Incivility, Work Withdrawal, and Organizational Commitment Among US Surgeons

Abstract

Objective: To evaluate the prevalence of incivility among trainees and faculty in cardiothoracic surgery, general surgery, plastic surgery, and vascular surgery in the U.S, and to determine the association of incivility on job and work withdrawal and organizational commitment. Background: Workplace incivility has not been described in surgery and can negatively impact the well-being of individuals, teams, and organizations at-large. Methods: Using a cross-sectional, web-based survey study of trainees and faculty across 16 academic institutions in the U.S., we evaluated the prevalence of incivility and its association with work withdrawal and organizational commitment. Results: There were 486 (18.3%) partial responses, and 367 (13.8%) complete responses from surgeons [including 183 (56.1%) faculty and 143 (43.9%) residents or fellows]. Of all respondents, 92.2% reported experiencing at least 1 form of incivility over the past year. Females reported significantly more incivility than males (2.4 ± 0.91 versus 2.05 ± 0.91, P < 0.001). Asian Americans reported more incivility than individuals of other races and ethnicities (2.43 ± 0.93, P = 0.003). After controlling for sex, position, race, and specialty, incivility was strongly associated with work withdrawal (β = 0.504, 95% CI: 0.341–0.666). There was a significant interaction between incivility and organizational commitment, such that highly committed individuals had an even greater impact of incivility on the outcome of job and work withdrawal (β = 0.178, 95% CI: 0.153–0.203). Conclusions: Incivility is widespread in academic surgery and is strongly associated with work withdrawal. Leaders must invest in strategies to eliminate incivility to ensure the well-being of all individuals, teams, and organizations at-large.

Eyes on incivility in surgical teams: Teamwork, well-being, and an intervention

“…In this study, reports of incivility were in line with those reported in other institutions worldwide [3][4][5][6][7]. While the absolute frequency may appear small (i.e., incivility events were observed or experienced a few times a week on average per person), efforts to reduce incivility are warranted given the growing evidence that incivility has the potential to impede team coordination and impact safety and patient outcomes.…”

“…Incivility can have significant costs to the well-being of staff and ultimately to patients, as well as having a negative impact on the overall culture, work performance, absenteeism and turnover, and commitment to the organization [ 5 ]. While research is beginning to address detrimental impacts of incivility, there is a paucity of work explicating mechanisms through which incivility can impact well-being outcomes.…”

“…Incivility tends to be more pronounced in the surgical area [ 6 ]. For example, 53% of operating staff (nurses, surgeons, anesthetists, technicians) reported they had been subject to uncivil behavior in theater [ 7 ] and recently 92% of surgeons, surgical residents, or surgical fellows reported experiencing at least one form of incivility in the past year [ 5 ]. In a study across seven countries, nearly all respondents reported being exposed to incivility or disruptive behavior in the past year, experiencing an average of 61 incivility incidents per year [ 3 ].…”

“…These small acts of rudeness that violate basic standards of respect can have large impacts on well-being, particularly when they accumulate over time [2]. Incivility in healthcare is prevalent with the majority of healthcare workers (HCWs) reporting having experienced incivility events [3][4][5]. Incivility tends to be more pronounced in the surgical area [6].…”

“…Incivility can have very detrimental consequences on effectiveness, performance, patient outcomes, and employee well-being [1,8,9]. In healthcare, incivility impacts compliance with infection control and medication protocols [10], operating performance [11,12], staff well-being [13], and job attitudes [5]. Additional research is needed to understand why incivility has these consequences and mechanisms to reduce its impact.…”