294: Eradicating Incivility in Healthcare, with Renee Thompson

We talk with Renee Thompson about why bullying and incivility in healthcare are not just culture issues, but patient safety risks. She shares how leaders unintentionally reinforce disruptive behavior, what actually happens in the moment when conflict is avoided, and how organizations can operationalize respect at scale.

• why incivility has always impacted patient outcomes, even when ignored
 • the hidden patterns leaders miss, including silence as a strategy
 • short-term comfort vs. long-term cultural damage
 • why high performers are often protected despite toxic behavior
 • a simple in-the-moment technique to stop disruptive behavior immediately
 • the role of awareness, scripting, and confidence in leadership action
 • the three pillars of the Healthy Workforce Culture Framework™
 • scaling culture change through systems, not just intention
 • self-awareness as the starting point for any culture transformation

Make sure you follow Renee Thompson on LinkedIn: https://www.linkedin.com/in/rtconnections/

Transcript

Why Bullying Is A Safety Issue

Dr. Pelè 0:07

Welcome to the Human Side of Leadership in Healthcare podcast. I'm Dr. Pillet. On this podcast, we explore how leadership is experienced in real moments, not just defined in theory, but how it shows up in conversations, decisions, and pressure, and how those moments shape trust, culture, and patient outcomes. Today we're talking about something every healthcare organization says matters, but often struggle, you know, to enforce how people treat each other in the moments that matter and what it really takes to eliminate bullying and incivility at the source. It's truly my pleasure to welcome Dr. Renee Thompson. Dr. Renee is a nurse speaker and the CEO and founder of the Healthy Workforce Institute. Renee, I'm really glad you're here. You told me to call you Renee, not Dr. Renee, so I'll go with that. How are you doing today?

Dr. Renee Thompson 1:01

Oh my gosh. Um, it's always a good day, Dr. Palay, when I get to talk to people about how we can address workplace bullying and instability, because as you know, we have important work to do in healthcare. We don't have time to be dealing with all the shenanigans that are out there when our you know patients' lives are depending on us to show up as a strong cohesive team, treat each other well with respect, professionals, and be able to provide really great care. So it's a great day for me. Thank you for inviting me to be on your show.

Dr. Pelè 1:32

Oh, yeah. And, you know, I am so excited about this topic because I'll be very, very honest and vulnerable. I've experienced this myself.

Dr. Renee Thompson 1:41

I know, I read the story.

Dr. Pelè 1:42

Yeah, as a vice president of human resources. So we'll get to that. But before we do, um, you know, you've dedicated your career to eliminating bullying and incivility in healthcare. When did this stop just being another people issue, you know, and become really a patient safety issue, like a core part of what success means in organizations, in healthcare organizations?

Renee’s Turning Point Story

Dr. Renee Thompson 2:06

You know, that's a good question and not a question I get asked often. So yeah, thank you for this. It's always been a patient care issue. We just haven't recognized it as such. And we, um, with the work that we do here at the Healthy Workforce Institute, um, most of the time we don't have to convince people that addressing bullying and incivility is a must-do, like a need-to-do, not a nice to do. However, sometimes we do have to convince people, and whether it's someone in an executive role or you know, administration role, um, a physician. And I always say, okay, this isn't my opinion. We have numerous studies that show the negative impact disruptive behaviors have on the very patients who we're serving. So it's always affected patient outcomes. Yeah. We've just not always recognized it as such.

Dr. Pelè 3:04

Yeah. You know, I I I uh I know that this can be a very personal issue. And my question though is to see if I can elicit a story from you about why, right? Like your why for getting into this is did you have an experience that sort of turned on a switch in your mind and you said, you know what? Here's my purpose.

Dr. Renee Thompson 3:25

Yes. I say, uh, of course I do. Uh I say I've done everything you could. I've been a nurse for 32 years, almost 33. I've done everything you could do as a nurse, you know, bedside education. I was a frontline manager. I worked in home care. I worked for a managed care company, you name it, I've done it. And I was in a corporate role. And I was responsible for um professional development of about 10,000 nurses across the system. So I built a lot of programs, student nurse internship programs, residency programs, preceptor programs, all that good stuff. Loved, loved, loved that work. Well, I would meet with a lot of nurses to talk about what they needed and the preceptor program and the new nurse. Dr. uh Pele, all they wanted to talk about was how badly the other nurses were treating them.

