Workplace incivility in Healthcare: The Role of Management

Julius Mutagubya

Independent Consulting Laboratory Technologist

DMLT, BLT, MBA

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Introduction and Key Definitions 1

• Incivility refers to rude, disrespectful, or impolite behavior or speech that violates social norms of politeness and courtesy. It can manifest in various forms, such as offensive language, personal attacks, rudeness, or disrespectful gestures.

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• Workplace incivility is defined as “low-intensity, deviant behavior with ambiguous intent to harm the target, in violation of workplace norms for mutual respect. Uncivil behaviors are characteristically rude and discourteous, displaying a lack of regard for others” (Andersson & Pearson, 1999).

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• Workplace incivility occurs 10 times more common than workplace violence in health care settings.

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• Ninety-five percent of the total workforce faces some form of workplace bullying or uncivil acts�

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�Introduction and Key Definitions 2�

Examples of Workplace Incivility

• Mobbing - defined as intentional verbal or nonverbal conduct by one or more individuals against another individual over a period of time that continuously and systematically intimidates, shows hostility, threatens, offends, humiliates, or insults a coworker; interferes with a coworker’s performance; or has an adverse impact on a coworker’s mental or physical wellbeing.
• Workplace bullying is defined as “repeated, unreasonable actions of individuals (or a group) directed towards an employee (or group of employees), which is intended to intimidate and creates a risk to the health and safety of the employee(s)”

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Poll question

• Have you ever experienced incivility at your workplace in the past 1 year?

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• A) Yes B) No C) I don’t know

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Source of Workplace Incivility

• from patients,
• direct supervisors,
• physicians,
• coworkers,
• and the general environment�

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Forms of workplace incivility

• Experienced workplace incivility

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• Instigated workplace incivility

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• Employees being victims of experienced workplace incivility (EWI) may feel stress due to an unhealthy work environment and may ultimately respond with instigated workplace (IWI).��

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Relationship between incivility and productivity

• Increased absenteeism (secondary to illness and depression),
• Decreased organizational commitment (staff engagement )
• Decreased productivity while at work,
• Incivility toward other employees and customers (hurting people hurt others)
• Decreased communication,
• Decreased reporting of problems,
• Separation from the organization
• Financial repercussions for the organization due to customer loss, bad reputation, low levels of creativity from employees, and high employee turnover intention

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Engagements at the health facility of the different stakeholders

Health Unit

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Health worker

Patient

Management

Other patients

Other Heath Workers

Instruments governing behaviors at health care Work place

• Human Resources manual
• Patients’ Charter
• Code of Conduct / Medical ethics
• National Laws
• By-laws
• Standing Orders
• Customer care policies

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Patient charter

• Ministry of Health is committed to initiate a process through which Patients’ Charter is put in place to ensure that the Rights of Patients are protected in the course of seeking health services.
• The objective of the patients’ charter is to empower health consumers to demand high quality health care, to promote the rights of patients and to improve the quality of life of all Ugandans
• The implementation of the Patients’ Charter will enhance community participation and empower individuals to take responsibility for their health.
• Patient Charter has three sections: patients’ rights; responsibilities of the patient and responsibilities of health workers

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Poll question

• Has your facility designated a person or a committee responsible for the observance of patient rights?

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• A) Yes B) No C) I don’t know

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SECTION 1: PATIENTS’ RIGHTS�

• The Right to Medical Care
• Prohibition of Discrimination
• Participation on decision – making
• A healthy and safe environment
• Proper Medical Care
• Right to receiving visitors
• Continuity of Care

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• Confidentiality and privacy
• The Patient’s Right to Medical Information
• Right to Redress
• Quick question
• Has your facility designated a person or a committee responsible for the observance of patient rights?

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SECTION 2: RESPONSIBILITIES OF THE PATIENT

• Provision of relevant, complete and accurate information for diagnostic, treatment rehabilitation or counseling purposes.

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• Compliance with instructions
• Refusal of treatment

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• Respect the rights of other patients and the health workers

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• Will - The patient is free to advise the health care workers on his/her wishes with regard to his/her death including dying in dignity, spiritual support

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SECTION 3: RESPONSIBILITIES OF HEALTH WORKERS

• Penalties - Any health worker who contravenes these rights may face appropriate disciplinary actions from Health Unit Management committees, Health Professional Councils, Medical Boards, and Courts of law

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• Duration of admission - The health worker shall determine each patient’s stay depending on the condition

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• Comments, Suggestions and complaints - Does your facility have a box for feedback?

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Challenges with patient charter

• Limited awareness of patients rights and responsibilities that has been lacking among the population of Uganda.
• Low community participation in the management of their health by promoting disease prevention , timely referral of patients to health facilities for immediate attention of their health problems and concerns.
• The Extent of implementation of the Patients’ Charter to enhance community participation and empower individuals to take responsibility for their health. This will promote accountability and improve the quality of health services.
• The Department of Quality Assurance of the ministry of Health has been charged with the responsibility of monitoring, supervising and evaluating the use of the patients’ charter including dissemination and regular review and revision of the charter.

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�Ethical Code of conduct�

• Code of Ethics: A document which reflects a set of guiding principles and values on the collective moral standpoint of a profession on which its practitioners rely.

Diversity / Respect / Dignity / Consent

Medical laboratory personnel shall:

• Value, respect and protect the rights, welfare, and dignity of all patients by providing patient care and service with respect for human rights, regardless of, but not limited to race, ethnicity, religion, language, sexual orientation, age and socio-economic status, mental or physical abilities at all times.
• Obtain free and informed consent from patients before undertaking any action, in accordance with relevant legislation and policies, recognizing that consent can be withdrawn at any time.
• Maintain appropriate professional boundaries with patients, colleagues, and other healthcare providers while delivering patient-centered care.

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Necessary skills for managing Work place incivility

• Good understanding of the policies in the work place
• Effective communication
• Fostering a positive work culture that aims at engaging all staff
• Conflict resolution - fostering a healthy and constructive social / work environment.
• Emotional intelligence
• Active listening – listening to understand not simply to respond
• Assertiveness – within the boundaries of one’s rights

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Resources for further reading

• Hutton, S. and Gates, D. (2008) ‘Workplace Incivility and Productivity Losses Among Direct Care Staff’, AAOHN Journal, 56(4), pp. 168–75.
• Raza, M.A. et al. (2022) ‘Impact of Experienced Workplace Incivility (EWI) on Instigated Workplace Incivility (IWI): The Mediating Role of Stress and Moderating Role of Islamic Work Ethics (IWE)’, Sustainability, 14(23), p. 16187. Available at: https://doi.org/10.3390/su142316187.
• Vasconcelos, A.F. and Link to external site, (2020) ‘Workplace incivility: a literature review’, International Journal of Workplace Health Management, 13(5), pp. 513–542. Available at: https://doi.org/10.1108/IJWHM-11-2019-0137.

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