Summary

What is known?
Interprofessional incivility, defined as low-intensity negative interactions with ambiguous or unclear intent to harm, has recently become an occupational concern in healthcare.
What is the question?
What is interprofessional incivility and what are its effects on medical performance, service and patient care?
What was found?
In total, 13 studies were included of heterogeneous origin, methodology and size (total participants = 26,534; mean MERSQI score = 7.8).
Interprofessional incivility was common among physicians (77%) and nurses (65%) and had both psychological and clinical outcomes, resulting in stress (97%), compromised patient safety (53%) and quality of care (72%), and errors (70%). Junior staff were affected twice as often as consultants, with higher rates in radiology, general surgery, neurosurgery and cardiology.
An impact on team performance was more frequently reported by nurses, junior employees and non-clinical staff. Disruptive surgeon behaviour increased anxiety in perioperative teams, leading to impaired performance overall.
In patient care, incivility was associated with AEs (67%), medical errors (71%), mortality (27%), compromised patient safety (24.7%) and quality of care (35.8%). Patients whose surgeons had higher numbers of co-worker reports about incivility were at higher risk of complications.
Strengths and limitations of the study

  • Papers included were diverse in terms of their geographical setting, methodology and scope, which enabled assessment of the many effects of interprofessional incivility with different foci, as well as a more extensive overview of the topic.

  • Research was conducted with nurses, medical, managerial and administrative staff, provided that at least one consultant/physician was present. This revealed the interconnectedness of the phenomenon from different perspectives.

  • Most studies did not use a prescriptive measure for incivility, such as the Workplace Incivility Scale,38 and neither were participants usually provided with clear definitions of ‘incivility’, ‘disruptive behaviour’ or ‘unprofessional behaviour’.

  • Different understandings of the nature of incivility could introduce bias into self-reports of incivility exposure and studies that relied on surveys and questionnaire were based on subjective judgements and observations.

What is the implication for practice now?
The impact of interprofessional incivility on medical performance, service and patient care appears systemic. Certain specialties might be more exposed, and higher work proficiency and seniority might be protective factors. The heterogeneity of the studies restricted the analysis and reliance on self-reports resulted in low MERSQI scores, although the quality of research improved in more recent studies. Quantitative methods for identifying and measuring incivility are lacking and further empirical research is needed. This could benefit the NHS and other stakeholders when designing targeted interventions. Witnessed incivility from a patient's perspective has also rarely been empirically investigated, and further exploration of this area is required. A dominant theme within patient complaints was ineffective or inadequate communication and its contribution to patient safety, misdiagnosis and patient/carer dissatisfaction. The undoubted link between poor communication and incivility implies that, until the issue of incivility is addressed across all parts of the care process, the implications for healthcare practice are significant.