Embracing Civility

The REAL Healthcare Reform!

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Are You Fed Up?

If you are fed up with incivility in your healthcare workplace, watch this:


Is it Possible to Be Pro-Bullying?

October is National Anti-Bullying Month, but anti-bullying campaigns are not limited to just this month.  It’s respectable and noble to be “anti-bullying” these days.  I dare say it’s even trendy. The opposite, pro-bullying, just doesn’t exist. At least no one will admit it.

So why are there still bullies? If we are all so emphatically against it . . . and no one is for it, how can it persist, especially in healthcare?

The fact is that the pro-bullies are the bullies themselves. Bullies desperately try to hold on to their bullying ways because without bullying, they have no power. Or so they think. You see, a bully usually acts out as a means to gain or retain power. Bullying usually comes from a person in a position of power (real or imagined) and involves an abuse or misuse of this power.

Do you work with a “pro-bullying” person? Is there a possibility that you are “pro-bullying” without even knowing it? Take this quick “self-awareness” quiz. Self-awareness is when you realize that, although you are not the center of the universe, everything you say and do can have an impact on others. Bullies tend to act out in a way that demonstrates a lack of self-awareness.

Imagine this conversation between a workplace bully and her target.

Target: It seems like you are just waiting for me to do something wrong so that you can criticize me.

Bully: That’s not true. I’m just trying to make sure you are doing things safely. And it’s not criticism. I’m trying to show you how to do things the right way.

Target: But, I’m doing things the way I was taught and I AM safe.

Bully: Well, maybe you were taught wrong.

Target: Fine, if you are trying to teach me, then can you please do it in private? I don’t think it’s good for the company’s reputation when you yell at me in front of patients and our co-workers.

Bully: I wish I had time to take a break and explain your mistakes to you every time you make one. But, I am busy actually working.

Target: I heard you tell our Supervisor that I was responsible for the spill that caused Mrs. G to fall the other day. You know that’s not true. Are you trying to get me fired?

Bully: All I know is I didn’t do it and you were the only other person in that area that day. It must have been you. I’m just doing my best to keep the patients safe.

This “bully” does not see herself as a bully. She has no self-awareness of the impact of her words and actions on herself, her workplace and her co-workers. She sees herself as smarter, better and faster than everyone else. She has an inflated sense of her own worth and importance in the workplace. She thinks her “way” of doing things is the best or only way. She believes that causing a co-worker to look bad makes herself look good. Unfortunately, this is the case with most bullies.

Bullies have their own unspoken pro-bullying campaign going on. Can Pro-Bullies be turned around? You bet! Bullying is a habit . . . and habits can change. It starts with self-awareness.

If you have one or more “Pro-Bullies” in your workplace, download this printable version of the Self-Awareness quiz and give it to your supervisor for distribution. If you are the supervisor, consider putting copies of the quiz in with paychecks or other announcements. Leave a pile in the break room. Pin it up in the locker room.

If you want to take it a step further, consider implementing a full scale civility training program like the one that goes along with the book, “The REAL Healthcare Reform.”

Tell us what you did or are doing to transform the pro-bullies in your workplace!

What’s Your Fire Ant Personality?

I was ambushed by an angry mob of ferocious fire ants over the weekend. And, by “ambushed” I mean I suffered three tiny, but excruciating bites. And by “angry mob” I mean I stepped into their home and they failed to welcome me with tea and cookies!

As I scratched, iced and cortisone’d my assaulted ankles I decided I should probably do a Google search to see if I needed to worry about any other symptoms or complications. Turns out—no! I didn’t seem to be allergic and I didn’t suffer enough bites to warrant a trip to the ER! Phew!

Then I stumbled on a study published a few years ago that made me think a little differently about the angry beasts. It seems they have some pretty interesting and distinct personalities!

  • About one third of the colony will play dead during an attack (from a human foot or another colony of fire ants).
  • Another third will run away.
  • The final group will stay and fight to the death. (These are the chumps that got me!)

The first group is made up of the youngest ants. After an attack they can be found curled up just like a dead ant. Then moments later they uncurl and walk away.

Middle aged ants tend to flee, which scientist think may be a tactic to protect the queen.

The eldest ants are aggressive and attack furiously. One researcher points out, “All worker ants are females, and so it’s the cranky old ladies who are the ones fighting to the death.”

Looking at the structure of the fire ant colony reminded me a little bit of the social structures found in most healthcare workplaces. It resembles how different groups deal with the pervasive culture of incivility.

