Civility, Incivility and being nice

I attended a talk this week given by Emily, the Equality, Diversity and Inclusion lead in the trust.

It was part of a two-day Quality Improvement programme in Rotherham.

Civility isn’t necessarily one of those things you tend to think about, it’s a little like the absence of pain.

When there is no pain, you are just you, getting on with things.

When an arthritic joint flairs or you bump your nose, suddenly, where there was painlessness, you have it.

Civility is the same.

Most of us go about our day to day lives, interacting with others, often, and to my mind, more since the pandemic, with appropriate, pleases, thankyous and patience; allowing the old man to fumble at the till, accepting that people have fallen out of practice with some behaviours.

What is civility?

Well, you will have heard of civil-servants, they are, I guess, those employed to work in roles that maintain the civil or social order, to ensure systems, plans and processes are in place to allow us to live without crashing in to one another, getting our wages on time, paying for what we owe, feeling safe walking home at night, having confidence in the safety of the food we eat and the transport we take. That kind of thing. Providing a magic blanket that most of us don’t think about but which keeps life ticking-over. We call this a civil society. Our civilisation is infinitely complex and precarious and it requires tending. Sure, there is more to be done, and there are many, thanks to Boris and team who fall outside the safety-net, yet, most of us will agree it is better to live within the boundaries of civility than without. (If you don’t agree, perhaps visit Yemen or Syria).

That was a long paragraph describing the obvious.

It is probably appropriate to borrow the terms micro and macro from economics to explain the rationale for Emily’s talk, you see, the macro-civility, we probably don’t need to bother too much about; there are rules and systems in place to keep us right – traffic lights and best-before dates on our food, it is the micro that is trickier.

Micro-civility is at the level of the individual. What I say or do to you.

Again, this is one of those things that we take for granted, particularly in the UK where civility has been honed over hundreds of years.

It is when it is absent that it hurts.

Most of us have experienced this.

Rudeness, passive or active aggression; dismissal, walking into a room and the clique ignoring your presence, being forgotten or overlooked either with or without intention; the emails you send which fall into a blank space, the smiles or eye contact that aren’t returned.

I guess some people are more prone to this than others, that is, receiving the incivility.

It is probably a matter of sensitivity too. If you have thick skin and a mountainous ego, it is easy to shrug-off, if not, less so.

Yesterday, I was out walking with my son and our dogs. I walked past someone who at first I didn’t recognise then was vaguely familiar. It was only when we had each moved-on that I realised who it was. At the time I did the dog-walking, smile and hello; had I known who it was I would probably have stopped for a chat.

I have glasses. My long distance vision has been a victim of age and Covid. Part of this was my not seeing him as I wasn’t wearing my specs. They hurt my eyes.

My dog walking colleague could either have been insulted or not thought anything more of it (he was wearing ear-buds and likely listening to something)(I tend not to talk with folk when wearing my ear-buds), alternatively he could have said, ‘Hi Rod!’ or, it could be that he has equally bad eyesight (he is about my age).

Who knows.

I don’t think that was incivility. That was just the complexity of everyday life.

Previously I experienced repeated bouts of incivility. It was a few years ago, at work.

It was all the usual. Emails that weren’t answered, meetings that I was not invited to or meeting minutes where my contribution was deleted, backs turned and decisions or discussions about me without me. That kind of thing.

In the end, when the bullying was too overt for me to look the other way I crashed and was on sick leave for several months.

That was the effect of incivility which I suspect is beyond not recognising someone on a dog walk.

And here is the point of Emily’s talk.

We live within a fairly clearly defined set of rules and expectations of what is right, what is reasonable and acceptable and what is not. Deviation is easy to spot.

Yet, when this deviation is on the micro-scale, particularly behind closed doors, the victims tend to be at a loss, often flounders, or, at least that is what happened to me.

There is another incivility, the grand-standing type, less common in today’s world of dressing someone down in public, of mocking them for perceived or actual failings or mistakes.

And all of this, what does it matter?

Life is tough. What do we care about a few victims here or there?

When you take these micro-actions and shift them to a health or social care environment, that is when things fall apart.

That is when the rudeness or the aggression from me to you affects you to such an extent that you are no longer functioning, that your judgment is impaired, your resilience diminished. Your thought processes delayed. You make mistakes. Your sleep pattern and health suffer.

Incivility from me to you is as bad as my stabbing you with a knife, just less bloody.

Emily showed us lots of evidence of this from academic studies. The effect of rudeness or incivility. Of blanking, of ignoring, of overlooking.

It shortens the victim’s lifespan, it affects their relationship with colleagues and friends and family. It is a terrible, pernicious thing.

And, yes, it is out there in healthcare.

What to do?

Well, the first is to call it out. To acknowledge that today, 2022, it is never acceptable for incivility to happen, particularly in the workplace, particularly in the NHS.

Incivility is an inversion, a perversion of everything we are aspiring to achieve in clinics and hospital wards.

It is the diametrical opposite of person-centred care, where the person is valued, celebrated.

The in-civil nurse or doctor is a bad doctor or nurse or at least one who has lost their way. Their actions or relationships with colleagues will spill-over to patients and vice-versa.

Call it out and do something about it.

The adage of, ‘the behaviour you walk past is the behaviour you accept,’ rings true here.

Call it out. Escalate. Don’t accept it.

If you see it and are not necessarily the victim, you can act too. If you don’t, your hand is on the knife.

It is as significant as that.

We complain about much in the UK and today, we have more to dislike than ever (Boris, et al) and yet, our society is at the extreme end of civility.

I am certain that behaviours we would not countenance are commonplace elsewhere.

We queue. We say please and thank you. We wait our turn; sure the odd sigh or raising of the eyes, but for the most we are pretty good. Let’s keep it that way and let’s celebrate our decorum, and remain on the look-out.