A worker raised concerns with Sylvia Gomes, the Freedom to Speak Up Guardian at East and North Hertfordshire NHS Trust, describing incivility they experienced during procedures. These were specialised procedures carried out by highly skilled interventionists with the support of a multidisciplinary team.

Sylvia met with the manager and team leaders to better understand the experiences of the team as a whole. It became clear that the multidisciplinary team frequently experienced incivility during procedures. Examples included sarcastic remarks, rudeness, sharp and overly critical comments, rolling of eyes, tutting. This behaviour was not consistent and there were many occasions when the same professionals would be kind and professional.

To assess the level of incivility being experienced, Sylvia invited all the multidisciplinary team members, including the interventionists, to complete an anonymous survey on workplace incivility.

This survey results showed that 70% of respondents had either experienced or witnessed incivility. Team members shared that they felt anxious and reported poor psychological safety within the team. This highlighted that incivility was increasing patient safety risk as it increased fears of speaking up. This was escalated to the Trust patient safety team.

The survey response was also shared with the interventionists, and a senior member of the patient safety team met with them and shared the Trust’s kindness and civility matters video , facilitating a reflective discussion. They agreed a change in behaviour, to a more civil and kind approach. While there was some improvement, this had limited impact and behaviour was not consistently in line with Trust values to Include, Respect and Improve. This absence of meaningful change resulted in Sylvia escalating the concerns about incivility to the Trust executives responsible for patient safety including the Chief Nurse, Medical Director and CEO.

The Responsible Officer informed the interventionists of expected standards of behaviour and the likely impact of not meeting these standards. This message from all levels of leadership within the Trust, including executives, that incivility is unacceptable played a crucial role in changing behaviours which resulted in meaningful change that continues to be sustained. Teams that experience incivility need additional support to rebuild psychological safety over several months.

As the interventionists’ behaviour changed, the team leaders worked on improving the multidisciplinary team members’ confidence by giving them opportunities to lead pre- procedure briefings with support. The team leader role for each room was implemented within the allied health care professional team which improved team working and gave team members leadership and management skills, increasing their confidence to challenge. Team members reported improvement in work environment and reduction in anxiety.

Sylvia said: “Whilst the incivility reported was a mild form of poor behaviour, because of its impact on patient safety and worker wellbeing, it could not be ignored.

“Workers who experience or witnessed incivility are less likely to Speak Up. It is therefore important when a concern regarding incivility is raised, it is taken seriously and explored further as it is likely to be affecting more than one individual.

“When dealing with complex issues, it is vital that the right people with authority and influence are involved as this drives action for change.”


This 100 Voices story appears in the National Guardian’s Office 2022-23 Annual Report