Dr. Pelè 4:16

Wow.

Dr. Renee Thompson 4:17

And it reminded me of my own experiences because I will tell you, when I was a brand new nurse, I was bullied terribly by my preceptor. And if it weren't for my man, something happened. Okay, my preceptor blamed me. I went home that night and told my husband, that's it. I quit. I can't do this anymore. Uh, you know, I'm I'm not cut out to be a nurse. If it weren't for my manager calling me the next day, which I thought she was calling to fire me, um, I would have quit. And I'll never forget this. She said, I know what happened. It is not your fault. You are a good nurse. You come back in, and then she got me a new preceptor. But when I listened to all those other nurses talking about their experiences, I thought to my, it was a moment where I thought, I realized it didn't matter where I worked or what role I had, I swear there was always someone who made it their mission to make my life difficult. And I thought, you know, working in healthcare is hard enough without worrying about your coworkers making it harder. And I decided enough was enough. And we've been talking about bullying and incivility and healthcare for a century, but what are we doing about it? So I decided to do something about it. And here I am, 15, 16 years later. Started with me as a speaker, and now we're a whole institute and we do speaking, we consulting, we have an online academy, and we are making it better. We are making a difference.

Early Warning Patterns In Culture

Dr. Pelè 5:53

Good for you. Good for you. Uh, I I think the the most powerful uh influencers on any decision or any uh topic are people who've lived it and who have been there. And I I I hear that. You know, you also brought something up as you were speaking uh about the culture that sort of supports this in the first place. And I I wonder, you've probably seen uh patterns showing up again and again. For any of our listeners who are wondering, are there any little secret patterns that are happening now that I haven't seen that maybe will let us know that uh maybe there's a little danger here. You're not focusing and you're letting some things happen that will lead to workplace bullying. You know, do you have any patterns that you recognize you could suggest?

Dr. Renee Thompson 6:37

Many.

Dr. Pelè 6:39

How about that? How about that for an answer? Many.

Why Leaders Stay Silent

Dr. Renee Thompson 6:44

Many, many. Um, there are some common things that I've noticed over the years doing this work. Um, first of all, we cannot expect anyone to adapt their behavior if they're not even aware their behavior needs to be adapted. We say things like this all the time. You know, um, somebody is misbehaving, somebody is abrasive, condescending, all those things. And we make this assumption that they know. Well, if nobody's ever sat down and had an honest conversation with them, we can't assume they know that when they walk in the door, everybody wants to scatter and get out of their way because you know, depending on what mood they're in, you know, that it's going to be a rough day. So, first of all, you can't assume that somebody's been told that their behavior is disruptive. Okay. And therefore, you can't expect them to adapt their behavior if they're not even aware. So heightening awareness is always where we start. You have to start talking about disruptive behaviors because we've normalized deviant behaviors for a century to the point where we don't even notice them. We say things like, great nurse, but great physician, but yeah, yeah, you know, oh we we kind of joke, and it's not really a joke. They must have witnessed a murder just to be employed here, or they they know this person, that person at the top, and so they're protected. Or we know this, they bring a lot of revenue to the organization. And look, I get it. You're a small community hospital and your bad Apple is the biggest revenue generator. It is hard to put a stake in around and say, Yep, you're not going to behave this way here. If you don't step up, we're gonna step you out. So that's definitely a pattern. And I'll give you one other primary pattern. Leaders use silence as a strategy. Nobody's equipping them with the knowledge, skills, tools, and confidence to be actually be able to address these behaviors. And I know I was one of them when I was a frontline uh nurse manager. I had never seen behaviors like I'd seen with my team members. I mean, yelling, you know, cursing, refusing to work with certain people. It was horrible. And I had no idea how to deal with it. And you may know this, there's a psychological reality that exists in all of us, and that we avoid pain. It's part of our survival. Well, confronting someone, especially if I'm a new manager and I'm in my 20s, and my most clinically competent nurse who's in their 50s or 60s is the one who's toxic. You want me to confront that person? Are you nuts? So uncomfortable, so painful. So I do what's comfortable, I don't say anything. And, you know, we have an opportunity to equip those leaders with the skills and the knowledge and the confidence to be able to address the behavior. So heightening awareness is huge, and equipping leaders is equally as important.

