Advancing Workplace Civility: a systematic review and meta-analysis of definitions, measurements, and associated factors

This research article focuses on the significance of Workplace Civility, defined as the respectful and courteous behavior exhibited by individuals toward their colleagues in the workplace. The primary objective of this study is to conduct a systematic review and a meta-analysis that synthesizes existing research by: (1) identifying operational definitions of the construct, (2) underlying the strongest correlations with other variables, (3) summarizing the effective strategies for promoting Workplace Civility, and (4) highlighting gaps in the literature, using the theory-characteristics-context-methodology (TCCM) framework. Multiple databases were meticulously searched, yielding 691 results, and ultimately 51 documents were included in the systematic review final sample following the application of predefined exclusion criteria. Then, a meta-analysis has been conducted including those studies with sufficient statistical data (k = 24) which allowed us to calculate 45 Effect Sizes. The review findings expose a notable dearth of research on Workplace Civility when compared to studies on incivility. This dearth highlights the pressing need for additional research endeavors to precisely define Workplace Civility, establish a robust theoretical framework, and develop reliable scales for its measurement. Related to the desirable correlates, organizational commitment, job satisfaction and mental health showed a high ES value, and for undesirable correlates, intention to quit showed a high ES value, while Emotional exhaustion only reached a medium ES value and physical symptoms showed a low ES value. Importantly, this study emphasizes that fostering civility in the workplace can yield significant benefits such as improved physical and mental well-being for workers, reduced burnout, and absenteeism rates. Thus, the promotion of civility in the workplace not only leads to healthier organizations but also enhances cost-efficiency, effectively averting the loss of both human and economic capital.

The Michigan Action Progress System (MAPS): Enhancing a Culture of Professionalism, Accountability, and Psychological Safety

OBJECTIVE

To prioritize trainee well-being, promote professionalism, and allow individuals to raise concerns without fear of retribution, one surgical department created an innovative process by which individuals can raise concerns and obtain subsequent support.

DESIGN AND SETTING

The University of Michigan Department of Surgery implemented the Michigan Action Progress System (MAPS) in February 2021.

PARTICIPANTS

General Surgery residents, faculty, and staff voluntarily participate in MAPS.

RESULTS

Since implementation, there have been 26 entries into MAPS. Petitioners included students (10, 38%), residents and fellows (7, 27%), staff (1, 4%), faculty (1, 4%), and anonymous petitioners (7, 27%). Concerns regarding racism (1, 4%), bullying (11, 52%), gender discrimination (1, 4%), and other incidents (8, 38%) were addressed though MAPS.

CONCLUSIONS

We have successfully implemented an innovative system that focuses on the needs of the user, consolidates handling of concerns, and emphasizes transparency, documentation, education, and improvement to promote a culture of professionalism and accountability.

Bioethics, Ukraine, and the Peril of Silence

By considering the history of bioethics and international humanitarian law, Joseph J. Fins contends that bioethics as an academic and moral community should stand in solidarity with Ukraine as it defends freedom and civility.

Nurse leadership in promoting and supporting civility in health care settings: A scoping review

AIM

This scoping review aimed to identify the existing evidence on how nurse leaders promote and maintain civility amongst nurses in health care settings.

BACKGROUND

Research on managing workplace incivility in nursing, a prevalent and concerning issue worldwide, recommends nurse leaders to command cultural change through strong leadership and civility interventions. However, there is very little empirical evidence summarizing and analysing how nurse leaders pragmatically achieve civility, and combat workplace incivility, in the health care setting.

EVALUATION

A scoping review was undertaken using the electronic databases CINAHL, Emerald Insight, MEDLINE, PsychINFO, PubMed and Scopus. Google Scholar was used to search for grey literature.

KEY ISSUES

The eight studies included in this review describe how nurse leaders promote and maintain civility under four key themes: (1) creating a shared vision, (2) educating self and others, (3) fostering accountability and (4) providing support.

CONCLUSION

The review provides an overview of commonly used strategies and actions that pragmatically promote and maintain civility in the health care setting by nurse leaders, while also highlighting areas of future research needed to strengthen the evidence base.

IMPLICATIONS FOR NURSING MANAGEMENT

It is important for nurse leaders to gain an understanding of evidence-based practices when addressing workplace incivility in order to address this prevailing problem for the future and safety of nurses moving forward.

Exposure to incivility does not hinder speaking up: a randomised controlled high-fidelity simulation-based study

BACKGROUND

Speaking up with concerns is critical for patient safety. We studied whether witnessing a civil (i.e. polite, respectful) response to speaking up would increase the occurrence of further speaking up by hospital staff members as compared with witnessing a pseudo-civil (i.e. vague and slightly dismissive) or rude response.

