One of the biggest misconceptions in healthcare is that incivility in healthcare is simply part of a stressful environment. Something to tolerate. Something to work around. But the data and lived experiences of healthcare teams tell a very different story.
Disruptive behaviors rarely start with aggression. They start with subtle, normalized behaviors that slowly erode trust over time. Eye-rolling. Exclusion. Dismissive communication. Condescending attitudes. And here’s the problem: when incivility in healthcare is tolerated, it doesn’t stay subtle. It escalates.
What begins as disrespect can turn into intimidation. Intimidation can lead to verbal aggression. And in some environments, that escalation continues into threats or even physical violence.
Workplace violence refers to any act or threat of violence against individuals while they are working or on duty, including behaviors that range from verbal abuse and threats to physical assault (National Institute for Occupational Safety and Health, 2024).
The financial impact alone should get every leader’s attention. In 2023, U.S. hospitals incurred an estimated $18.27 billion in annual costs related to violence. Of this, approximately $3.62 billion was invested in prevention, targeting risks both within healthcare facilities and in surrounding communities.
However, the majority of expenses occur after an incident takes place. Post-event costs totaled roughly $14.65 billion, including medical treatment, lost productivity, case management, staffing challenges, and facility repairs. The largest share of these costs is driven by treating injuries resulting from violence, making post-event healthcare expenses the primary contributor to the overall financial burden (American Hospital Association, 2025).
But beyond the financials, the culture tells an even more urgent story. The 2026 Press Ganey Healthcare Safety report reveals that nearly half of employees (47%) view their organization’s safety culture as weak. What’s most concerning is that safety risks rarely begin with high-profile incidents, they take root much earlier. Small cracks in communication, a gradual erosion of trust, and hesitation or fear around speaking up quietly set the stage for harm long before it becomes visible.
Violence doesn’t come out of nowhere. It grows in cultures where incivility in healthcare has been allowed to take root.
Why “Low-Level” Behavior Creates Unsafe Cultures
Leaders often focus on the most visible issues. The yelling. The overt conflict. The incident that demands immediate attention. But it’s the quieter behaviors that do the most damage because they change how people show up at work.
When incivility in healthcare is present:
- People stop speaking up
- Communication breaks down
- Team members avoid each other
- Psychological safety disappears.
And when people don’t feel safe to speak up, patients are at risk. This is not about hurt feelings. This is about missed information, delayed action, and compromised care.
The Role of Tolerance: What Leaders Allow Becomes Culture
We have been normalizing deviant behaviors for decades, which is one of the reasons bullying and incivility in healthcare continues to thrive. The real question is why?
Why do we tolerate behavior when we know study after study proves negative outcomes because of it?
Incivility is often overlooked for a few common reasons:
- The individual is clinically excellent
- They generate revenue
- They’ve “always been this way”
- They have tenure or perceived influence
But the reality is that nothing damages a team faster than watching a leader tolerate bad behavior.
When leaders ignore incivility in healthcare, the message is clear:
- Behavior is optional
- Respect is negotiable
- Accountability is inconsistent
And that’s when culture starts to break down.
Early Intervention Changes Everything
The good news is that incivility in healthcare does not have to escalate if leaders act early. However, that only happens when leaders are equipped with the knowledge, skills, tools, and confidence to act.
Addressing incivility at the first sign stops progression before it intensifies, reinforces clear behavioral expectations, protects psychological safety, and builds trust across the team.
Early intervention is not about being punitive. It’s about being clear. It’s about saying, “this is not how we treat each other here.”
The Solution: A System. Not a Single Conversation
You cannot solve incivility in healthcare with one conversation or one training. It requires a system.
That’s exactly why we developed the Healthy Workforce Framework™.
This framework is built on three essential pillars:
- Strengthen the Organization
- Equip Leaders
- Empower Teams
When these three elements work together, organizations shift from reacting to incidents to preventing them.
The Bottom Line
Incivility in healthcare is not “low-level.” It is the early warning sign. If we ignore it, we allow it to grow. If we address it early, we change the trajectory.
Because the safest organizations are not the ones that respond best to violence. They are the ones that prevent it by refusing to tolerate incivility in healthcare from anyone and everyone – team members, patients, family members – everyone.