New graduates curl up and play dead when attacked. They may be unsure of how to respond or may fear the consequences that may come from defending themselves.

The more experienced workers tend to cope by ignoring the problem or retreating.

You can draw your own conclusions about the third group!

The interesting thing about the comparison though is that the fire ants act this way out of a primal instinct to protect their home and their family (aka colony) from danger. That makes sense. They are tiny little creatures trying to survive in a giant’s land. But, why do we do it?

Think about the fire ants the next time you are at work. Do you play dead, retreat or fight to the death? And, why? If you play dead, you’re giving the aggressor the confirmation he or she needs to feel powerful. If you ignore the problem or retreat, you may inadvertently perpetuate the problem by “protecting the queen.”

If you’re the one on the attack, think about what you are working so hard to defend. I can assure you, it’s not as important as your home or your entire family (like it is for the fire ants).


It’s Here! Civility Training for Your Organization!

It’s time to order your organization’s new Civility Training Program!  We are proud to offer the only healthcare-specific civility training program designed to meet the unique needs of the healthcare environment.

Based on our popular book, “The REAL Healthcare Reform,” this program is a complete turnkey solution that contains everything you need to get a civility training program up and running with minimal effort.

Training packages are available for as few as 12 learners and come complete with a copy of The REAL Healthcare Reform for each learner and an Instructor’s Manual for the educator.

The Instructor’s Manual is full of engaging classroom activities, thought-provoking discussion questions, convenient PowerPoint presentations, tips for improving participation and a CD with master copies of all the handouts and presentations. (Read a sample chapter!)

The best part is that the program materials are appropriate for every individual in your healthcare organization, clinical and non-clinical alike. Administrators, managers, nurses, aides, secretaries, and everyone in between, will find the program easy to use and understand. In addition, the program provides six hours of inservice credit for all Certified Nursing Assistants.

Healthcare organizations who provide civility training will find that it:

1. Meets Joint Commission’s recommendations.  This program meets the Joint Commission’s recommendation to provide training that reduces “behaviors that undermine a culture of safety,” particularly intimidating and disruptive behaviors among staff members.

2. Reduces costly medical errors. Incivility ruins communication among the healthcare team and poor communication is a direct threat to patient safety. Civility training decreases dangerous and potentially deadly medical errors by improving teamwork and communication.

3. Increases employee retention. A staggering number of healthcare employees report having quit a job because of incivility. Civility Training improves employee retention at every level, saving organizations the precious time and money involved in hiring and training new employees.

4. Cuts down on “call-outs” and absenteeism. Working in a culture of incivility leads to more absenteeism.  As many as 47% of healthcare employees report spending less time at work because of incivility. Civility training creates an atmosphere that energizes and inspires those who are in it. Employees who are energized and inspired will look forward to coming to work, thus reducing the rate of absenteeism.

5. Eliminates conflict and drama. Incivility leads to conflict and conflict = DRAMA! Healthcare professionals who embrace civility are less likely to burn out, bully or “eat their young!” This means less conflict and drama in the workplace!

6. Improves patient satisfaction and enhances the organizations reputation. Disgruntled, dissatisfied and disengaged employees don’t provide quality care to the patients they serve.  This leads to a decrease in patient satisfaction. Patients who are dissatisfied with the care they receive share their negative experience with others in the community.  Healthcare organizations that embrace civility enjoy improved patient satisfaction . . . and satisfied patients who speak well of the organization in the community enhance that organization’s reputation.

The benefits of using THIS Civility Training Program include:

1. The hard part is DONE!  Our Civility Training Program will save you time, effort and money.  You don’t have to create the program yourself.  We did that for you.  And you won’t have to hire an expensive “expert” trainer to come into your facility to deliver the training. The Instructor’s Guide will show you how to seamlessly deliver the content to healthcare professionals from a wide variety of backgrounds and settings with a wide range of learning styles.

2. Two simple products give you everything you need!  Our program consists of a workbook style booklet that goes hand-in-hand with the companion Instructor’s Manual. The Instructor’s Manual comes with a CD loaded with additional worksheets, quizzes and PowerPoint presentations. These two products contain everything you need to conduct your civility training.

3. It’s easy to customize the program to meet your specific needs! You can choose to arrange a full day “seminar” to cover all of the material in one day.  Or, you might like to break the content into chunks and deliver it over several shorter sessions.  This option is great for shift workers.  You can hold a morning session for one shift and an afternoon or evening session for other shifts.

