Predictors and triggers of incivility within healthcare teams: a systematic review of the literature

Abstract

ObjectivesTo explore predictors and triggers of incivility in medical teams, defined as behaviours that violate norms of respect but whose intent to harm is ambiguous.DesignSystematic literature review of quantitative and qualitative empirical studies.Data sourcesDatabase searches according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline in Medline, CINHAL, PsychInfo, Web of Science and Embase up to January 2020.Eligibility criteriaOriginal empirical quantitative and qualitative studies focusing on predictors and triggers of incivilities in hospital healthcare teams, excluding psychiatric care.Data extraction and synthesisOf the 1397 publications screened, 53 were included (44 quantitative and 9 qualitative studies); publication date ranged from 2002 to January 2020.ResultsBased on the Medical Education Research Study Quality Instrument (MERSQI) scores, the quality of the quantitative studies were relatively low overall (mean MERSQI score of 9.93), but quality of studies increased with publication year (r=0.52; p<0.001). Initiators of incivility were consistently described as having a difficult personality, yet few studies investigated their other characteristics and motivations. Results were mostly inconsistent regarding individual characteristics of targets of incivilities (eg, age, gender, ethnicity), but less experienced healthcare professionals were more exposed to incivility. In most studies, participants reported experiencing incivilities mainly within their own professional discipline (eg, nurse to nurse) rather than across disciplines (eg, physician to nurse). Evidence of specific medical specialties particularly affected by incivility was poor, with surgery as one of the most cited uncivil specialties. Finally, situational and cultural predictors of higher incivility levels included high workload, communication or coordination issues, patient safety concerns, lack of support and poor leadership.ConclusionsAlthough a wide range of predictors and triggers of incivilities are reported in the literature, identifying characteristics of initiators and the targets of incivilities yielded inconsistent results. The use of diverse and high-quality methods is needed to explore the dynamic nature of situational and cultural triggers of incivility.

Prevalence of incivility between ophthalmology and emergency medicine residents during interdepartmental consultations

“…29 Additionally, it has been theorized that that when faced with unchecked incivility in the workplace, they are more likely to withdraw from work and work‐related tasks, a behavior not seen as often in males. 30 The disproportionate exposure of females to incivility, 10 in frequency (as was the case in this study) or along with other concomitant discrimination, may play a role in the sex‐based differences seen in response to incivility. The discrepancies identified in our study warrant further scrutiny to help ensure a positive environment for all trainees, regardless of sex.…”

“…Of the eight studies focused on physicians, only three included trainees and none were focused on trainee–trainee interactions. 10 Our study sought to examine incivility between resident physicians in EM and ophthalmology. While EM physicians are represented to a small extent in the literature, to our knowledge, there are no studies looking at incivility among ophthalmology physicians or trainees in particular.…”

“…Studies have explored incivility in the general workplace, 1 in the field of nursing, 8 , 9 and in the emergency department (ED); 5 however, little is known about the prevalence of incivilities between physicians and, in particular, among physicians‐in‐training. 10 As a unique population in the health care setting, physicians‐in‐training (also known as resident physicians) play a significant role in direct patient care across a variety of practice settings. While nurses and students have been identified as at high risk for disrespectful treatment, 6 residents are also a vulnerable population given their low position in the medical hierarchy.…”

The Influence of Co-Worker Incivility Towards Deviant Behaviour: a Quantitative Study of Casual Dining Restaurants Frontline Employees in the Klang Valley, Malaysia

“…Past study conducted by Smith and Morin, (2018) also indicated incivility received from work environment leads employee to engage in antisocial attitude that comes with financial obligation for the company. Thus, co-worker incivility is considered as one of the important triggering factors that promotes employees' negative attitude (Keller & Yule, 2020). This research provide and evidence that Coworker incivility is prevailing in casual dining restaurants and there is lack of tanning facilities for front line employees.…”

Witnessed Incivility and Perceptions of Patients and Visitors in Hospitals

“…Rather, patients/visitors are commonly discussed in an indirect way. Many studies have discussed how incivility among health care providers may have downstream consequences on patient safety and health outcomes ( 17 , 18 ). Other studies have documented incivility and other forms of mistreatment toward patients, but through the lens of health care providers ( 19 – 21 ).…”