Hospitals in Victoria are trialling a new workplace civility program designed to address job burnout and improve outcomes for patients.

Saying good morning to a colleague can make the workplace a happier place, but can it also make it a safer one? Absolutely, according to Michael Leiter, a global expert on workplace civility and job burnout. He’s designed a world-first “civility intervention” for a large Victorian hospital network. So far, the results are extremely promising.

“Uncivil workgroups lose their mission focus,” says Leiter, a Canadian professor of organisational psychology now based at Deakin University. “Bad work relationships make you exhausted, cynical and disengaged. There’s a very solid link between unpleasant interactions and feeling burnt out.”

For Suellen Bruce, director of people, culture and communication at Western Health, the trigger for enlisting Leiter’s help was high absenteeism – a challenge for many health services. While the industry target is 4.1 per cent, Western Health, which runs three major public hospitals in Melbourne’s fast-growing and culturally diverse western suburbs, sits at around 4.6 per cent. That means greater use of agency and casual staff and a daily scramble to fill roles in a busy, 24/7 service environment.

Catalyst for change

Western Health had already launched a positive workplace strategy, called ‘Don’t Walk Past’, after a scathing 2015 Victorian auditor-general’s report on the health sector’s poor management of bullying and harassment.

“It was a wake-up call for all of us,” says Bruce. “To not just deal with issues on a case by case basis but to look at root causes. We all needed to lift our game because there were significant OH&S issues for staff and major concerns about the effect on patient outcomes.”

That strategy, combined with a range of educational initiatives on each person’s responsibility to manage themselves and speak out against inappropriate workplace behaviour, and annual surveys of Western Health’s 6500 staff, had generated improvements. “But we hadn’t really tackled the whole team approach,” says Bruce.

Holistic HR

Thinking broadly about the issue is crucial, says Leiter. His research on Canadian health providers showed that each hospital had units where people were not getting on. They had tried replacing the leaders and transferring out the troublemakers, but some units remained unpleasant places for people to work.

Much of this had to do with what Leiter calls incivility – usually in face-to-face interactions. Not saying good morning, excluding people, gossiping, undermining others, not showing appreciation and just general rudeness are all examples. The environment became toxic as incivility was reciprocated and effort and motivation decreased.

Typically, this type of behaviour bubbles along until there’s an explosion. Leiter cites one Canadian example where a persistently rude senior nurse told a junior nurse, “Make sure you don’t screw it up this time.” The junior grabbed her by the shoulders and screamed, “Stop it!”

HR was forced to intervene.

Incivility is not just about staff complaints, attrition, burnout and absenteeism, however. In a hospital environment, workplace incivility can also have a negative effect on patients. “Healthcare is all about teamwork,” says Leiter. “A patient’s treatment is constant across various disciplines.”

If, for example, a nurse feels too intimidated to bother a medical specialist, vital information may be lost. “Anything that interrupts the smooth flow of accurate, in-depth information will harm patients,” says Leiter. “People’s lives depend on it.”

A civil undertaking

To get the ball rolling at Western Health Bruce and her organisational development manager, Anne Wright, pitched the civility intervention proposal to 10 of the organisation’s most senior leaders and as a result, five workgroups agreed to be part of the trial. Bruce asked them all to complete a baseline survey that measured respect and engagement in their group, which generated a 60 per cent response rate. The two groups with the highest response rate were selected as the first wave. One was an outpatient clinic with 16 staff, and the other was a hospital ward of 50 people.

Each group nominated a co-facilitator to work with lead facilitator Jo Wintle from organisational development consultancy PeopleScape. In each case, the co-facilitator was a middle manager trusted by their team who had strong interpersonal skills. Wintle ran a half-day workshop to train them, both for the program and to maintain the civility focus once the program had finished. A series of workshops and surveys are scheduled to continue throughout 2018.

While the final data on the effectiveness of the intervention will not be available until next year, when Leiter publishes his research, Bruce says the signs so far are promising. Attendance at the first three (non-compulsory) sessions exceeded 90 per cent, including people coming in on their days off. “We certainly didn’t expect that,” says Bruce.

Wintle says the sessions provide a “psychologically safe place” to have difficult, confidential conversations about day-to-day interactions and increase awareness of civility. “People get quite emotional; this is what life looks like for them,” she says of people who have been affected by rudeness. “You’re not going to be best friends with everyone at work, but you do need to treat each other with respect.”

If that sounds a lot like common courtesy or good old-fashioned manners, Bruce and Leiter agree – to a point. “It shouldn’t be that hard,” says Bruce. “But when people are extremely busy the time available to communicate well and be polite shrinks.”

Peacemaking

Leiter also says that in a multi-cultural, multi-generational environment, you can’t assume everyone has the same idea of what constitutes good manners. And workplace incivility is not necessarily deliberate. “A lot of rudeness is unintentional, clueless or inconsiderate,” he says. “It takes a degree of intelligence and generosity to see things from another’s perspective and anticipate the effect of your actions on others.” Examples of behaviour that many wouldn’t think twice about include talking over the top of colleagues or having loud discussions in the corridor outside someone’s office.

He also says that a civility intervention is not just about stamping out bad behaviour. “A significant number of the workgroups are not interacting in either a positive or negative way. But this middle ground is not effective as they’re not fully engaged – they’re missing out on the positives. You need to actively encourage positive encounters, not just stamp out negative behaviour to get maximum performance improvement.”

Leiter’s research shows that overall, engagement is higher in civil workgroups and work quality is better in a team that feels like it is a community.

“Being able to interact positively with other people is a fundamental occupational requirement in most jobs, but particularly in healthcare. So you can’t just send one or two people off for training: it’s really about the whole group and people wanting to be valued as a member of that group.”

This article was originally published in the September 2018 edition of HRM magazine.