Workplace incivility and bullying have persisted in healthcare since their uptick during the COVID-19 pandemic.
As the healthcare landscape continues to evolve, so do the challenges teams face, according to Brian Reed, vice president and chief human resources officer for Indianapolis-based Indiana University Health’s east region.
“The heightened complexity of care, increased patient acuity, and the emotional toll of healthcare work can all contribute to moments of tension among patients, families and team members alike,” Mr. Reed told Becker’s.
Justin Bowser, MSN, RN, a clinical nursing director at Luminis Health Anne Arundel Medical Center in Annapolis, Md., said he has noticed an increase in incivility among healthcare teams over the past two years — often fueled by burnout that contributes to a more stressful work environment and strains team dynamics.
Staff members are also frequently facing incivility from patients and hospital visitors, an ongoing issue health systems are continuing to address. A 2024 survey found that nurse leaders witnessed bullying and incivility from patient families the most often, closely followed by staff nurses.
“There’s been a noticeable rise in negative behaviors from patients and their families, which adds another layer of pressure for staff,” Mr. Bowser said. “These external stressors can heighten frustration and, unfortunately, sometimes spill over into interactions among colleagues.”
The Vanderbilt Health Center for Patient and Professional Advocacy, which partners with hospitals and health systems to promote professional accountability, tracks unprofessional behavior by individuals, specialties and organizations. Reports of such behavior rose slightly during the pandemic but have since returned to baseline as organizations settle into a new normal, according to center President William Cooper, MD.
Here are seven strategies to reduce workplace incivility among healthcare teams:
1. Address the behavior directly and give feedback.
The Vanderbilt center tracks whether individuals improve after receiving feedback on unprofessional behavior. “Consistently, we find that 85% to 90% of individuals who receive feedback after modeling a pattern of unprofessional behaviors improve and have fewer reports after the intervention,” Dr. Cooper told Becker’s.
IU Health introduces each team member to its community agreement and addresses concerns through employee relations and several committees. “When patterns of incivility arise, targeted interventions such as team-specific training and conflict resolution support are deployed,” Mr. Reed said. “This approach fosters accountability while preserving a positive, collaborative work environment.”
2. Set expectations early.
Mr. Bowser encourages staff to address negative behaviors early and at the lowest level possible. “I also prioritize preparing team members to engage in courageous conversations with confidence and professionalism,” he said. “We offer access to training and courses that help staff navigate difficult conversations, whether with colleagues or with patients and families.”
IU Health East Region sets behavioral expectations during onboarding and department orientation. “Leaders are equipped to respond promptly to concerns, helping maintain a culture of respect and teamwork,” Mr. Reed said.
3. Focus on values.
Chillicothe, Ohio-based Adena Health has seen improvement in team dynamics — including a 90th percentile score on the survey prompt “I enjoy working with my coworkers” — by reinforcing values and peer feedback, according to Heather Sprague, chief human resources officer.
“We are constantly encouraging our employees to give feedback to one another in a respectful and kind manner,” Ms. Sprague said. “We are also on a high-reliability journey and one of the key principles is cross-checking and asking clarifying questions. This is a safe way for our employees to work with one another in a collegial manner without being put on the defense.”
4. Prioritize consistent accountability.
Dr. Cooper said leaders must commit to the values and agree to hold everyone to the same standard. Then, the system must create and sustain the right infrastructure of policies, wellness resources, data and tiered interventions.
“Finally, the organization has to agree not to blink when someone who is felt to bring high value is identified as being an outlier,” he said. “These gut-check moments are often watershed experiences for health systems as they see the success of making difficult decisions and the positive cultural impact fair and consistent accountability can bring.”
5. Limit exposure to negative behaviors.
Reducing exposure to unprofessional behaviors also limits negative experiences in the workplace, the center found. In a study published with Houston-based MD Anderson Cancer Center, the system found a reduction in employee turnover after interventions, Dr. Cooper said.
6. Use a standardized huddle process.
A recent Vanderbilt study found that structured, timely huddles can help systems respond to reported behaviors by boosting communication, trust and consistency.
“Healthcare leaders should recognize the importance of having a prompt response when certain types of behaviors or actions are reported,” Dr. Cooper said in a news release about the study. “Consistency ensures that individuals who are reporting behaviors and individuals who may be identified in reports are treated fairly and in a balanced way … [P]articipants have the chance to share a range of opinions to guide the huddle’s ultimate triage decision.”
7. Implement communication and resolutions programs.
Communication and resolution programs, which address unintended patient harm, can also reveal patterns of disrespect and toxic environments. A recent Vanderbilt study noted that CRPs prioritize safety and transparency, and that investigations can identify broader cultural concerns.
“When a CRP investigation identifies patterns of disrespect, intervention is key,” the study said. “But also required is a plan supported by a well-defined infrastructure that links the right people, organization and system support to identify and address every [colleague of concern] in a fair, effective and timely manner.”
