Civility and Respect Bulletin

Civility and Respect: How We Can Be at Our Best During the Pandemic and Beyond

Release Date: April 23, 2020

Content Attribution

Well Doc Alberta has reviewed, synthesized, adapted, and

added to information from the following sources.

Please consult these sources if you want more information.

Bulletin development:

Jennifer Williams MD, Physician Associate, Well Doc Alberta

Jennifer Bailey MD, Physician Associate, Gastroenterology Wellness Committee

Alicia Polachek MA, Director, Well Doc Alberta

Bulletin review:

Jane Lemaire MD, Director, Well Doc Alberta

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What are Civility and Respect?

Civility is a professional competency that refers to working together to achieve a mutual goal, often with a benevolent purpose. Civility is culturally informed and thus may manifest differently across cultures.

Respect is based on illustrating care and compassion for others and acknowledging their dignity.

Owed respect refers to inherent value and right to dignity. Everyone should be given this respect. A deficiency of owed respect leads to a toxic environment, lack of joy and fulfillment, and burnout.
Earned respect refers to being valued for a job well done. A deficiency of earned respect is associated with decreased motivation, accountability, and productivity.

Civility, respect, and physician wellness are intertwined. Incivility is a symptom of burnout and burnout is a consequence of toxic environments.

Why are Civility and Respect Important Within Physicians’ Workplaces?

Civility and respect are paramount to healthy work environments. Benefits include improved communication and relationships; thriving teams and individuals; inclusive and compassionate communities; improved patient safety and outcomes; a culture of growth and development; and system sustainability. Civility and respect also correlate with reduced burnout, turnover, and sick leave, as well as increased job satisfaction, perceived fairness, positive morale, and engagement.

Unfortunately, incivility and disrespect are common, occurring in both subtle and overt ways. This may take the form of disruptive, passive aggressive, or dismissive behaviours; humiliating or demeaning treatment; passive or systemic disrespect; and outright conflict or rudeness. It may also take the form of bullying, abuse, harassment, and discrimination, with direct effects on psychological safety. Incivility and disrespect have serious consequences for physicians, patients, and the system. This includes reduced professional fulfillment, engagement, performance, creativity, flexibility, motivation, productivity, and prosocial behaviour, as well as increased burnout, turnover, psychological complaints, depression, anxiety, stress, immune dysfunction, and musculoskeletal complaints. Consequences for patients include decreased psychological safety, compromised communication, and negative diagnostic and procedural performance outcomes when there is incivility and disrespect within their healthcare teams.

What Happens to Civility and Respect During Times of Crisis?

During times of stress and crisis such as the COVID-19 pandemic, we may alter our usual behaviours as we enter ‘survival mode’. As physicians, we may experience uncertainty, loss of control, decreased competence (perceived or real), and loss of connection due to physical distancing. There may also be additional pressures outside of work. The overall increased stress levels may augment burnout, moral distress, compassion fatigue, and frustration, heightening the risk of incivility within the workplace.

This is a time of incredible change and with incredible change comes incredible opportunity.

Reframing the COVID-19 pandemic as an opportunity to strengthen our teams, build connections and camaraderie, reinforce medicine as our professional calling, and build a supportive culture can promote and foster civility. These behaviours are contagious, thereby presenting an opportunity to spread civility and respect during this challenging time.

How Can We Enhance Civility and Respect During the Pandemic and Beyond?

Practice self-care. Sleep, nutrition, hydration, and exercise increase our bandwidth to build and sustain connected, compassionate, and respectful teams.
Be mindful in our interactions. We are all in this together and many of us are working in uncomfortable situations. We all have the same goal of providing quality patient care. Focus on empathy and compassion and be mindful of how your behaviours may impact others.
Practice compassion. This applies to ourselves as well as others. We will not always be perfect. Remember that these are challenging times, and people may not be at their best, including ourselves. Be patient and seek to understand, rather than responding defensively. Have a genuine curiosity in others and how they are doing.
Reflect on our professional calling. Finding a sense of purpose in our work helps maintain equilibrium and foster engagement, meaning, satisfaction, gratitude, and civility.
Build connections. Positive relationships can counterbalance the effects of incivility. Zoom rooms, Facetime, phone calls, and other communication channels can support connections.
Foster non-work endeavours. Research suggests that non-work endeavors create a buffer against the experience of rudeness at work. Those who thrive in non-work endeavours report 38% more satisfaction in handling of work situations, 80% better health, and 89% greater thriving at work.
Set goals and expectations of civility. Develop a code of civility and hold each other accountable. If you witness incivility or disrespect, speak up and check in with those involved.
Be direct and respectful in your communication. If you feel safe to discuss the encounter, prepare for the discussion; rehearse your ideas and accept honest feedback; be aware of non-verbal communication in yourself and others; explain how the issue (not individuals) and behaviour is harmful; prepare for emotional responses; be an active listener; and focus on going forward with mutual purpose.
Be the change you want to see. Role model civility and respect. If you witness mistreatment of a colleague, be an upstander by speaking out against it. We all have the power to stand up to injustice, incivility, and disrespect. In doing so, we can create the change we want to see. As Albert Einstein stated, “the world will not be destroyed by those who do evil, but by those who watch them without doing anything.”

Turn Toward

Shinzen Young, a mindfulness expert, uses this formula: Suffering = Discomfort x Resistance

The discomfort is a sensory experience, whether it is physical (pain), mental (confusion), or emotional (unpleasant emotion). At a sensory level, the discomfort does not come with a story. The stories, ideas, thoughts and feelings that come with the discomfort are what the resistance is. Discover how the inner reactivity manifests at the level of your senses — explore your mind and body from a sensorial perspective. Listen to a guided exploration of your mind and emotional body (5 min).

You can now apply mindful awareness to turn toward the experience of suffering and appreciate, untangle and discover the sensory experiences that create resistance. Doing so, you may find that the distress is much less. What used to be overwhelming may become bearable. Listen to the “See, Hear, Feel” instructions (5 min) and guided practice (10 min).

Anchor Away

Alternatively, with mindfulness, you can choose to anchor your attention away from the discomfort. You can select an object of focus (not related to your discomfort) to pay attention to. An object of focus is a specific sensory experience or an aspect of the sensory experience that you want to focus on.

Feel Rest: In this mindfulness practice, the object of focus is relaxation or restful sensations in the body.

Listen to the “Feel Rest” instructions (5 min) and guided practice (11 min).

Feel Good: In this mindfulness practice, the object of focus is positive emotional sensations in the body.

Listen to the “Feel Good” instructions (7 min) and guided practice (12 min).

Where and When to Practice and for How Long

You can practice anywhere at any time of the day such as before and after meeting with a patient, when you are waiting, before going to bed, when you walk from the parking lot, when you listen to a report… You can practice for short bursts of 30 seconds here and there and aim for a total of 10 minutes per day.

You can find all the audio resources mentioned in this Education Bulletin here.