Karen Ellison: The power of civility during a pandemic

During the pandemic it’s been more important than ever for doctors to have the support of their team. Yet incivility is a common threat to these professional relationships and, by extension, patient outcomes, writes Karen Ellison

A few years ago, I heard a talk by Chris Turner, a consultant in emergency medicine, about the power of civility in medicine and the Civility Saves Lives initiative. He explained how incivility in the workplace creates a toxic web of negative outcomes, both within individual interpersonal relationships and right up through the wider organisational culture. The talk still resonates with me daily, and it is particularly pertinent now as healthcare professionals have faced extreme and unrelenting pressure due to the covid-19 pandemic. 

In his talk, Chris Turner cited research showing how civility really does save lives. For recipients of mild to moderate rudeness there is, on average, a 61% reduction in cognitive ability and, in his words, “in the moment we make people less.” Not only that but the impact of rudeness extends to onlookers who experience a 20% reduction in performance and a 50% reduction in willingness to help.

My personal way of projecting the sentiment behind the Civility Saves Lives initiative has been to follow my three Hs: humankind, humility, and honesty. I have tried to live by these three Hs all my life. As a practising doctor in obstetrics and gynaecology from 1987 through to 2012, I found the incivility between staff incredibly frustrating, often upsetting, and occasionally outright astounding. Sadly, many medics undermine each other, backstab each other, and are frankly rude to each other. Working in this high pressured profession requires certain skills for which we train for at least five years as a medical student, followed by many years of specialist training. But who trains us to be civil? Who teaches us that incivility is an anomaly not becoming of a professional?

I left the NHS to be a medicolegal consultant with the Medical Protection Society (MPS) for various reasons, not least because I recognised an increasing number of dysfunctional interactions in several teams in the NHS—a situation that did not assist with good patient care.

Since then, I have supported many doctors over the years with complaints, reports, ethical advice, regulatory referrals, disciplinary matters, and inquests. The vast majority of the complex cases and the ones that take the longest to resolve are born out of a dysfunctional department and often feature an element of professional jealousy and rivalry. Criticising each other’s weaknesses cannot bring out the best in collaborative working. Just think how much we could improve the effectiveness of clinical teams and our own workplace satisfaction if we were able to admire our colleague’s skills and cultivate learning from them. After all, we all have our areas of excellence that should feed into gold standard patient care.

A proportion of complaints are also brought because a healthcare professional criticises a colleague in front of a patient by words or deeds—a quick eye roll suggesting “he/she did what?” is enough. These acts of incivility that take place in front of patients not only chip away at a clinician’s confidence and a healthcare team’s overall cohesion, they also damage patients’ confidence in the care they’re receiving and the health service overall.

During the pandemic, the NHS has witnessed increasingly complex clinical scenarios and there has never been a greater need for supportive teamwork. At MPS, however, we have heard of several cases where the care of patients with covid-19 has been affected by suboptimal team working, which was in turn related to communication issues between team members. More than ever, as the stakes rise in patients with this complex new disease, incivility, rudeness, and our inability to treat each other with respect can make the difference between a poor outcome and a good one. 

I’ve heard of cases where undermining behaviour has caused great stress to doctors attempting a procedure or involved in some other aspect of patient care. Increasing tension among medical staff against a backdrop of depleting resources and exponential demand on services seems to result in ever more common incivility, feeding a continuous loop of stress and burnout. 

I can think of no better reason and no better time for us all to consider the three Hs— humankind, humility, and honesty—as we interact with colleagues each day. We can—and must—all do better and this includes NHS organisations who must embed a culture of civility, embracing their freedom to speak up guardians and introducing Schwartz rounds where possible. Harnessing the power of civility in medicine allows healthcare professionals and their teams to perform at their best, optimising outcomes and ultimately saving lives. 

Karen Ellison is medicolegal consultant at the Medical Protection Society. Twitter @dr_ellison

Competing interests: The MPS provides the right to request access to expert advice and support on clinical negligence claims, complaints, GMC investigations, disciplinaries, inquests, and criminal charges such as gross negligence manslaughter. This article was not commissioned.