and individuals, as rewards provide opportunities for intrinsic satisfaction and self-efficacy. 1
• Develop more fair and equitable policies that address inequities in leadership positions, compensation, and career pathways, particularly for people of color who are often in lower-paid positions. 1

Build Psychological Safety and Trust

Foster an environment where any team member can speak up about safety and civility concerns regardless of hierarchy, seniority, or background. 1, 2

• Model "deference to expertise" where any team member can assume leadership for a given situation based on their skills and knowledge, not rank. 1
• Support "stop the line" authority where anyone can halt processes when safety or civility is compromised. 1
• Rebuild trust in management by demonstrating consistent follow-through on reported concerns and transparent communication about actions taken. 2
• Create a good community that provides social support, trust, and effective means of working out disagreements to promote better job engagement. 1

Collect, Analyze, and Report Data

Implement continuous monitoring of incivility incidents, responses, and outcomes to drive accountability and improvement. 1

• Collect data on incidence, outcomes, and key process variables related to workplace incivility and its impact on patient safety. 1
• Analyze aggregate data to identify trends, recurrent hazards, and opportunities for best practice development. 1
• Report findings publicly to all stakeholders, making annual reports of workplace culture and civility available to demonstrate transparency and accountability. 1
• Use validated tools such as the Agency for Healthcare Research and Quality safety culture surveys to identify specific gaps and monitor improvements. 1

Implement Concurrent Multi-Strategy Interventions

Deploy structured culture change interventions that combine multiple behavior change strategies simultaneously, as single interventions are insufficient. 2

• Combine training sessions with other actions such as codes of conduct, professional accountability programs, and policy changes. 2
• Address both individual and organizational levels through changing work patterns, developing coping skills, obtaining social support, redesigning tasks, and improving recognition systems. 1
• Ensure protected time and resources for institutional champions who lead civility initiatives, with clear mandates from leadership. 1

Common Pitfalls to Avoid

• Do not rely solely on one-time training sessions, as evidence shows short-term implicit bias training is insufficient for lasting workplace climate change. 1
• Do not focus exclusively on individual behavior while ignoring systemic contributors like workload, inadequate resources, and inequitable policies. 1, 2
• Do not implement reporting systems without ensuring nonpunitive responses and timely feedback, as this discourages future reporting. 1
• Do not ignore the disproportionate burden of incivility on minoritized staff, as this perpetuates structural inequities. 1, 2
• Do not separate incivility from patient safety initiatives, as workplace incivility directly impacts patient outcomes through disrupted teamwork and increased errors. 1, 2, 4