When someone is rude or aggressive to us, we soon move to anger. But in that moment before anger, we feel belittled, dismissed, and powerless. It’s not just our emotions. Our brains also react by thinking less well with a 61 per cent reduction in cognitive ability. And it changes how we think: we become more hostile and aggressive. The rudeness also impacts onlookers. Their performance decreases by 20 per cent and they experience a 50 per cent reduction in their desire to help others. When this happens in a health-care setting, it impacts patient care.

These were some of the insights Dr. Chris Turner, an emergency physician in the UK who helped start the Civility Saves Lives organization shared during a recent VPSA keynote speaker event. (Watch a recording of the event here.)

Inappropriate behaviours affect how we feel about the workplace. The 2024 VCH-wide physician wellness survey found that the over 1,000 respondents’ major pain points included the need for collegiality and connection as well as for psychological safety at work. These two concerns also affect another major issue: the health human resources crisis. The survey showed that 60 per cent of respondents had experienced disrespectful behaviour at work, with 29 per cent having experienced violence at work. Forty-three per cent experienced burnout; only 31 per cent felt professionally fulfilled.

Dr. Turner is blunt in his assessment of disrespectful behaviour. “When we permit rudeness, our patients die unnecessarily,” he said. To get positive outcomes in health care, he noted, we need to not only master skills personally, but we also need to create team mastery because the types of complex situations we work in require a team approach. We must work together towards a shared goal.

“If we want to know what others think, we need to ask and we need to listen,” emphasized Dr. Turner. “Psychological safety can’t be created in isolation. It’s a relationship and must be co-created. Others see things differently and there will be disagreement.”

Dr. Turner noted three responses when there is disagreement:

1. Fight to win! Winning provides a dopamine hit but winning should not be equated with doing the right thing. It’s about domination.
2. Conflict avoidance. Some people will accommodate other opinions to avoid a fight. They will not share information, which means their thoughts will not be considered.
3. Listen to understand. This requires compromise and adaptation. It is also best when we are listening to a diverse group with varying opinions. It can be difficult but can also lead to more considered decisions.

When we feel valued and respected, we are more willing to share information and knowledge. Good leaders and team members turn on the tap of information. Wise leaders, said Dr. Turner, ask questions when they don’t know the answers and they ask a diverse audience. They use the information they gather to get to the best answer. This enables individuals to perform at their peak and leads to the best outcomes for patients, staff, and the organization.

Dr. Turner was joined for the session by Dr. Yann Brierley, a pathologist at Vernon Jubilee Hospital who is also the leader of the Civility Matters project. He was inspired to do this work after noticing that many of his colleagues dread coming to work because of the microaggressions and hostility they experience there. He was motivated to take action after watching Dr. Turner’s TEDTalk.

The project, which has received funding from Doctors of BC through Facility Engagement, Physician Quality Improvement, Health System Redesign, and Interior Health NAVIG8 program, aims to cultivate an environment where everyone feels valued, heard, and respected. This is achieved by highlighting the real impact of rudeness, demonstrating team benefits, and providing free toolkits.

Survey results indicate the project has had a positive impact wherever it has been implemented. Participants speak to the value of everyone doing the training together and now speaking a common language. Dr. Brierley emphasized that staff motivation is key and to insist that the status quo where disrespectful behaviour is accepted is no longer tolerated. It needs explicit and unwavering support at both the medical and operations levels. Change is slow and difficult, he said, but worthwhile.

Post-event survey feedback

Twenty-eight of the approximately 90 medical staff who attended the session completed the post-event survey. The responses included:

• 93% agreed/strongly agreed that the session helped them recognize the nuances and complexity of respectful behaviours in professional interactions.
• 100% agreed/strongly agreed that after this session they understand how respectful behaviours influence team performance in health-care settings.
• 93% said they can identify examples of how respectful or disrespectful behaviour impact collaboration and patient care (7% were unsure).

Comments about the session included:

• Turner’s presentation was amazing and captivating. I really appreciated his perspective, the analogies, and the stories he shared.
• The focus highlighted obvious examples of disrespectful behaviour. It would be good to also have a focus on the more subtle everyday moments between staff that undermine relationships and trust but equally impact on patient care and staff well-being.
• This is a much welcomed subject and much needed awareness at the workplace…. I certainly would like to try and listen to understand the other party in a conflict. Thank you for bringing attention to these resources.
• This is a deeply important topic affecting everyone in health care—providers and patients alike.
• I loved and appreciated the content, but I loved how it was delivered with a great sense of humour and a touch of personal connectedness.
• I hope that leadership continues to support this kind of education and work to foster respectful behaviour (and by association, high performing teams) in health care.
• Good session, but I would have liked to have heard more about systemic failures, rather than focus almost entirely on individual behaviour. Workplace culture has to change not only from the bottom up but also from top down.

VPSA now has thresholds that it is trying to exceed at its events. The association is aiming for diversity of attendance—over 60 per cent of departments/divisions representing greater than half our membership were represented at this speaking event. We aim for a net promoter score of greater than 50 per cent for speakers (this event achieved a 67 per cent net promoter score). We also have set a target that more than 75 per cent of survey respondents agree that the session met its objects… this event enjoyed 98 per cent agreement.