The Cascading Effect of Civility on Outcomes of Clarity, Job Satisfaction and Caring for Patients

Implementation of a model of care requires partnering among members of the health care team and patients and their families. Each participant must have clarity about each person’s role and how the system is used to implement and/or utilize a model of care delivery. A community hospital in the Midwest implemented Relationship-Based Care (RBC), a model based on concepts of partnering with self and others to build inclusive systems of care. Implementation included education about the culture of caring and discussions centered on the concept of civility as a prerequisite to role clarity within the concept of partnering in caring for self and others. The discussions demonstrated to hospital leaders that incivility, involving negative cultural norms, fundamentalism, oppression, hierarchical leadership, and conformity to old ways, was a barrier to creating a caring environment. This study examined the impact of civility on professional clarity, social and technical dimensions of work, and caring for patients and families. Civility was measured by a 24-item instrument using Bartholomew’s theory of civility (2006). The instrument includes two dimensions of civility: education in civility during academic and clinical training, and the experience of civility in the work setting. Results revealed that staff who had received and observed civil behaviors from academic faculty and clinical preceptors were more likely to report working within a civil environment. This in turn predicted greater levels of clarity, which then predicted greater satisfaction with both the technical and social dimensions of the job. The final outcome, caring for patients, was predicted by job satisfaction.