Silos, status and silence: Study examines organizational factors around incivility in medicine

With a reported rise in incivility and unprofessional behaviour in medicine, understanding organizational factors and developing systems-based solutions may help to address these issues, says a new study by Department of Medicine faculty. The study was led by Professors Reena Pattani, Shiphra Ginsburg and Sharon Straus and published in Academic Medicine on June 13.

“We sought to understand the role that healthcare organizations might play in contributing to, and mitigating, toxic behaviours in the workplace within healthcare,” said Pattani, an assistant professor in the Department of Medicine and physician at St. Michael’s Hospital.

According to the study, nearly 60% of medical trainees report experiencing harassment or discrimination over the course of their education, and more than 30% of physicians say they are exposed to rude, dismissive or aggressive behaviour on a weekly basis.

Incivility in the workplace has a correlation with negative effects on the mental health of staff, as well as with productivity, team cohesion and organizational commitment. And the impact can be serious.

“Medicine is a work environment with heightened complexity involving the care of patients with acute or life-threatening conditions, so incivility may also have consequences for patient outcomes, ” Pattani said.

The researchers interviewed a diverse group of individuals from across the Department of Medicine at the University of Toronto. All of the participants described collegial relationships with their colleagues, but they also all saw, heard of, or directly experienced uncivil behaviour.

Participants identified several organizational factors that contribute to incivility among physicians, including physician’s non-employee status in hospitals, departmental silos, poor leadership styles, a culture of silence and the existence of “power cliques.” They also suggested strategies to prevent, report and address incivility.

“The common themes that emerged included the need for the preservation of confidentiality; clearly articulated processes, defined and widely disseminated consequences with illustrative examples; as well as a rehabilitative approach for the victim and perpetrator of incivility,” said Straus, interim Physician in Chief at St. Michael’s and Division Director of Geriatric Medicine in the Department of Medicine

Existing strategies to influence behaviour in healthcare typically include feedback and awareness campaigns, which often focus on changing individual conduct rather than looking at the overall workplace culture.

“Although behaviour and individual personality may occasionally play a role, there may also be organizational factors that breed incivility, and this warrants further exploration,” said Straus.

In academic medicine, Pattani explained that trainees may have a more difficult time learning, or they may experience a loss of empathy towards patients and colleagues, as a result of burnout from working in a hostile environment.The researchers observed that burnout itself may contribute to an “incivility spiral,” suggesting that unprofessional behaviours may amplify the risk of further incivility.

They say that hospitals must work in tandem with the university to address this problem. Using this research, the department aims to develop a strategy to promote safe reporting, fair investigations and a rehabilitative approach to disciplinary actions.

Photo: Doctor by Hamza Butt via flickr