4 There is a pricing option for every budget. When you are ready to order, call In the Know at (877) 809-5515 to choose the package that’s right for you. (See bulk discount pricing below.)

5. The program pays for itself. Incivility steals from your entire organization. Organizations like yours can end up paying dearly for incivility with their profit margins. In the Know’s Civility Training program will improve patient care, decrease costly medical errors and will inspire and energize your team. Best of all, it will decrease employee turnover at every level, saving you the time and money involved in hiring and training new employees.

To learn more about this new Civility Training Program, please call 877-809-5515. We are here to answer all of your questions!

Civility Training Program Package Options

Online ordering is currently not available for these packages,
so please call 877-809-5515 to place your order.

Number of Learners

Qty Discount Price Each Instructor’s Manual Your Cost
12 50% 9.97 69.99  $189.59
24 55% 8.97 69.95  $285.23
50 60% 7.98 34.98  $433.98
100 65% 6.98 34.98 $732.98
150 70% 5.98 Free $897.00
300 75% 4.98 Free $1,494.00


What change do you want to be a part of?

We were honored to be contacted this week by Tomas Spath and Cassandra Dahnke from The Institute for Civility in Government. Although our target audience is different (politicians for them, healthcare for us), our platform is the same. Our common goal: Civility.

Those of you who have read our book, “The REAL Healthcare Reform” may already recognize The Institute for Civility in Government. They inspired our thoughts about civility with their “definition.” They were, and continue to be a great inspiration to us!

If you are not already aware of their work, philosophy and goals, please see the Editorial Letter re-printed below. If you have an interest in restoring civility to public and political discourse, please contact The Institute and find out how you can begin to make a difference in your own community.


An Editorial Letter from
Tomas Spath and Cassandra Dahnke
The Institute for Civility in Government.

Things change.  That’s what they say.  And indeed they do.  Technology changes.  Norms change.  Culture changes.  Laws change over time.  Some of the change is good, and some – not so much.

The more things change, the more they stay the same.   That’s what they say.  Some people lead.  Others follow.  Everyone is in it for themselves.  Greed abounds.  Corruption is real.  The world is always at war somewhere.  People are essentially kind.

Which truth is true?  Both?  Neither?  One or the other?  One more than the other?  The way you answer those questions says a lot about the way you approach life.

If you believe that the more things change, the more they stay the same, you probably don’t have much incentive to get involved in a whole lot beyond your personal space.  Why bother?  It’s not going to make a difference anyway.

If you believe things change, you may say that civility is old fashioned and has lost its place as a priority.  You may believe civility is quaint, weak – a social “nicety” with no real purpose.  The world has moved on.

Or, if you believe things change, you may want to roll up your sleeves and do something to counteract the growing polarization in this country.  You may want to help restore civility to our communities and nation.  You may want to (gasp!) get involved and make a difference!

We decided to do just that when we became aware that in this country we, as a society, lack the basic skills and will to maintain civility with one another even in the midst of disagreement.  It isn’t that we immediately get ugly and hateful and angry (although we do that with alarming frequency).  But as often as not, once we discover we fundamentally disagree with someone else we shut down, conversation stops, and we walk away – never to relate on anything more than a superficial level again, if that.

So we launched the Institute for Civility in Government – a grassroots, non-partisan, non-profit organization whose purpose is to teach civility skills and give voice to all those who long to shift the culture from one of polarization and antagonism to one of mutual respect and cooperative effort.  Yes – give voice to Republicans, Democrats, Libertarians, Independents – everyone!  The Institute doesn’t take a position on anyone or any issue.  We just say we need to do this thing called governing – at any and all levels – better.  And the good news is we can!

We can give other people a chance to be heard without shouting them down, calling them names, or tuning them out.  We can express our own viewpoints from the strength of our own position rather than by the weaknesses of someone else’s.  We can operate on the trust that most of us truly want the best for our city, state and country, even if we don’t always agree on what the best is.  We can model the behavior we teach our children – to do unto others as we would have them do unto us.

What is civility?  We define civility as “claiming and caring for one’s identity, needs, and beliefs without degrading someone else’s in the process.”  It’s not about giving in just to get along, but claiming our own beliefs even as we respectfully allow others to claim theirs.  That doesn’t sound so very difficult, does it?  And yet it seems to elude us.