Dr. Pelè 10:07

You know, it's interesting. Um, you know, let's focus on leaders for a second. But as you said, you know, people, employees, leaders, everyone, we all tend to either move away from pain or move toward pleasure, right? As you I think you were implying, and that's totally true in the psychology of humans. You know, I wonder if maybe we misunderstand what pain and pleasure is. So, for example, you said in some of the things you've talked about and written uh that people don't leave for better pay. They leave because of how they're treated. And I'm wondering if leaders are missing that and and they're not knowing what the pain and pleasure really is. They're thinking it's, you know, it's pay or something. Well, what's your thought on that?

Dr. Renee Thompson 10:46

So it's uh sometimes I'll say this in this way it's trading short-term uh comfort for long-term pain. Okay. So I don't say anything to this competent nurse because I'm afraid that that nurse is gonna quit. And so I justify, I do workarounds, I you know, try to accommodate, but that is comfortable for me. So if you say that, you know, pleasurable, it's because I I don't have to confront. But what people don't understand by keeping that bad apple, in the long run, you're gonna lose really good people.

Dr. Pelè 11:32

Yeah.

Dr. Renee Thompson 11:32

So it's embracing the discomfort, and you can do that by you know, again, being equipped. And the key in all of this, too, is to be so to know that you have support from your executives from HR. And before you sit down and have that conversation with that clinically competent, you know, person is to give everybody a heads up. Hey, I'm having this conversation and the whole documentation process. But yeah, numerous studies show that people will give up money for a good culture, people will leave a bad culture and go somewhere making less money. We know that. I mean, that's what the studies show. Yeah, it's not about the money, it's about the how people treat each other.

Dr. Pelè 12:22

Absolutely, 100%. And you know, one of the things that I talk about on this podcast is that gap between what leaders know. Like leaders know what you just said, and what actually happens under pressure, what people do under pressure. You know, I I I wonder your perspective on why it may be that some leaders know incivility is harmful, yet they still fail to address it in the moment. What's happening in that moment? Is it the pressure? You know, why is it that people aren't doing what they know?

Dr. Renee Thompson 12:53

Yeah, there are uh several reasons, okay. Sometimes is they don't know what to say. And I I I'm that way. If somebody is rude to me and it's unexpected, they're they they say something really disrupted. Like, I don't know what to say in the moment, you know. But oh, the next day, oh, I can think of all sorts of things that I could have said and should have said. And one of our strategies, and it's one of our most popular resources, is scripting. So it's knowing what to say, having a situation where somebody, you know, behaves the same way over and over again, but you're caught off guard, is having a script that you can practice so in the moment you can use it. Because, you know, it, you know, it when we're caught off guard, especially if we feel that there's a little threat there, you know, our fight or flight response takes over. And sometimes, you know, we want to clobber the guy, you know, or run away, or we say something that we think is stupid. And so we stop confronting because we feel that we haven't handled previous situations well. And again, my counter to that is you have to have scripts, you have to be prepared. What if this person acts in this way? How will I respond? What if they act in this way? How will I respond? But then it's also fear of retaliation. And that was my issue. I had one of my nurses who was um the source of 50% of all of my complaints, both employees and patients. And it was during a nursing shortage, and she worked steady nights and she would work a lot of overtime. But I finally decided I have to confront her. And I did. I was a nervous wreck. I'd never really confronted someone, and I sat her down in my office and I was really nervous. And I told her, I mean, I told her what she was doing and the complaints, and she looked at me and she's like, okay, no problem. Yeah, yeah, I'll work on this. And then I thought, oh, this is easy. Okay. And then I'll tell you what she did. The following week, she looked at the schedule to see what night she was scheduled to work, a night that we were also short already, and she called off that night, knowing that I was either going to have to spend my entire day trying to find someone to fill her spot, or I was gonna have to work it for her. She retaliated against me, but I couldn't prove it. So there's a lot of leaders who I talk to who are afraid of confronting because they fear retaliation. Yeah, it probably is a conversation I have with leaders almost weekly.

