What factors help and hinder efforts to address incivility in Australasian emergency departments? A modified Delphi study of FACEM perspectives

Abstract

Objective: Workplace incivility is a global challenge for healthcare and a major leadership challenge facing emergency physicians. However, little is known about emergency physicians' understanding of the factors that help and hinder attempts to address incivility, or what emergency physicians believe are the priority factors to address. The present study makes a novel contribution to research in this area by examining the perceived enablers of, and barriers to, efforts to address incivility in Australian and Aotearoa New Zealand EDs. Methods: An online modified Delphi study was conducted with 22 FACEMs. To structure the process, participants were sorted into four panels. Using a three-phase Delphi process, participants were guided through the process of brainstorming, narrowing down and ranking the factors that help and hinder attempts to address incivility in EDs. Results: There was general agreement that FACEMs' cross-department relationships and networks were key helping factors, and that poor workplace culture and time pressure were major hindering factors. However, despite agreement about these three factors, a wide range of intrapersonal, interpersonal, intergroup, and organisational factors were identified as pertinent to attempts to address incivility in EDs. Conclusion: The causes of incivility in Australian and Aotearoa New Zealand EDs are complex and highlight incivility in EDs as a key adaptive leadership challenge of emergency physicians. Fundamentally, the results underscore the need to foster a workplace culture of respect, inclusion and civility in Australasian hospitals.