METHODS

In this RCT in a single, large academic teaching hospital, a single simulated basic life support scenario was designed to elicit standardised opportunities to speak up. Participants in teams of two or three were randomly assigned to one of three experimental conditions in which the degree of civility in reacting to speaking up was manipulated by an embedded simulated person. Speaking up behaviour was assessed by behaviour coding of the video recordings of the team interactions by applying 10 codes using The Observer XT 14.1. Data were analysed using multilevel modelling.

RESULTS

The sample included 125 interprofessional hospital staff members (82 [66%] women, 43 [34%] men). Participants were more likely to speak up when they felt psychologically safe (γ=0.47; standard error [se]=0.19; 95% confidence interval [CI], 0.09-0.85; P=0.017). Participants were more likely to speak up in the rude condition than in the other conditions (γ=0.28; se=0.12; 95% CI, 0.05-0.52; P=0.019). Across conditions, participants spoke up most frequently by structuring inquiry (n=289, 31.52%), proactive (n=240, 26.17%), and reactive (n=148, 16.14%) instruction statements, and gestures (n=139, 15.16%).

CONCLUSION

Our study challenges current assumptions about the interplay of civility and speaking up behaviour in healthcare.

Gender Differences in the Relationship Between Workplace Civility and Burnout Among VA Primary Care Providers

BACKGROUND

Civility, or politeness, is an important part of the healthcare workplace, and its absence can lead to healthcare provider and staff burnout. Lack of civility is well-documented among mostly female nurses, but is not well-described among the gender-mixed primary care provider (PCP) workforce. Understanding civility and its relationship to burnout among male and female PCPs could help lead to tailored interventions to improve civility and reduce burnout in primary care.

OBJECTIVE

To analyze gender differences in civility, burnout, and the relationship between civility and burnout among male and female PCPs.

DESIGN

Multi-level logistic regression analysis of a cross-sectional national survey.

PARTICIPANTS

A total of 3216 PCP respondents (1946 women and 1270 men) in 135 medical centers from a 2019 national Veterans Health Administration (VA) survey.

MAIN MEASURES

Outcomes: burnout; predictors: workplace civility and gender; controls: race, ethnicity, VA tenure, and supervisory status.

KEY RESULTS

Workplace civility was rated higher (p<0.001) among male (mean = 4.07, standard deviation [SD] = 0.36, range 1-5) compared to female (mean = 3.88, SD = 0.33) PCPs. Almost half of the sample reported burnout (47.6%), but this difference was not significant (p = 0.73) between the genders. Higher workplace civility was significantly related to lower burnout among female PCPs (odds ratio [OR] = 0.46, 95% confidence interval [CI] = 0.31 to 0.69), but not among male PCPs (OR = 0.71, 95% CI = 0.42 to 1.22). Interactions between civility and other demographic variables (race, ethnicity, VA tenure, or supervisory status) were not significantly related to burnout.

CONCLUSION

Female PCPs report lower workplace civility than male PCPs. An inverse relationship between civility and burnout is present for women but not men. More research is needed on this phenomenon. Interventions tailored to gender- and primary care-specific needs should be employed to increase civility and reduce burnout among PCPs.

Arts and Humanities to Teach Civility in Health Professions

Incivility is defined as rude or disruptive behavior which may result in psychological or physiological distress for the people involved. These behaviors, which appear to be more pervasive than ever in today's society, both in academia and in the health-care system, negatively affect professionals' well-being and the workplace environment. Nurses have an obligation to practice with compassion and respect, and to develop creative solutions for addressing incivility. Education about incivility should begin in prelicensure programs for all health professions, so that students understand the behavior expected of them as professionals. When health-care professionals embody the ideals of respect and civility, they set an example for others to follow. The arts and humanities can be used as a pedagogical tool to provide innovative learning opportunities to teach these values through the affective domain of learning. This article discusses one of the creative avenues for facilitating such opportunity, the use of the arts and humanities to teach civility in health professions education.

The Effects of the Civility, Respect, and Engagement in the Workplace (CREW) Program on Social Climate and Work Engagement in a Psychiatric Ward in Japan: A Pilot Study

Background: Good social climate and high work engagement are important factors affecting outcomes in healthcare settings. This study observed the effects of a program called Civility, Respect, and Engagement in the Workplace (CREW) on social climate and staff work engagement in a psychiatric ward of a Japanese hospital. Methods: The program comprised 18 sessions installed over six months, with each session lasting 30-min. Participation in the program was recommended to all staff members at the ward, including nurses, medical doctors, and others, but it was not mandatory. A serial cross-sectional study collected data at four time-points. Nurses (n = 17 to 22), medical doctors (n = 9 to 13), and others (n = 6 to 10) participated in each survey. The analysis of variance was used to evaluate the changes in the following dependent variables, the Essen climate evaluation schema (EssenCES), the CREW civility scale, and the Utrecht work engagement scale (UWES) over time. Result: We found no significant effects. The effect size (Cohen’s d) for EssenCES was 0.35 from baseline to post-installation for all staff members. Effect sizes for EssenCES for medical doctors and UWES for nurses were 0.79 and 0.56, respectively, from baseline to post-program. Conclusions: Differences in social climate and work engagement among Japanese healthcare workers between the baseline and post-installation of the CREW program were non-significant.