Dr. Pelè 15:34

Yeah, that fear of conflict, maybe even losing a high performer, you know, things like that. You know, let's take a real moment, right? A nurse snaps at a colleague, uh, a physician dismisses someone in a meeting, you know, the language is beginning to move in that direction. What should a leader do in that moment to maybe uh curtail, reduce, mitigate? What can a leader do?

Dr. Renee Thompson 16:02

Uh easiest thing to do, uh, especially because it's what you're asking me is overt behavior, somebody's yelling, cursing, whatever. Easiest thing to do, it's it's my visual and verbal cue technique. So you actually uh show a timeout symbol with your hand and say the words and say the person's name. So, like timeout Tina, because there's nothing that'll get somebody's attention more than somebody saying their name. So you gotta try to, wherever you are, you gotta try to get in front of them. Hey, time out Tina, and then just name the behavior you're yelling at, and then say the person's name, Amy, and you need to stop. So it's timeout, say the person's name, name the behavior. You just drop the F bomb in the middle of the you know, patient care hallway, whatever that is, if if it's against someone else, say that person's name, tell them to stop. All your only goal is to stop the disruption because when everybody else hears this, it's affecting their ability to think clearly after that. Because everybody's gonna be like, ooh, oh my god, did you hear what happened? You know, humans love drama and they will make up stories and it'll even get worse. But you take a look at stopping that disruption and then pull that person aside later on and sit down and say, Help me to understand why you thought it was okay to treat Amy this way. Okay. And let's say, because I use this example a lot, you're at a staff meeting and they start criticizing. Well, it's to say, even if your concerns are valid, even if you are right, that's not how we treat people here. That's not how we handle it. So it's it's letting them know, no, we're not gonna do that. But it is my simplest, easiest to implement technique. Time out, name the behavior, tell them to stop.

Dr. Pelè 18:02

It sounds to me like that technique requires doing it soon.

Dr. Renee Thompson 18:08

Meaning immediately.

Dr. Pelè 18:10

Like immediately, like you know, what what happens if you if you let things slide over time? I mean, is inaction um a way of reinforcing that behavior in the first place?

Three Pillars Of Culture Change

Dr. Renee Thompson 18:21

Yes, if you don't say anything, especially if you're the leader and your team members are around you, if you say nothing, people think it's okay to treat other people that way. You will lose trust and credibility as a leader. And I I always remind leaders, you might be thinking, Oh my gosh, I cannot believe they're I'm gonna talk to them. Yeah, I'm gonna bring them into my office if they're you know, they report to me. I'm gonna talk to them. Well, everybody else who's standing there, they're not mind readers. They don't know that you you think this is terrible and you're going to have a conversation with them. Yeah, that's why you have to stop it in the moment. And when you do that and you role model that type of response, others will follow.

Dr. Pelè 19:07

Yeah, absolutely. You know, you've built uh the healthy workforce culture framework. Yes. What what are what are the core elements that actually make culture stick? The right culture. What are the core elements that make culture stick?