What is at stake?  What difference does it make if we yell and scream and call other people names?  Well, for one thing – words are formative.  Disagreeing with someone can easily slide into disliking them.  Disliking them can easily slide into demonizing them.  Demonizing them can easily slide into victimizing them.  It’s a slippery slope that the human community has traveled down too many times already, and it’s time to stop.  It’s time to hold to a standard of civility – not because it is the law, but because it is the national will.

While it is unfortunate that we have reached a time and place where we must organize for civility, we evidently have.  Yet the good news is that as more and more people give voice to their support for civility, it will become politically expedient for our elected officials to model the behavior we expect.

If we cannot listen and speak with one another with respect, there is little else we can accomplish together.  And if we don’t practice civility everywhere, the day may soon come when we cannot find civility anywhere.

Change doesn’t happen by itself.  People make it happen – for better or for worse.  What change do you want to be a part of?


Please visit www.instituteforcivility.org for
more inforation about this great organization!

It’s an Easy Choice…

Choosing manners

Every word you speak and every action you take boils down to this: they are the individual personal decisions that you must make every day. So, why not choose civility?

Do you need more incentive? Consider this: incivility causes decreased morale, lower self-esteem and increased diagnoses of anxiety, depression and even post-traumatic stress disorder. And, working in a culture of incivility leads to more absenteeism.  One study found that 47% of respondents reported spending less time at work because of incivility.  Absenteeism in healthcare leads to dangerous staffing ratios, and unsafe staffing ratios cause poor quality of care and an increase in medical errors.

Still not convinced that civility matters? If your workplace is infected with incivility, that bad behavior between co-workers could be costing you a raise and/or improved benefits. Remember that organizations pay for incivility with their profit margins.  One study found that workers’ stress resulting from incivility costs US corporations as much as $300 billion a year. Would you rather your organization waste money on incivility or spend it on you?

It’s an easy choice…



August is National Win with Civility Month!

Can you believe it’s time to flip the calendar to a new month again? Tomorrow is the first day of August! Phew . . . and it’s a hot one. The dog days of summer are enough to test anyone’s patience and civility!

We can’t take a break from the heat, but we can take a break from incivility! August is National Win with Civility Month.

Civility expert, Dr. P. M. Forni, author of The Civility Solution writes, “Incivility often occurs when people are stressed, unhappy, and rushed.” Sound familiar?

As a healthcare professional, you (and your co-workers) probably spend a good portion of your workday feeling stressed, unhappy and rushed. It’s no wonder healthcare workplaces have become breeding grounds for incivility.

Will you commit to embracing civility for this one month? Our challenge to you is to do one thing each day that honors your commitment. Of course you can always do more if you want!

If you need some ideas on what to do, go to our Top Ten Ways to Embrace Civility at Work, or check out the suggestions listed in our change.org petition!

What will you do to honor this observance? Leave us a comment! We’d love to hear from you!


Civility STAT!

  Answers to your personal questions about
combating workplace incivility right NOW!

We get lots of questions about workplace incivility, and we’d like to share them with you! While each problem is specific to the individual who sends it,
most people will be able to relate and make use of the information.

If you have something you’d like to ask our workplace incivility experts, click here and send us your anonymous question.  We will never publish real names or workplaces in this column.


Dear Civility Stat,

I’ve worked at the same LTC facility for years. When I first got here, the atmosphere was really backstabbing and unfriendly. So a bunch of us got together and we all signed a pact to get along- no backbiting allowed- and it seemed to work for years.

About six months ago a new DON was hired and it’s like she seems to prefer an environment that is competitive and unfriendly, so she encourages it here. Now we are all backbiting, bullying and being mean to each other.

I don’t enjoy coming to work anymore and I don’t know what to do. I get a sick feeling in my stomach on my way to work every day. Do you think I should just look for another job?



Dear JP,

I’m really sorry to hear about your situation at work. When someone in a position of power, such as a supervisor or manager is responsible for creating the culture of incivility, finding a solution can seem impossible.

The first thing that jumped out at me when I got your email was the idea of the “pact to get along.” I love this idea. It’s no wonder it worked for years! Are there any of the original “pact” signers left? If so, I would start there. Get the core group together and draft another pact. Then, get the newer hires on board. I would even invite the new DON to sign it!

Here is a sample Civility Pact anyone can use. Feel free to personalize it to meet your own needs!

Keep us posted, JP. We’d love to hear how this works out for you!


What Makes Assertiveness So Complicated?

