The path to organizational civility is marked PFOC

Cynthia Clark |

It leads to a healthy workplace!

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Imagine a dynamic work environment where you truly thrive in your career and profession—a productive, vibrant milieu where you feel valued, affirmed, and appreciated for your contributions. Envision being a respected member of an organization that encourages creativity and expression of diverse ideas—where high-performing teams thrive and where commitment to patient safety and civil interaction forms a solid foundation for a healthy, productive work environment.

Cynthia ClarkThe American Nurses Association (ANA, 2016) describes a healthy work environment as safe, empowering, and satisfying—a place where all members of the organization perform with a sense of professionalism, accountability, transparency, involvement, efficiency, and effectiveness while being mindful of the health and safety of all people. Similarly, the American Association of Critical-Care Nurses (AACN, 2016) has reaffirmed six standards for establishing and sustaining healthy work environments: skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership.

In my book, Creating and Sustaining Civility in Nursing Education (2017), I build on these essential standards, suggesting that healthy work environments require co-creating and adhering to a shared vision and mission, core values, and team norms. To ensure commitment to a positive, productive work environment, policies and procedures need to be implemented, and effective communication and constructive conflict-negotiation skills must be mastered at all levels of the organization.

 Ability to recruit and retain employees by providing satisfying jobs is a mark of a healthy organization. Particularly in healthcare, where patient safety is an unimpeachable goal, creating and sustaining a healthy, productive workplace are essential. To assist organizational leaders and teams in fostering an environment where employees thrive and patient care flourishes, I developed an eight-step, evidence-based guide, which I summarize below. A more complete description is provided in the above-mentioned book.

Pathway for Fostering Organizational Civility (PFOC)
Transforming an organization’s culture requires dedication to a shared vision, a well-articulated strategic plan, firm commitment to meeting long-term objectives, and supportive, decisive leadership. There is no universal, one-size-fits-all approach to fostering positive organizational change, but following the PFOC step by step will help guide your organization.

Step 1: Raise awareness and enlist leadership support
To foster a desirable work environment, it is essential to 1) raise awareness of the types and frequency of uncivil behaviors that are occurring in the workplace; 2) educate key stakeholders about the deleterious effect of such behaviors on individuals, teams, and the organization itself, as well as on patient care; and 3) enlist broad-based, leadership support for implementing a strategic action plan that helps reduce and eliminate these counterproductive behaviors. In most cases, formal leaders possess a keen vision of a better work environment and will support movement toward positive change. However, because transformational and sustained change requires broad-based collaboration, individuals seeking to enact such change need the support of leaders, administrators, and key stakeholders throughout the organization who share a similar vision and have the necessary resources to support it.

That’s why raising awareness is so important. Calling attention to incivility and its harmful effects and expressing sincere desire for change can be powerful motivators when enlisting support from leaders to transform the culture. Such support is essential not only because leaders and administrators have access to necessary resources, but because they have a vested interest in seeing the organization succeed and frequently possess a broader view. Their knowledge of the workplace and encounters with incivility—both past and present—can help identify potential problems and provide insight into possible solutions.

Step 2: Assemble a Civility (or Organizational Design) Team
To transition to a more productive organizational culture and enact the PFOC Action Plan, a Civility Team—also known as an Organizational Design Team—must be assembled and empowered with the legitimate authority to bring about change. In other words, team members need the power to make decisions. Without it, they will be unable to bring about needed changes. In addition to authority, the team will need support and resources. Members of the team should represent rich and diverse ideas, be committed to the organizational vision, and dedicate themselves to teamwork and collaboration.

Step 3: Assess organizational culture and civility at all levels
Every organization possesses a unique history, culture, and workforce. Careful and thorough assessment of the organizational culture can yield meaningful information for customizing the PFOC Action Plan. To make this assessment, tools specifically designed to evaluate the culture—both before and after implementing the action plan—should be considered along with information gleaned from formal and informal reports, notes, evaluations, satisfaction surveys, interviews, focus groups, and open forums. To produce a report that is less likely to be biased, external researchers may be helpful in collecting and analyzing the data.

Step 4: Develop plans, policies, and strategies
In this step, the Civility Team consolidates data obtained in Step 3 and translates it into a strategic PFOC Action Plan that will be implemented in Step 5. This information, compacted and interpreted for easier comprehension, generates a compelling vision for organizational change that must ultimately be shared and committed to by all members of the organization.