Dr. Renee Thompson 19:23

Uh quick little backstory on how this all happened. So I was asked uh about 10 years ago to uh somebody reached out to hire me as a consultant to come to their organization to implement my strategies. And at first I thought, consultant? I don't know how to be a consultant. Well, like anything, you figure it out. And what I developed over time was what we call our department culture change initiative, and where we go in and we work with like service lines and we we truly transform the culture. And I had um one of the chief medical officers of an organization we were working with who wanted to hear more about this because he was new there, he had heard great things about the culture. And when I explained it to him, he said, Oh, so this is your top-down, bottom-up, and everything in-between approach. And I thought, oh my God, you're right. So basically, our framework is three pillars. You have to strengthen the organization. So your executive team has to be on board. You have to hardwire training on bullying and incivility for all team members, right from the time they walk in the door for the first time, and ongoing okay, development for especially the leaders. Build strong relationships with HR. And there are a lot of other components to strengthening the organization. You have to equip the leaders with, as I said earlier, the knowledge, skills, tools, and confidence to address disruptive behaviors because it is the quintessential role of the leader who's responsible for their culture. And then it can't just be the leaders, you have to empower the teams. So, this is where we focus on a shared responsibility. It's not just the leader's job, it's everyone's job, and we have a lot of strategies for that. So we recently published this in January, but we've been implementing this framework for 10 years with great success.

Dr. Pelè 21:25

Wow, that's that's awesome. You know, uh, whenever I think of uh the scope of work that you and other uh consultants in healthcare do, I think of the question of scale. You know, it's it's one thing to have you know some uh you know guidelines written in a document somewhere, and it's another thing to make sure the entire organization uh can somehow uh turn what they're learning into behavior and actions and then ultimately patient experience results and things like that. What are your th what's your thinking around the question of uh scaling your methodologies or any methodology within healthcare?

Dr. Renee Thompson 22:00

Well, great question because that's what we're doing right now. We know our system works. How do we get it to the masses? And the consulting that we do is very labor-intensive for my team, myself. And we've been looking at how do we train other people in this system and give them all the supportive materials that they need to not only implement this in their organization, but to spread it. And we've actually done some pilots with this where we've trained other leaders in our system, and they've been able to transform their culture and then help other departments in their organization transform theirs too. So we're working on this using our framework at a much larger scale. So we're uh probably within the next couple of months going to be looking for our pilot organizations who want to work with us to scale this across their system.

Dr. Pelè 23:05

Yeah.

Dr. Renee Thompson 23:06

Because again, we know our system works.

Dr. Pelè 23:08

Yeah.

Dr. Renee Thompson 23:09

Not only do we want to scale it, we also want to make sure that those organizations can sustain it.

Dr. Pelè 23:15

Yeah.

Dr. Renee Thompson 23:16

And that's why the framework is so important because it gives you what you need to sustain.

Dr. Pelè 23:21

You know, we've we've talked uh quite a bit about clinicians, you know, doctors, physicians, nurses. My experience of you know, incivility, I mentioned earlier on, actually came from the administration side of the business. I I was a vice president of HR and I I saw more of that than I I am I'm here to report. I don't even want to go into it. But I I I wonder you can feel my pain, right? But I wonder um as we as we sort of maybe maybe bring this down for any listener and get practical, whether you're an admin or you're a nurse or you're in you're you're a physician. What is one action that you would suggest uh people take away that they can do today, this week, to either be more aware of these signs as they show up, or or maybe just behaviors they should focus on doing or not doing? You know, how do we get practical for people?

Dr. Renee Thompson 24:16

Yes. Um I'm gonna give you an answer that might not be expected.

Dr. Pelè 24:22

I like those.

What A Bully-Free System Looks Like

Dr. Renee Thompson 24:25

It's so easy to point fingers at everyone else. I'm asking everybody to turn that finger back towards themselves and ask, how do I show up every day? Am I part of the problem? Is there something that I could be doing differently? Because again, that whole self-awareness thing, I might be the one who's the problem, but I don't know it because everybody's afraid to say something to me. So here's a practical way to figure this out. Whatever role you have, let's say you're uh a manager, okay? Well, it's just easy to say that role. Ask for feedback one level up and one level down. So if you're a manager, ask your director tell me one thing that I'm doing well, one thing you think I should work on. Because when you present it that way, work on. We all have something we need to work on. Likewise, maybe ask your charge nurse what's one thing that I'm doing well, and one thing I could work on. Now, you can add some additional context with my communication, how I treat people, like you know, you can add that level of context. But it all culture change starts with each one of us thinking in terms of and reflecting on how we show up every day because we are the only ones we have control over. And so that's what I would recommend people do.