Our friend and fellow nurse, Beth Boynton, RN, MS (author of Confident Voices: The Nurses’ Guide to Improving Communication & Creating Positive Workplaces) opens a really great discussion in her new blog, Bleeding Hearts, Shark Infested Waters Meet the Relativity and Complexity of Assertiveness.

In the article, Beth writes,

“Assertiveness is way more complicated than being firm or just speaking up for yourself . . .”

This is so true—and definitely worth further exploration.

It’s easy for someone to say, “Well, you just have to be more assertive.” But, as Beth points out, it’s much easier said than done.

Beth outlines at least six reasons why being assertive is so complicated.  A few highlights include that assertiveness:

“. . . involves individual developmental qualities such as self-esteem, self-awareness, and self-efficacy.”

“. . . takes place in the context of relationships.”

Is influenced by, “gender, age, ethnic and personality differences.”

I think that another point to add is that assertiveness may not always be consistent for people. In other words, a person may be able to behave assertively in certain situations but not in others. For example, you may find it easy to behave assertively when you are in familiar surroundings, or your “comfort zone,” but have trouble finding your assertiveness in unfamiliar surroundings, like at a new job or when being “floated” to a new floor.

Here is a chart from our book, “The REAL Healthcare Reform: How Embracing Civility Can Beat Back Burnout and Revive Your Healthcare Career.” that compares assertive behaviors to passive and aggressive behaviors.




Description You put everyone’s
needs first—while ignoring your own.
You stand up for your rights while showing respect for the rights of others. You stand up for
your own rights—
but violate the
rights of others.
How You View Your
Self and Others
You may think:I am not important.

I don’t matter.

You believe:Everyone is important.

We are all equal.

You tell others:Your feelings are not important.

You don’t matter.

I’m superior.

Verbal Habits and Styles You:Apologize frequently.

Speak in a soft or unsure voice.

You:Use “I” statements (to take ownership of your own actions).

Speak in a firm voice.

You:Use “you” statements (to blame or accuse others).

Speak in a loud voice.

Non-Verbal Habits and  Styles You:Avoid eye contact.

Stand with stooped shoulders.

You have:Direct, non-threatening eye contact.

Relaxed posture.

You:Stare with accusing eyes.

Have a tense posture, with clenched fists.

or Results
Low self-esteem.Not respected by others. High self-esteem.Self-respect.

Respected by others.

Low self-esteem.Disrespected.



Do you think it’s possible to behave assertively in every situation and within every relationship? If not, what are your challenges? What do you think you can do to overcome those challenges?

Leave us a comment! We’d love to hear from you!


If there was a penalty for being rude . . .

incivility, civility, bullying, workplace bullying, change.orgHow would you feel if the government decided to regulate your attitude? If there was a penalty for being rude, unkind, short-tempered or mean, would you be guilty?

What if there was a monetary fine or even jail time for bullying? Would you quickly find yourself broke and/or behind bars?

– In Australia, one Union is pushing for mandatory jail time for workplace bullies.

– A bill in the Philippines, known as the “Anti Cyber Bullying Act of 2012″ seeks to penalize violators with a fine of 50,000 to 100,000 Philippine Pesos (that’s $1,100 to $2,300 USD) and imprisonment for six months to six years.

– Forty nine states in the US now have laws against bullying that allow victims to sue their employer for failing to prevent or punish workplace abusers.

– The Joint Commission has determined that “behaviors that undermine a culture of safety” are now considered a Sentinel Event and requires several new Leadership Standards, including requirements to provide education that focuses on civility and professionalism for all persons.

Look, no one likes to be TOLD what to do. And certainly, we don’t need to be nagged, reprimanded or reminded to “be nice.” And, while it may be difficult to admit that you have behaved in an uncivil way, most of us have been judgmental, jealous, rude or even short-tempered at one time or another.

Unfortunately, these behaviors are extremely contagious, and over time can infect an individual, a team, and an entire organization.

Today we face a worldwide, growing epidemic of incivility and SOMETHING HAS TO CHANGE!

Let’s not wait for our employers and our government to tell us how to behave. We can do this on our own. Each of us has the power to turn this problem around . . . and we can do it one person at a time. Let’s start a grassroots movement to restore civility to our workplaces, schools and public discourse, TODAY!

All you have to do is make a few basic changes in the way you interact with others. When you do this, your positive behaviors will go “viral!”

It works because just as rude and uncivil behaviors beget more rudeness and incivility, your kind, considerate and civil behaviors will bring about more kindness and civility!

Try it . . . you’ll see! Be sure to check back and let us know how it’s working for you!


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