Effect of nurses' perception to workplace civility climate on nurse-physician collaboration

AIMS

To assess the effect of nurses' perception to workplace civility climate on nurse-physician collaboration and determine whether the largest contributor to changing the climate of the workplace are the employees or top management.

DESIGN

This study used non-experimental descriptive cross-sectional study design, which using purposive sample (139 nurses) working at Health Insurance Hospital.

METHOD

The current study data were collected by using self-administered questionnaires including three tools: (a) a structured interview questionnaire includes personal data; (b) perceived workplace civility climate scale (15 items); and (c) Nurse Physician Collaboration Scale (27 items).

RESULTS

Main result of this study reveals that there was a positive statistically significant correlation between workplace civility climate and collaboration (0.208* ). Studied nurses were perceived top management with the high score (87.5) than employees (65.2).

CONCLUSION

Workplace civility climate was demanded for well collaboration between nurses and physicians to provide high-quality services; when nurses and physicians have increase chance to work in civility climate, combining with response to incivility and low intolerance for it, they will be more collaborated.

RECOMMENDATION

Policies and procedures are very important in healthcare settings to address uncivil actions and establish a civilized climate.

Role of Family Motivation, Workplace Civility and Self-Efficacy in Developing Affective Commitment and Organizational Citizenship Behavior

The mechanism connecting the antecedents to positive attitudes like affective commitment (AC) and positive behaviors like organizational citizenship behavior (OCB) is an under-researched area in the field of positive organizational scholarship. Drawing on Social Exchange Theory (SET), this study empirically validates family motivation and civility as antecedents of affective commitment and organizational citizenship behavior through the mediating mechanism of self-efficacy. The process by Hayes (2013) was used to analyze time-lagged and multi-source data collected from 335 employees of educational and telecom sector. Results indicate that the relationship of affective commitment with family motivation and civility is partially mediated whereas the relationship of organizational citizenship behavior with family motivation and civility is fully mediated by self-efficacy. This study adds to the literature of family-work enrichment accounts by validating family motivation as a novel antecedent for positive behavioral outcomes. The implications of the study are discussed.

Promoting Civility in the OR: An Ethical Imperative

Recognizing, addressing, and preventing incivility in the health care environment, including the perioperative area, requires an intentional and informed approach to foster healthy workplaces and protect patient safety. Several important foundational documents and position statements speak directly to the nurse's responsibility to protect patient, coworker, and personal safety and promote civility and respect. In the complex, fast-paced environment of the OR, the pressure to meet patient needs, performance outcomes, and patient safety standards can lead to conflict and incivility. In this article, we present a case-based scenario to illustrate a multilevel evidence-based response to an uncivil encounter that could negatively affect patient safety in the OR. After the scenario, we discuss the responses to the encounter from the organization, the nurse manager, and the individual nurse. When nurses speak up and resolve issues, they report better patient outcomes, greater satisfaction in the workplace, and heightened organizational commitment.

Can Civility Norms Boost Positive Effects of Management Commitment to Safety?

We proposed that civility norms would strengthen relationships between management commitment to safety and workers' safety motivation, safety behaviors, and injuries. Survey data were obtained from working adults in hazardous jobs-those for which physical labor is required and/or a realistic possibility of physical injury is present (N = 290). Results showed that management commitment positively related to workers' safety motivation, safety participation, and safety compliance, and negatively related to minor injuries. Furthermore, management commitment to safety displayed a stronger positive relationship with safety motivation and safety participation, and a stronger negative relationship with minor worker injuries when civility norms were high (versus low). The results confirm existing known relationships between management commitment to safety and worker safety motivation and behavior; furthermore, civility norms facilitate the relationships between management commitment to safety and various outcomes important to worker safety. In order to promote an optimally safe working environment, managers should demonstrate a commitment to worker safety and promote positive norms for interpersonal treatment between workers in their units.

Pharmacy students' opinions on civility and preferences regarding professors

OBJECTIVES

To determine the types of classroom behavior that pharmacy students consider uncivil, participation in such behaviors, what type of professor and classroom setting they prefer, and changes in these opinions over time.

METHODS

A survey instrument was used to collect data about students' feelings concerning incivility, participation in uncivil behaviors, and preferences concerning classroom experience. Demographic data were used to identify characteristics of student populations and ensure the same students were studied over different time periods.

RESULTS

Younger students felt cheating was the most uncivil classroom behavior while older students most disliked cell phone/beeper use. Chewing gum was least offensive for all groups. Students desired that teachers cared about their learning experience, but few would phone a professor at home.

CONCLUSIONS

Differences in views concerning civility were found among pharmacy students in their first, third, and fourth years, which may indicate that students' beliefs, actions, and preferences change as they progress through the curriculum.