Dr. Pelè 25:58

That is a powerful uh uh reflective suggestion. I I just think it's powerful that you went there with that. Thank you. You know, let's say we see a world in which health care healthcare organizations actually and truly were able to eliminate bullying and civil and incivility. What would feel different? Paint a little vision for us, you know, not just for teams, but for for patients.

Dr. Renee Thompson 26:23

Well, I will start with me. I will close my company and spend more time with my grandkids. Okay. Nobody needed me. That's what I would do. Okay. Just kidding, but not really. Um, we would never have a nursing shortage, we would never have a physician shortage, we would have the right people in healthcare, you know, there'd be a waiting list in every organization. And we know based on the studies, patients would receive amazing care. When I think about these patients, those patients are our families, you know, it's my mom, my child, my grandkids. It's it's us, it's me. And so create if we eliminated bullying and incivility, our metrics would be at the top of the charts. Like we would not have infections like we do right now because studies show like one a rude surgeon has a 10% increase in infection in his orthopedic patients. Okay. That's just one of a gazillion studies. So the world would be a better place, healthcare would be a better place. People would love coming into work, they wouldn't be burned out. You know, we talk a lot about well-being. Well, that there's your well-being right there.

New Website And David Strategy Book

Dr. Pelè 27:39

Yeah, right. You know, I I'm I'm looking at your website right now, and what a bold claim. You know, I love it. You we erat you you eradicate bullying and incivility in healthcare, period. I mean, you don't get more specific than that. You know, what's exciting for you next? What's on the horizon? What projects are you excited about? What's good, what's coming up for the health care, sorry, the healthy workforce institute.

Dr. Renee Thompson 28:04

Well, you mentioned the website, so I will tell you we are in the process of redesigning our website. That website, I think we um created that website in 2018, so it's pretty old, and I'm really excited about the new look of it. And I'm also in the process of writing a new book.

Dr. Pelè 28:21

Ah, do you have a title yet?

Dr. Renee Thompson 28:23

Uh sort of sort of you're working at it. Yeah, yeah, it's uh um a slingshot strategy to eliminate bullying and incivility based on the story of David and Goliath.

Dr. Pelè 28:36

Ooh, that's gonna be exciting. And I love the the leading with that with the story because you know how that just gets past the mind and into the heart, right? That's awesome.

Closing Thoughts And Thanks

Dr. Renee Thompson 28:45

Yes, and it it came about because I was talking to my business coach and I was frustrated and I just blurted out, you know, I feel like David against Goliath, and the Goliath is the cruelty in the world, and also that Goliath is sometimes the executives are just not willing to put in the financial resources. The people who are reaching out to me, you know, they want my help so much, but they can't get the approval for it. And it's just really frustrating. We had this whole conversation about David and Goliath, and you know, David put on his armor that Saul gave him, and it didn't feel right, it didn't fit. So we took the armor off and used a slingshot, and we all know defeated Goliath. And, you know, what are what's the armor that we're using in healthcare to to address this issue? It doesn't fit. And so I talk about traditional armor and then the slingshot strategy. So um in the process of writing it, I'm really excited. It'll it'll be a new keynote for me and probably a lot of other, you know, we atomize everything. So lots of different ways that we can get this content out.

Dr. Pelè 29:45

Wow, that's that's really exciting. And um, you know, I'll make sure that we have uh a link to your LinkedIn page in in the show notes because I'm sure you'll have this book and and whatever is happening new in your business uh up there. Uh I'm gonna call you Dr. Renee again, if you don't mind. Yeah, um, but I I really appreciate you stopping over and and chatting with us. Learned a lot and uh really fun to talk with you.

Dr. Renee Thompson 30:09

Well, thank you. It was uh you know my pleasure being here. I really enjoyed our conversation and appreciate the good work that you do.

Dr. Pelè 30:15

All right, you have an awesome day.