During this phase, assessment findings are reviewed to identify areas of strength and excellence, reinforce and celebrate efforts already in place to enhance a positive workplace, and implement specific strategies to improve areas of concern and deficiency. In preparing strategy, include clear objectives, expected timelines, and required resources (financial, human, and organizational).

Policy development is a priority, a critical item in the PFOC Action Plan. Policies need to be specific, extend beyond simply defining disruptive behavior, and include a clear plan for addressing incivility in a fair, consistent, and confidential manner. Policy statements should also include measures to reward acts of civility and demonstration of desired behavior.

A PFOC Action Plan includes a team charter or civility charter—a written, well-constructed document developed and agreed upon by all members of the team. The charter includes the team’s direction, purpose, goals, and processes for decision-making. In addition to providing a road map for how work will be accomplished by clarifying roles and responsibilities, the charter includes a clearly articulated commitment to coworkers and well-defined norms for behavior. When these structures are in place and become operational, teams and organizations have a clearer vision of the future and are thus better positioned for success.

Step 5: Implement Action Plans with policies and evidence-based strategies
To secure broad-based commitment to the PFOC Action Plan, Step 5 on the Pathway for Fostering Organizational Civility includes establishing the two-pronged goal of helping all members of the organization to recognize 1) the undesirable consequences of incivility and 2) the desired outcomes of achieving a positive, productive, and civil workplace. Key staff-development topics to address in this phase include improving communication skills, developing a conflict-capable workforce, enhancing teamwork and collaboration, and building leadership skills and capacity. This may be accomplished through reflection exercises, civility assessments, role-playing, simulation exercises and debriefing, and implementation of evidence-based communication and conflict negotiation tools for use in ongoing practice sessions.

Step 6: Evaluation and reassessment
The Pathway for Fostering Organizational Civility is a circular path, not a straight path with a finish line. It’s a cyclical process that includes assessing, planning, educating, strategizing, evaluating, and reassessing. Evaluation and reassessment do not complete the pathway but are necessary steps to review the effectiveness of the change process in bringing about organizational health and civility.

Ongoing and periodic re-administration of empirical and anecdotal tools to measure progress and goal achievement is highly recommended. Similarly, focus groups and community forums can be useful in garnering feedback from employees and other key stakeholders involved in the initiative. Acquisition and monitoring of ongoing assessment data are also useful in formulating recommendations to continue implementing or to refine the PFOC Action Plan.

Step 7: Reward civility and consolidate successes
Recognizing and celebrating individual and collective achievements fuel momentum for change while rewarding individual and organizational efforts. Evidence of success includes fulfillment of shared vision, values, and norms; achievement of long- and short-term goals; improved morale and job satisfaction, and gains in recruitment and retention rates. Other indicators of success include more effective communication and decision-making skills; resonant and reliable leadership; meaningful recognition of members; growth of new programs, initiatives, endowments, and revenue; career advancement; and increased community trust and integrity. Celebrations can be formal or informal—the goal is to honor and reward successes, achievements, and accomplishments.

Step 8: Expand the civility initiative by sharing knowledge, lessons, and experience
To expand and sustain the civility initiative and continue fostering organizational transformation, new members should rotate onto the Civility Team while some current members of the team remain to facilitate passage of knowledge, lessons learned, and experience gained. With these objectives in mind, this phase includes identifying effective leaders and members of the current Civility Team who should continue serving while recruiting other promising team members to initiate the next phase of the PFOC initiative. Useful discussion topics for this step include individual, team, and organizational accomplishments; process progression and assessment; vision alignment; and lessons learned.

In conclusion, creating and sustaining organizational civility require an evidence-based framework to structure processes and initiatives. While each organization’s experience is unique, when members of an organization come together and share experiences, the possibilities for organizational health and civility are endless.

Editor’s note: Cynthia Clark will be presenting at the Creating Healthy Work Environments conference, slated for 17-19 March 2017 at the JW Marriott in Indianapolis, Indiana, USA. The theme of the conference is “Building a Healthy Workplace: Best Practices in Clinical and Academic Settings,” and Clark’s Plenary II presentation is titled “Creating Healthy Work Environments: Powered by Civility, Leadership, and Ethical Practice.”

Cynthia Clark, PhD, RN, ANEF, FAAN, nurse consultant for ATI Nursing Education, founder of Civility Matters, and author of Creating & Sustaining Civility in Nursing Education, is a psychiatric nurse/therapist and an expert in fostering civility and healthy workplaces.

Clark, C.M. (2017). Creating and sustaining civility in nursing education. (2nd Ed.). Indianapolis, IN: Sigma Theta Tau International.


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